Accessing HRT & Surgery

There are a lot of misconceptions regarding access to hormone replacement therapy. I’m here to help you navigate through this difficult process. If you are looking for medical resources such as doctors and clinics, please visit this page.

Should the information within this page be confusing, or if you have additional questions, please do not hesitate to reach out to Jennifer, who can help guide you through this process.


HRT & Surgery FAQ

No. While it is generally suggested to have a diagnosis of Gender Dysphoria in order to access HRT, it is not required that a formal diagnosis be made by a Psychologist or Psychiatrist. Your family doctor or NP can make this determination and prescribe you HRT. See the bottom of this page for resources for doctors to help them with dosing and diagnoses.
You must be on HRT for one year before accessing Gender Affirming Surgery.
No. Your family doctor can prescribe you appropriate HRT without a clinic's intervention, and can also refer you for Gender Affirming Surgery. For more information on the requirements for surgery, you can visit the government of Ontario site:
Breast removal surgery is covered with referral, however breast reconstruction is typically only covered if there is no breast growth as a result of HRT. For more information you can visit:
Gender Affirming Surgery wait times vary greatly. Typically these surgeries are done either in Toronto or Montreal. It is best to speak with someone at a clinic that does referrals in order to get a sense of wait times, but usually it is from 1-3 years.
The results of any HRT can vary from person to person. In general, the following effects are common on feminizing hormones: - Body fat redistribution - Decreased muscle mass - Softening of skin - Decreased Libido - Decreased spontaneous erections/male sexual dysfunction - Breast growth - Decreased testicular volume - Decreased sperm production - Thinning and slowed growth of body and facial hair You can find more information about the effects of feminizing hormones at the bottom of this page.
The results of any HRT can vary from person to person. In general, the following effects are common on masculinizing hormones: - Skin oiliness/acne - Facial/body hair growth - Scalp hair loss - Increased muscle mass/strength - Body fat redistribution - Cessation of menses - Clitoral enlargement - Vaginal atrophy - Deepened voice You can find more information about the effects of masculinizing hormones at the bottom of this page.
In order to change your gender marker on your driver's license (to M or F), you need a letter from a Doctor or Psychologist. If you are looking for such a letter and are unable to get one from your doctor, please send an email to You do not need any supporting documentation to change your gender marker to an X. For more information, please visit:
You can complete an application to change your gender marker on your birth certificate, by visiting this website: Note that you will need supporting documentation from your Doctor or Psychologist for this.
You can change your legal name in Ontario by filling out a form and completing a criminal record check. Visit this website for more information:

Resources for You & Your Doctor

Often, primary care physicians are reluctant to prescribe hormones therapy if they are unfamiliar with the process of obtaining HRT, or if they are unfamiliar with the different options. In this case, reaching out to a Psychotherapist, Social Worker, Counsellor, or Psychologist will not be beneficial, as none of these individuals are able to prescribe medication.

My advice would be to discuss this with your primary care physician, and work to educate them on the process so they may feel more comfortable. I have included a number of resources below for your convenience.

  1. Protocols for Hormone TherapyThis document is a comprehensive, easy to read guide for primary care physicians to provide their clients with HRT, provided by Rainbow Health Ontario. It outlines the requirements for HRT, provides a list of terminology, steps for assessment, and includes a guide to the different types of hormones and their effects. This document is great for your physicians as well as for yourself if you are unfamiliar with the process.
  2. Sherbourne Trans Care GuidelinesSherbourne Health Centre provides trans individuals with HRT and integrative medical care as they move through their physical transition. They have created this comprehensive guide to trans care that outlines each potential stage of the process and provides individuals and practitioners with valuable information and tools.
  3. Effects of Feminizing Hormones:This is a list of the different types of feminizing hormones and their effects; what to expect and what not to expect. From Rainbow Health Ontario.
  4. Effects of Masculinizing Hormones:A list of what to expect and what not to expect when taking masculinizing hormones. From Rainbow Health Ontario.
  5. Families In TransitionA guide for families of trans individuals. This guide includes terminology and offers an alternative, unbiased view to help families better understand and support their trans family members.
  6. Trans Care for Youth: Sick Kids Hospital has a trans care clinic specifically for youth. A referral can be sent by your family doctor to begin the program.
  7. TransHealthcare List of Gender Surgeons in Canada
  8. Transition-Related Surgery FAQ for those considering surgery. This guide is below in full, and includes what is covered by OHIP and what is not, definitions, and the process for getting surgery.
  9. Trans Primary Care Referrals & Advocacy. Includes support letters, changing sex designation, and process information.

Therapy, HRT & Surgery

Hamilton Family Health TeamHRT, Surgery Referrals
Shelter Health NetworkHRT, Surgery Referrals
Sherbourne HealthTrans Clinic, Resources
Rainbow Health OntarioService Provider Directory
London Intercommunity Health CenterTrans Friendly Services
Stonechurch Family Health CenterTrans Friendly Services
Church Wellesley Health CenterHRT, Surgery Referrals
Hamilton Trans Health CoalitionHRT, Surgery Referrals
Connect-ClinicHRT, Surgery Referrals
QuestHRT, Surgery Referrals

You can find a full list of documents recommended by Rainbow Health Ontario for your primary care physician here.

For more information, resources, and support, please visit Rainbow Health Ontario or the Sherbourne Health Centre.

Transition Related FAQ

Additional Resources