Medical Affirmation

Medical affirmation may involve the suppression of monthly bleeding, puberty blockers, electrolysis for hair removal, surgery, and gender-affirming hormone therapy. For those who seek them, medical interventions can be a critically important part of how 2STIGD individuals affirm their gender. Medical forms of affirmation are not only medically necessary, but life saving.

It is important to note that some 2STIGD individuals may choose to socially and medically transition, but not surgically transition. Alternatively, individuals may socially and surgically transition, but not desire to medically transition. Each individual will have different goals and expectations, all of which are valid.

Where To Get Care

Primary Care Providers

Dr. Em Lane
Fredericton Downtown Community Health Centre
Mailing Address: 339 King St., Fredericton, N.B. E3B 1E4
Telephone: 506-452-5900
Fax: 506-452-5793
Dr. Lane will be accepting referrals from health care providers in New Brunswick for the services listed below, but not for general primary care. Patients without a primary care provider are encouraged to register with Patient Connect NB online or by calling 811.
Please fax referrals along with any relevant information and investigations to the above fax number for the following services:
– Transgender and gender diverse care
– Contraception care (including Nexplanon and IUD insertion)
– Medical abortion care
– Small procedures (i.e., lumps and bumps, skin biopsies, etc.)

Keltie Keir, MN NP

Region: Fredericton
Telephone: 506-453-5379
Patients can request an appointment for gender-affirming by calling Sexual Health Services.

Dr. Monica Graves
Mailing Address: Saint John Regional Hospital, PO Box 2100, Saint John, N.B. E2L 4L2
Telephone: 506-849-2504
Will accept referrals from other providers.

Dr. Sara Thomas

Gender Affirming Care Clinic at Mount Allison

Wallace McCain Student Centre (ground floor, West Wing)

Mount Allison’s Gender Affirming Care Clinic on campus has extended its services to the wider region. Any resident of New Brunswick or those with other provincial health coverage seeking gender affirming care can be referred to the University’s Wellness Centre to book an appointment.

Referrals are required and are welcome from any healthcare professional, including mental health professionals, and can be sent by email to clinic@mta.ca or by fax (506) 364-2172.

Dr. Kathleen Taylor

Region: Fredericton

Telephone: 506-455-1946

Fax: 506-455-4600

Will accept referrals from other providers as well as counselors and therapists. Does not accept self referrals or pediatric referrals at this time.

Primary focus is on hormone therapy but also provides assessments and referrals for gender-affirming surgeries.

Offers phone consultations for patients who are out of region and unable to travel.

Endocrinologists - Adult

Dr. Christa Bowes
Mailing Address: 1015 Regent St. Suite 206, Fredericton, N.B. E3B 6H5
Telephone: 506-447-4418

Dr. Tania Gallant (Adult only 16+)
Mailing Address: 100 Arden St. Suite #222, Moncton, N.B. E1C 4B7
Telephone: 506-857-5758
Fax: 506-857-5086

Dr. Heather Mackenzie
Mailing Address: 681 Mountain Rd., Moncton, N.B. E1C 2P4
Telephone: 506-860-2300

Dr. John Dornan
Mailing Address: Saint John Regional Hospital, PO Box 2100, Saint John, New Brunswick, E2L 4L2
Telephone: 506-648-7304
Fax: 506-648-7305

Dr. Michael Pelkey

Mailing Address: 11300 route 130, Waterville, NB E7P 0A4
Referrals must be accompanied by a letter from a qualified mental health professional stating that the patient meets the criteria for gender dysphoria and is ready to proceed with hormone therapy.

Hormone Readiness Assessment

A hormone readiness assessment is an evaluation conducted by a health care professional to determine if a patient is ready to begin gender-affirming hormone therapy (GAHT). The decision to initiate GAHT should be a collaborative, patient-centered process that focuses on both psychosocial preparation and informed consent.

The World Professional Association for Transgender Health Standards of Care requires an assessment before GAHT is started. Gender-affirming care in N.B. is guided by Version 7 of the Standards, which were published in 2011. In N.B., a WPATH letter of recommendation for the initiation of hormones is not required. However, it should be noted that version 8 of the standards of care have recently been published and will soon replace SoC-7 on all NB forms.

While there is no required waiting period required prior to initiating GAHT, there are a number of steps that a primary care provider is required to follow to ensure GAHT is provided in the safest manner possible. The role of your primary care provider (with or without the support of a multidisciplinary team) is to facilitate a decision-making process that informs, educates, and supports you and your goals. Assessment by a psychologist or psychiatrist is not required for most people, however your primary care provider is required to assess both your mental and physical health as part of a hormone readiness assessment and may refer to appropriate specialists as needed.

