Surgical Management

Gender-affirming surgery is surgery that helps a patient’s physical characteristics align with their gender identity. Not all patients will desire surgery but in those that do, this is usually the last step in the transitioning process. The three broad categories are breast/chest surgery, also known as “top surgery”; genital surgery, also known as “bottom surgery”; and non-chest/non-genital surgery. Not all surgeries are available in the Moncton area and not all have available financial coverage. See the links below for more details.

Surgical techniques have greatly improved in recent years and and reconstructive genital surgery that preserves neurologic sensation is now the standard. Genital surgery performed in Montreal is done using one standard technique and is not customized to patient preferences. Patients with the means to do so may wish to look elsewhere for more specialized or advanced surgical options.

The American Endocrine Society emphasizes that the decision to undergo surgery (especially genital surgery) should not be taken lightly: “If the social transition has not been satisfactory, if the person is not satisfied with or is ambivalent about the effects of sex hormone treatment, or if the person is ambivalent about surgery then the individual should not be referred for surgery”. Dissatisfaction with social and physical outcomes during the hormone transition may be a contraindication to surgery.

Those who undergo a gonadectomy will no longer require suppression of their natal hormones but will require hormone replacement therapy, surveillance, or both to prevent adverse effects of chronic hormone deficiency.

Mental health professionals should address at minimum the following aspects of a patient’s presentation prior to providing a referral for hormonal or surgical management:

  • Conduct a full assessment of the patient’s gender identity and possible gender dysphoria; diagnose gender identity disorder if appropriate;
  • Provide information regarding options for gender identity and expression and possible medical interventions; refer as required to qualified specialists;
  • Assess, diagnose, and treat co-existing mental health concerns;
  • Assess eligibility, prepare, and refer for hormone therapy as required.

See the Downloads section for a printable summary of surgical options and requirements.

Male to Females