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Camh Gender Reassignment Operation

Sherbourne Health Centre is dedicated to supporting the health and wellness of our trans clients. Below you’ll find updates regarding our services, including information on the transition-related surgery (TRS) assessment and referral process. To receive updates on access to TRS in Ontario, subscribe to our mailing list below.

Information Update – August 17, 2016

  • In March, the Minister of Health announced that people seeking OHIP approval for transition-related surgeries (TRS, also known as gender affirming surgeries or GAS, or Sex Reassignment Surgeries or SRS) would be able to get assessments and referrals from “qualified” primary care providers, as well as the Centre for Addiction and Mental Health (CAMH).
  • Sherbourne has been working to ensure that our providers are fully trained and competent to provide assessments and referrals for trans clients. We are now able to provide assessments and referrals.

If you are a registered client of Sherbourne:

  • If you wish to be assessed for TRS, please make an appointment with your family doctor or nurse practitioner. Depending on your needs, there may be multiple surgery planning visits with your health care team.
  • Some assessments are more complex than others. Your provider will discuss options with you. If your provider can complete the assessment and referral, they will make arrangements for you to be removed from the CAMH waiting list, if you were already on that list.
  • Please note that all of Sherbourne’s primary care teams have providers who are trained and qualified to provide assessments. You do not need to be a client of the LGBTQ Family Health Team (the 2nd floor).
  • If your regular family doctor or nurse practitioner at Sherbourne is away (e.g. on parental leave), you can discuss options such as being assessed by another qualified provider with your health care team, e.g. your Registered Nurse.

If you are not a registered client of Sherbourne:

  • If you would like to become a registered client, please contact a Client Resource Worker at (416) 324-4180 to make an intake appointment.
  • If you live outside the City of Toronto and are looking for a primary care provider who can do your assessment and referral, please visit the Rainbow Health Ontario provider directory or contact for more information.
  • If you are a trans person and need a safe, inclusive place to recover after your transition-related surgery, you may be eligible to stay in our in-patient Infirmary. You may be eligible whether or not you live in Toronto.  For more information about Infirmary admissions criteria, contact the Intake Nurse at (416) 324-41088.

Sherbourne is working to expand our programs and services to better support trans clients.  In the coming months we are hiring new, additional staff to provide trans clients with more mental health support, help navigating the health care system and other social supports, and a safe, inclusive place to recover from TRS in our in-patient Infirmary.

Previous Updates

On March 1, 2016, the Minister of Health announced that people who are seeking OHIP approval for Gender Confirming Surgery (GCS, also known as Sex Reassignment Surgery, or SRS) will no longer need to go through CAMH.  Instead, people will have the additional option to get approval from “qualified” primary care providers (Family Physicians, Nurse Practitioners, Registered Nurses, Psychologists and Social Workers with Masters level education.  This will be a great change for trans people, removing an unnecessary and highly challenging barrier to access.  To ensure that providers are prepared and comfortable with the assessment and referral process, the Ministry requires providers to take training in accordance with WPATH Standards of Care.  Until this training occurs, and until other details are worked out, individuals wanting to access GCS will still need to go through the current process.

This announcement means that change is coming, but your health care providers are not yet able to provide referrals for surgery.  Do NOT remove yourself from the CAMH waiting list until this new system is in place.

May 6, 2016

New information has been released by the GRS clinic in Montreal, which can be found here:
The clinic is assuring candidates for surgery that disruption caused by the recent fire will be minimal.

April 25, 2016

  • CAMH is sending letters to primary care providers who have referred patients to CAMH, to advise the providers that they can now complete GCS assessments and referrals. If you were referred to CAMH by another provider and then started accessing primary care at Sherbourne Health Centre, we recommend that you contact your old provider and ask them to send the letter from CAMH to your provider at Sherbourne.

April 18, 2016

Following the changes to Ontario’s GCS regulations we are working to ensure that we can provide these new services in the most safe and equitable way possible for Sherbourne clients.  As part of our expanding trans health services a cross-agency working group and various clinical sub-groups are developing resources and protocols for GCS assessments and referrals as a priority.

  • A clinical sub-group is preparing information which will support Sherbourne’s medical and mental health clinicians to provide Gender Confirming Surgery assessments and referrals. Our goal is to have doctors, nurse practitioners, nurses, psychologists and registered social workers at Sherbourne providing this service as soon as possible.
  • We are working with the Centre for Addiction and Mental Health (CAMH) to understand which Sherbourne clients are on the CAMH waitlist. Sherbourne will be working with clients to determine if a CAMH or Sherbourne assessment best suits their needs. Please contact your primary care provider to discuss what would suit you best.