Hormone readiness assessments often take place over a number of visits, depending on the length of time available per visit, the clinical situation, and the experience of the clinician. More visits may be required for individuals with complex physical or mental health issues, or for folks who are socially isolated. Fewer visits may be appropriate for a “straightforward” situation, for more experienced clinicians, if appointments are longer, or if you have a referral from a WPATH mental health provider. Fewer visits may also be recommended in situations where harm reduction is the priority (e.g., extreme distress, is currently taking hormones unprescribed, etc.).

Below we outline the steps of a hormone readiness assessment and cover some of the basic questions that a primary care provider may ask you when getting ready to initiate GAHT.

Patient History

Discuss the rationale for assessment period: Establish rapport
Ensure optimal readiness
Ensure patient has all information they need to start GAHT
General medical intake & medical history

Patient Education, Readiness, & Supports

Allow patient to articulate their transition goals
Ensure patient expresses reasonable expectations
- Patient understands timeline of changes
- Patient understands limitations of GAHT
Discuss effects on fertility and options available for preservation
- Discuss pregnancy risk and options for contraception & implement these if needed
Discuss psychosocial readiness
- Ensure supports are in place to facilitate healthy adjustment
- Refer to psychological support/counselling if necessary
- Review potential costs (e.g. medication, hair removal, fertility)
Discuss risks, side effects, potential benefits and expected changes (reversible vs. irreversible) associated with treatment and ensure patient demonstrates understanding
Ensure patient possesses capacity to consent
Review medication options/treatment routes

Possible Questions to Explore Gender Identity and Expression

How do you identify in terms of gender?
How do you feel about your gender identity?
What actions, words, and attitudes from others help you feel the most affirmed in your gender?
What has prevented you from feeling positive about your gender identity?
What types of support have been helpful to you?
How do you relate to the gender binary? In what ways do or don't you identify with expectations based on gender binary?
What does it mean to you to transition? How do you understand the starting and ending points of transition, if they exist? Transition can include many different components and stages. Which parts are necessary for you to feel affirmed in your gender?

Have you taken any steps to express your gender differently/to feel more comfortable in your gender? If prompting is needed: Some people ask others to use a different name and pronoun, or make changes to their hair or clothing styles. If they have taken steps to express their gender differently: What was that like for you? How did that feel?

Asking about psychosocial preparation and supports

What concerns or thoughts do you have about how transition will affect and be affected by your work/school life?
Who has supported you along the way? If the patient has not spoken with anyone else yet: Who do you think might be supportive if you bring this up with them?
Have you done anything to prepare yourself for this step? If prompting is needed: Have you talked with any peers or asked friends or family for support? Have you done any reading or research?
Some people find it helpful to have the support of a counsellor for either decision-making or ongoing support after beginning hormones—would you be interested in a referral to a trans-competent counsellor?
In what ways do concerns related to your gender affect your mental health or emotional well-being and vice versa?
What sources of support do you have to help buffer the stressors that you are facing?
What kinds of support and advocacy do you need at this time?

Risk Management

Ensure absence of absolute contraindications
Optimally manage precautions
Manage psychiatric comorbidity, if present
If smoker, advise smoking cessation counselling
- Smoking cessation is recommended for individuals looking to start hormones due to increased health risks of smoking tobacco products while on hormones (e.g., blood clots, heart attacks, strokes, diabetes, and cancer). In addition, most gender-affirming surgeries require that an individual stop or restrict smoking to access surgery. Currently, there is not enough research on the effects of smoking cannabis while on estrogen- or testosterone-based hormones. However, you will be required to stop or restrict smoking cannabis to undergo surgery.

Baseline Data

Vitals (e.g., blood pressure, temperature, heart rate, height, and weight).
Focused Physical Exam
- A focused physical exam is recommended prior to the initiation of GAHT. The exam should include screening for conditions such as hypertension and active liver disease, which may increase the risks of GAHT.
- A physical examination of the chest and genitals is not required before the initiation of GAHT. However, for folks who are considering breast augmentation, taking measurements prior to GAHT can help with accessing surgery.
Blood work
Health screening commensurate to age & risk profile

Differential Diagnosis

Rule out other possible diagnoses (i.e. psychiatric disorders that could mimic gender dysphoria such as psychotic or dissociative disorders)
Ensure patient meets DSM Criteria for Gender Dysphoria
No evidence of Intersex condition (e.g. ambiguous genitalia, abnormal baseline hormone profile).

