• Fill out and return the Service Inquiry Form

• You will need 1 or 2 referral letters from licensed mental health care providers that address the WPATH Standards of Care guidelines. The number of referral letters you need to get depends on the requirements of your insurance provider. Contact us if you need a referral to such a clinician. 

• With some insurers, you are more likely to get surgery approval if you've been using HRT for at least 12 consecutive months before surgery. Your referral letters need to include the approximate month and year that you started HRT. If you cannot or don’t wish to take HRT, your referral letter will need to provide information on why HRT is not appropriate for you. 

• Ensure that your therapist sends a letter of support for this surgery to CGSP. Your therapist can email, fax, or mail your letter. If your therapist does not have experience writing letters of support for medical intervention for transgender people, please encourage your therapist to contact us before writing the letter. 

• Before being scheduled for a consultation you must attend or be scheduled for an online information session presented by our surgical teams. Contact CGSP to be scheduled for the information session. 

• Patients seeking a phalloplasty must wait to begin hair removal until after the consultation with the surgeon, as a hair removal diagram unique to the technique used for a particular individual will be shared at the consultation. 

Please note that before your consultation appointment with Plastic Surgery, you will need to be completely smoke-free and nicotine-free for at least one month. A nicotine test will be given before scheduling surgery. We cannot schedule your surgery if you smoke or vape any substance or use/consume any nicotine-containing products. 

Body mass & your ability to have surgery 

Healing from both metoidioplasty and phalloplasty can be impacted by body weight. Also, for a phalloplasty the amount of fat tissue present can impact the ability for a neophallus (penis) to be created. Because of this your surgeon may discuss weight loss with you to decrease the chances of complications and your results to be compromised.  Body weight will not impact your ability to schedule a consultation, but it may impact your ability to have surgery.  

For phalloplasty if you have a body mass index (BMI) of 30 or greater you may be at an increased risk of surgical complications. If you have a BMI of 40 or greater there are technical issues with creating the neophallus (penis) and that prevents our doctors from doing the surgery. 

For metoidioplasty if you have a BMI of 25 or greater you may be at an increased risk of surgical complications. This increases the difficulty of the surgery and can impact your final results. If you have a BMI above 30 this can create a technical problem during the creation of a longer urethra. 

At the time of your consultation, your surgeon will discuss with you whether they can perform your surgery based on your overall health, BMI, and the way your body is shaped.