Keep up to date with changes to Gender Confirming Surgery (GCS) access in Ontario

Previous updates

On November 6th 2015, The Minister of Health announced that there will be a change to the regulation on who can assess and approve requests from trans people for SRS (also known as gender affirming surgery or GAS).  The new regulation will allow a broader range of regulated and experienced health care professionals to provide these assessments/approvals for GAS/SRS.

There will no longer be only one place where assessments/approvals are provided. As providers become trained and available, these services should become available across Ontario.

CAMH will still be available to provide assessments and approvals but their role may shift to offering assessment and approval services for clients without access to other qualified providers, or for clients with more complex issues.

If you are currently on the CAMH Waitlist
We advise that you donot take yourself off the CAMH waitlist. Although the regulatory change is good news, these types of changes take time to put in place.  Talk to your family doctor about the changes and ask to make a plan for when they come into effect.

The first of March last year read like a victory for transgender Ontarians.

Across the province, over 800 primary care physicians and nurse practitioners were granted the ability to assess patients for gender-confirmation surgery. The provincial change released a burden on Toronto’s Centre for Addiction and Mental Health, formerly the only site able to complete medical referrals. Their wait list had skyrocketed to 1,516 patients.

So why — over a year later — are there still 761 patients on the list?

Inside the halls of CAMH, Adult Gender Identity Clinic psychiatrist Dr. Chris McIntosh spoke to The Star on Tuesday, immediately following a lunch meeting about recruiting a new psychiatrist.

Though part of a $2 million sum the Ontario Ministry of Health’s slotted last year to clear the referral bottleneck went to hiring two social workers and a psychologist at CAMH, the clinic needs more physicians.

The way the process works depends on the patient. The first task is to assess for gender dysphoria, for which the diagnosis criteria changed in 2012. Previously, the diagnosis required a patient to identify with the opposite gender in a binary system. New criteria allows for identification with any gender that is different than the patient’s natal gender.

McIntosh then often has to consider a host of other psychiatric and social markers. Cases can be complicated by a lack of stable housing, for example, which would present a risk during recovery. Mental health conditions like depression or PTSD are factored in. The most problematic cases, McIntosh said, come when patients have intellectual disabilities and the clinic faces questions of informed consent.

“It can be more difficult to assess their capacity to understand what gender is,” he explained. The clinic has some psychologists with backgrounds in neuropsychology that can assess IQ, but the process is knotted with ethical dilemmas and often labours on for a while.

The time spent waiting for referrals has dropped by 33 per cent over the last year, but the CAMH website still warns that “as our clients have waited for a long time, our social worker calls all new clients a month or two before we’re ready to schedule your first appointment.”

For 761 patients, that limbo is their reality.

Once they’re in, the referral process can be anywhere from two appointments to a whole row, culminating in pre-approval paperwork sent to the Ministry. Four-to-six weeks later, patients must contact a clinic called GRS Montreal — which, until next year, remains the only clinic in Canada that does all gender-confirmation surgeries.

The first genital surgery outside Montreal is slated to take place in 2018 at Women’s College Hospital in Ontario, Hoskins’ Thursday statement announced. Until now, the province has been spending $4 million a year sending patients outside Ontario — $2.7 million for those headed to Quebec, and $1.2 million for operations outside Canada.

Across the border, San Francisco, California and Austin, Texas are frequent choices for patients who can secure a recommendation by an Ontario physician. Though the procedure is covered by OHIP for pre-approved patients, going to the U.S. can incur significant transportation and accommodation costs. The Ministry also confirmed they’ve sent patients to Belgium, Thailand, Serbia, England, Italy and Germany.

Staying north of the border, patients have had to wait anywhere from another three months to another year after Ministry approval — with particularly long holdups for a phalloplasty. “It’s a surgery that requires a high level of expertise, but at the same time, that should really mean that we’re starting to develop that expertise,” McIntosh said.

Hoskins’ announcement makes Ontario only the second Canadian jurisdiction with surgeons trained to provide genital transition surgery. Patients from all other provinces and territories are still forced to travel substantial distances.

Moving forward, the Trans Health Expansion — which partners CAMH with Women’s College Hospital, Sherbourne Health and Rainbow Health Ontario — is in the early stages of a “complex, long-term” reform process. The 2016 change and Hoskins’ Thursday announcement make a dent in the problem, but are far from a solution.

“One of the keys will be building surgical capacity in the system,” Trans Health Expansion wrote in an email to the Star. “However, surgery is just one issue; to sustainably improve trans health, the disparities in social determinants of health for this population – like housing, poverty and unemployment – will also need to be addressed.”

With files from Rob Ferguson