The Criteria For The DSM-5 Diagnosis of Gender Dysphoria (ADULT)

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months duration, as manifested by at least two of the following:

A marked incongruence between one’s experienced/expressed gender and primary and/ or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
A strong desire for the primary and/or secondary sex characteristics of the other gender (or some alternative gender different from one's assigned gender).
A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
A strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender).

B. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).

The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.

The Criteria For The DSM-5 Diagnosis of Gender Dysphoria (Child)

A marked incongruence between an individual’s experienced/expressed gender and their assigned gender that has been present for at least 6 months and is associated with clinically significant distress or impairment in functioning
A strong desire to be of the other gender or an insistence that one is the other gender
PLUS 5 of the following:
- A strong preference for wearing clothes typical of the opposite gender
- A strong preference for cross-gender roles in make-believe play or fantasy play
- A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
- A strong preference for playmates of the other gender
- A strong rejection of toys, games, and activities typical of one’s assigned gender
- A strong dislike of one’s sexual anatomy
- A strong desire for the physical sex characteristics that match one’s experienced gender

The Criteria For The DSM-5 Diagnosis of Gender Dysphoria (Adolescent)

A marked incongruence between an individual’s experienced/expressed gender and their assigned gender that has been present for at least 6 months and is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
PLUS 2 of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
- A strong desire to be rid of one’s primary and/or secondary sex characteristics (or a desire to prevent the development of anticipated secondary sex characteristics)
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender

Effects of Testosterone-Based Hormones

Effects of Estrogen-Based Hormones

HORMONE RESOURCES

Intramuscular Injection Guide

Gender Affirming Hormone Therapy Injection Guide

Subcutaneous Injection Guide

Surgery

New Brunswick Medicare now covers certain gender-affirming surgeries for Two-Spirit, trans, Indigiqueer, and gender-diverse folks living in New Brunswick. Folks considering gender-affirming surgery that is covered by Medicare are required to approach their family physician, nurse practitioner, and/or mental health professional to undergo a surgical readiness assessment.

A surgical assessment ensures that an individual is prepared for the surgery and will have the best possible post-surgical outcome. In NB, a surgical readiness assessment involves the following steps:

Gather Basic Surgery Information

Gather the following information:
- Patient’s anticipated timeline for having surgery
- Surgery type
- Who the desired surgeon is
- Pre-op requirements
- If applicable, insurance coverage and requirements
Verify that the patient is physically fit and has no significant physical health problems that would contraindicate or complicate the proposed surgery:
- Health screening commensurate to age & risk profile
- Focused physical exam
- Vitals (incl. BP, T, HR, Ht, Wt, Waist & Abdo circ.)

Patient Expectations

Verify that:
- The patient has realistic goals and expectations of the surgery
- The patient is informed of and understands any alternative procedures
- The patient is psychologically prepared for surgery

Possible Questions to Explore Patient Expectations and Goals

Who would you like to be your surgeon and where would you like to have surgery if possible?
Which surgery are you planning to have?
How do you foresee surgery helping to affirm your gender?
Can you tell me what you know so far about the surgery itself and what to expect?
Do you know anything about the pre-op requirements and expectations? If so, what do you know?

Patient Supports and Planning

Verify that the patient has:
- An adequate support network, a stable lifestyle, and the gender identity of the individual has remained stable over time
- Engaged in a responsible way with the assessment/treatment process
- A post-surgical plan (i.e., transportation, aftercare, caretaker, etc.)

Possible Questions to Explore Patient Supports

Have you identified a support person(s) to help you with your pre- and post-surgical care?
What is your post-operative care plan? How can I assist you in this plan?
What kinds of support and advocacy do you need at this time?
Will you be able to access medication after surgery?
Do you have adequate financial support for the procedure (if necessary), transportation and/or accommodation, and for aftercare?

Primary Clinical Criteria

Verify that the patient has:
- Reached the age of 18
- Persistent, well-documented gender dysphoria diagnosis
Capacity to make a fully informed decision and to consent for treatment (see Informed Consent Model):
- Understands the procedure/s
- Understands associated risk/s and complications
Reasonably well controlled medical or mental health concerns, if they are present
An aftercare / follow-up plan

Surgical readiness assessments should use criteria established by WPATH. The WPATH assessment involves a comprehensive psychiatric assessment and prolonged medical management before surgery is considered an option. Please note: It should be noted that version 8 of the standards of care have recently been published and will soon replace SoC-7 on all NB forms.

