Sex reassignment and plastic surgery with Dr. Pierre, Brassard, Montreal, Canada

Since everyone is asking questions from everywhere, I decided to write an article to save time. I describe the procedure I followed to get my approval of the RAMQ. This article is for information only and has no legal value: it is my opinion.

Well, before I explain my path, I remember the criteria for eligibility for a  sex reassignment surgery. I am not talking about money I talking about the criteria that apply before the surgeon operates. My surgeon is Dr. Pierre Brassard. You can find on its website, the eligibility criteria. I also refer you to the World Professional Association for Transgender Health, which publishes a document “WPATH Standards of Care.” You will find on page 20 a list of criteria they recommend:

XII. Genital Surgery

Eligibility Criteria. These minimum eligibility criteria for various genital surgeries equally

apply to biologic males and females seeking genital surgery. They are:

1. Legal age of majority in the patient’s nation;
2. Usually 12 months of continuous hormonal therapy for those without a medical;
3. 12 months of successful continuous full time real-life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and generally should not be used to fulfill this criterion;
4. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real-life experience at a frequency determined jointly by the patient and the mental health professional. Psychotherapy per se is not an absolute eligibility criterion for surgery;
5. Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches;
6. Awareness of different competent surgeons.

Readiness Criteria. The readiness criteria include:

1. Demonstrable progress in consolidating one’s gender identity;
2. Demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health; this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance).

I remain you that all these criteria must all be met to access to a sex reassignment surgery. So for me, I had, in-hand:

• More than one year of hormone therapy with a letter signed by my doctor endocrinologist Dr. Jean-Hugues Brossard, dated November 2008 with a August 2009 record from my pharmacy indicating that the hormone therapy is still ongoing.
• A report of my sex therapist / psychotherapist Gilberte Talbot who followed me for over a year in Psychotherapy.
• A second letter from Dr. Michel Campbell, who supports the recommendation of my sex reassignment surgery proposed by Mrs Talbot.
• Today, I do not have a full year of real life test but in a month it will be true and my surgery is scheduled for February 9. So pretty after the completion of my first year.

Several aspects are evaluated in these two reports and they cover the criteria of wpath and Dr. Brassard.

So once I got all these documents, I simply presented in the offices of Dr. Brassard located 995 De Salaberry with these documents. They look at them and they have been able to book a surgery date. From that moment, I had 2 choices: 1 – Assume the cost of surgery, the hospital stay and house of convalescent (Asclepiade) or 2 – Make an application to RAMQ for costs coverage by the public health system. Without a doubt, my choice was the second one.

To do so, Suzanne Dugré from the clinic of Dr. Brassard, took copies of my documents and send a request to the CHUM to cover the costs of my surgery. Three weeks later, I received a message from her confirming the coverage of costs by public health system. A huge news for me.

As you probably know, the cost of these surgeries had always been covered by the RAMQ, but it was necessary that this surgery is performed in a public health system such as the Czech Republic or Thailand. It was also required that surgery is prescribed by a physician affiliated with the RAMQ with a license number. For several years the only physician who were prescribing the surgery was Dr. Pierre Assalian from the Montreal General Hospital.

But there were some cases where a family physician had prescribed a sex reassignment surgery and the RAMQ had agreed to cover the surgery cost outside the province in a public health system.

Since the beginning of this year, easing of the law on public-private partnership, allowing public hospitals to do business with a private hospital. Thus, public funds in health remain among us now and create jobs in Quebec.

So for those who are interested in doing a similar path, make an appointment with your psychologist in this objective. Take your time, it takes several meetings before receiving the letters. Moreover, we need two letter, do not hurry it may be long. So, start immediately!

I invite you to make sure that the letter from your therapist will be accepted. Not all psychologists, sexologists, or psychiatrists are expert in gender identity. So check before being disappointed!

If you have any questions, you can contact me directly or the clinic of Dr. Brassard.