Face, the Issue: Should OHIP Cover Facial Gender-Affirming Surgery?

Endoresed in:

October, 2023

Paper Type:

Position Paper


  • Gavin A. Raner (Western University)
  • Sharbel A. Najm (Western University)
  • Penelope Neocleous (Western University)
  • Katrina M. Jaszkul (Queen’s University)
  • Julian Diaz-Abele (Université de Montréal)


Transition-related gender affirming surgery (GAS) refers to surgical procedures for transgender and gender diverse (TGD) patients, which help to align one’s external gender expression with one’s internal gender experience. GAS most commonly refers to “top surgery,” which addresses the patient’s chest, and “bottom surgery,” which addresses the patient’s genitalia. However, facial surgery is a crucial and often overlooked part of GAS. From professional headshots for job applications to social media profiles, an individual’s face is a core element of one’s identity and provides the foundation for social impressions. Moreover, the face offers more social and gender cues in face-to-face interactions one’s chest or genitalia would – both of which can more easily be hidden or simulated with clothing. As such, TGD individuals’ transitions often involve changing their facial appearance to better express the gender that is congruent with their internal identity. Masculinizing hormones affords greater changes to one’s underlying facial bone structure, as compared to feminizing hormones. Consequently, for many transfeminine (male to female or non-binary) people, facial gender affirming surgery (FGAS) is required for transition because makeup and hormonal treatments alone are insufficient for achieving the facial appearance appropriate for the gender they need to express.


  • We can suggest that the assessment for a patient’s eligibility for FFS be modeled after criteria for other transition related surgeries (TRSs).
  • We can suggest modeling the coverage for FFS after current coverage of other GASs.
  • Our ask is that the Ministry of Health Ontario update OHIP to cover FFS as a medically necessary procedure, in congruence with the current international standards of care guidelines for transgender health.