In NB the follow is required:

Criteria for chest masculinization surgery (one referral)

Persistent, well-documented gender dysphoria (will change with version 8);
Capacity to make a fully informed decision and to consent for treatment;
Age of majority in a given country (within NB, must be at least 18)
If significant medical or mental health concerns are present, they must be reasonably well controlled.

Hormone therapy is not a prerequisite.

Criteria for breast augmentation (not covered in NB):

Persistent, well-documented gender dysphoria (will change with version 8);
Capacity to make a fully informed decision and to consent for treatment;
Age of majority in a given country (within NB, must be at least 18)
If significant medical or mental health concerns are present, they must be reasonably well controlled.

Although not an explicit criterion, it is recommended that that folks undergo estrogen-based GAHT (minimum 12 months) prior to breast augmentation surgery. The purpose is to maximize breast growth in order to obtain better surgical (aesthetic) results.

Criteria for genital surgery (two referrals)

Criteria for hysterectomy and ovariectomy and for orchiectomy:

Persistent, well documented gender dysphoria (will change with version 8);
Capacity to make a fully informed decision and to consent for treatment;
Age of majority in a given country (within NB, must be at least 18);
If significant medical or mental health concerns are present, they must be well controlled;
12 continuous months of hormone therapy as appropriate to your gender goals (unless the individual has a medical contraindication or is otherwise unable or unwilling to take hormones).

The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible estrogen or testosterone suppression, before the individual undergoes irreversible surgical intervention.

Criteria for metoidioplasty or phalloplasty and for vaginoplasty:

Persistent, well documented gender dysphoria (will change with version 8);
Capacity to make a fully informed decision and to consent for treatment;
Age of majority in a given country (within NB, must be at least 18);
If significant medical or mental health concerns are present, they must be well controlled;
12 continuous months of hormone therapy as appropriate to your gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones);
12 continuous months of living in a gender role that is congruent with their gender identity.

Following the completion of a surgical readiness assessment a PCP and/or psychologist determines that someone is clinically eligible for surgery and completes the Gender Confirming Surgery Prior Approval Request form. Once prepared the request form is sent to the Executive Director of Addictions and Mental Health, who in turn forwards it to New Brunswick Medicare for consideration. Upon approval, a surgical plan is put in place by the patient's medical team.

In addition to completing the Prior Approval Request form the following are required to access Medicare covered gender-affirming surgery:

Must be at least 18 years of age;
Must hold a valid NB Medicare card;
One or two referral letters;
For all genital surgery: 12 continuous months of GAHT for all bottom surgeries unless there is medical contraindication, or inability / unwillingness to undergo hormone replacement therapy;
For genital reconstruction: 12 continuous months of living in a gender role congruent with their identity unless a specific reason has been stated in a referral letter.

According WPATH, a referral letter recommending surgery should include the following information:

Your general identifying characteristics;
Results of your psychosocial assessment, including any diagnoses;
The duration your primary care provider and/or mental health professional has known you, including the type of evaluation and therapy or counselling to date;
An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting your request for surgery;
A statement about the fact that informed consent has been obtained;
A statement that your primary care provider and/or mental health professional is available for coordination of care and welcomes a phone call to establish this.

In New Brunswick, two letters are required for genital surgery. If two referral letters are required and the first referral letter is from a Physician or Mental Health Professional who mainly had a clinical relationship with you, the second referral letter must be from a different Physician or Mental Health Professional who had an evaluative role with you.

Gender-Affirming Surgeries Covered By NB Medicare

Subcutaneous mastectomy & chest contouring

Removal of breast tissue and creation of a flatter and/or more sculpted chest

Requirements:

Only Partial Coverage
One WPATH/ CPATH Supporting Letter

Hysterectomy with bilateral salpingo- oophorectomy

Removal of uterus, ovaries, and fallopian tubes

Requirements:

Two WPATH/ CPATH Supporting Letters

Orchidectomy

Removal of testes

Eliminates need for testosterone blocker

Requirements:

Two WPATH/ CPATH Supporting Letters

Vaginoplasty (including Vulvoplasty)

Creation of vagina and vulva (including mons, labia, clitoris, and urethral opening)

Requirements:

Two WPATH/CPATH Supporting Letters
Orchidectomy previously performed in a public hospital in Canada.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Clitoral release

Ligaments around clitoris are cut releasing clitoris from the pubis and allowing creation of penis 4-6cm long

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed in a public hospital in Canada, the cervix must be completely removed, and a pathology report confirming this must be provided to the Centre Métropolitain de chirurgie in Montreal.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Metoidioplasty

Clitoral release plus urethral lengthening and incorporation into penis, increased girth of penis using skin from labia. Creation of scrotum from labia, +/- vaginectomy and scrotal implants

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Phalloplasty

3 phase surgery to create penis, scrotal sac, and testes using genital and tissue grafted from forearm, thigh or back

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Construction of the urethra

Performed either simultaneously with a phalloplasty or during second intervention after phalloplasty. This procedure will allow urine to flow through the tip of the phallus.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Insertion of testicular implants

Insertion of 1 or 2 gel-filled testicular implants into the scrotum.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Insertion of penile implant

Insertion of an implant into the phallus that was formed during the phalloplasty.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Gender-Affirming Surgeries Covered By NB Medicare

Subcutaneous mastectomy & chest contouring

Removal of breast tissue and creation of a flatter and/or more sculpted chest. Only Partial Coverage.

Requirements:

One WPATH/ CPATH Supporting Letter

Hysterectomy with bilateral salpingo- oophorectomy

Removal of uterus, ovaries, and fallopian tubes

Requirements:

Two WPATH/ CPATH Supporting Letters

Orchidectomy

Removal of testes

Eliminates need for testosterone blocker

Requirements:

Two WPATH/ CPATH Supporting Letters

Vaginoplasty (including Vulvoplasty)

Creation of vagina and vulva (including mons, labia, clitoris, and urethral opening)

Requirements:

Two WPATH/CPATH Supporting Letters
Orchidectomy previously performed in a public hospital in Canada.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Clitoral release

Ligaments around clitoris are cut releasing clitoris from the pubis and allowing creation of penis 4-6cm long

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed in a public hospital in Canada, the cervix must be completely removed, and a pathology report confirming this must be provided to the Centre Métropolitain de chirurgie in Montreal.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Metoidioplasty

Clitoral release plus urethral lengthening and incorporation into penis, increased girth of penis using skin from labia. Creation of scrotum from labia, +/- vaginectomy and scrotal implants

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Phalloplasty

3 phase surgery to create penis, scrotal sac, and testes using genital and tissue grafted from forearm, thigh or back

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Construction of the urethra

Performed either simultaneously with a phalloplasty or during second intervention after phalloplasty. This procedure will allow urine to flow through the tip of the phallus.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Insertion of testicular implants

Insertion of 1 or 2 gel-filled testicular implants into the scrotum.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Insertion of penile implant

Insertion of an implant into the phallus that was formed during the phalloplasty.

Requirements:

Two WPATH/CPATH Supporting Letters
Hysterectomy with bilateral salpingo- oophorectomy previously performed.
Travel to the Centre Métropolitain de Chirurgie, Montréal, Québec

Gender-Affirming Surgeries Not Covered By NB Medicare

Breast construction

Implantation of prosthesis to enhance size and shape of breasts

Facial surgery

May include alterations to the facial bones, cheeks, forehead, nose, hairline and areas surrounding the eyes, ears, or lips

Tracheal shave

Reduction and reshaping of Private Variable BC thyroid cartilage

Voice surgery

Alteration of vocal fold mass and/or tension to elevate pitch

Pectoral augmentation

Implants placed beneath pectoral muscles to increase size and projection of muscles

Liposuction or lipofilling

Removal or transfer of body fat to achieve desired body contour

SURGERY RESOURCES

Buy, Borrow, Do Checklist

*some items are specific to BC.

We are excited to announce that we will be partnering with TransCare+ in 2024! Once our resources are integrated there, this website will direct route you to our space on their website, where you will continue to be able to access our content.

Medical Affirmation

On This Page

Where To Get Care

Paediatrics – Child/Youth

Primary Care Providers

Endocrinologists - Adult

Hormone Readiness Assessment

Patient History

Patient Education, Readiness, & Supports

Risk Management

Baseline Data

Differential Diagnosis

Next Steps

Effects of Testosterone-Based Hormones

Effects of Estrogen-Based Hormones

HORMONE RESOURCES

Surgery

Gather Basic Surgery Information

Patient Expectations

Patient Supports and Planning

Primary Clinical Criteria

Next Steps

Gender-Affirming Surgeries Covered By NB Medicare

Gender-Affirming Surgeries Covered By NB Medicare

Gender-Affirming Surgeries Not Covered By NB Medicare

SURGERY RESOURCES

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