gender reassignment ontario

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Changing your sex designation on your birth registration and birth certificate

How to change your sex designation on your Ontario birth registration and birth certificate.

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What you need to know.

Ontario has a Gender Identity Policy that aims to:

• recognize and respect all transgender and non-binary people in Ontario, and
• give all Ontarians access to identification that matches their gender identity

The policy also helps ensure that gender or sex information is collected or displayed by the Government of Ontario only when it is relevant or necessary, and that Ontarians can better understand why it is collected or displayed.

If you were born in Ontario

Your birth must be registered in Ontario in order to change your sex designation on an Ontario birth registration.

Ontario can only change the sex designation on birth registrations that it maintains and issue birth certificates reflecting the change.

Ontario does not issue Change of Sex Designation Certificates.

Change sex designation on Ontario birth registrations and certificates

Anyone with an Ontario birth registration may apply to change their sex designation on their birth registration so it matches with their gender identity. With supporting documents, you may request a change to your sex designation to F (female), M (male), or X (non-binary). You may also request a birth certificate that displays your updated sex designation ( F , M , or  X ).

The process you follow to change your or your child’s sex designation will depend on your or your child’s age.

If you or your child are aged:

• 15 or under, the parent will apply for the child
• 16 or 17, you can choose to apply as an adult or as a child , or
• 18 or older, you will apply as an adult

For an adult

• born in Ontario
• 16 years of age or older

Please complete the following forms:

• Application for Change of Sex Designation on a Birth Registration of an Adult
• Statutory Declaration for a Change of Sex Designation on a Birth Registration of an Adult

Along with the forms, please provide:

• a letter signed by a practicing physician or psychologist (including a psychological associate) authorized to practice in Canada, that includes the statements necessary to support your request ( see Application cover sheet for instructions ). In some cases, alternatives to the required letter may be acceptable
• all previously issued birth certificates, birth certificates with parental information and certified copies of your birth registration
• a completed Application form for a birth certificate , along with applicable fees

For a child

• 17 years of age or younger
• Application for Change of Sex Designation on a Birth Registration of a Child completed by a person with legal custody ( e.g.  a parent)
• Statutory Declaration for a Change of Sex Designation on a Birth Registration of a Child completed by a person with legal custody ( e.g.  a parent)
• Consent form providing written consent of the child
• Consent form providing consent of all persons with legal custody of the child other than the applicant
• Proof of notice to all persons with legal access to the child
• a letter signed by a practicing physician or psychologist (including a psychological associate) authorized to practice in Canada, that includes the statements necessary to support the child’s requested change ( see Application cover sheet for instructions ). In some circumstances, alternatives to the required letter may be acceptable
• all court orders (original or court-certified copies) or separation agreements that include information about custody status, access to the child, or provisions regarding the sex designation of the child
• all previously issued birth certificates, birth certificates with parental information and certified copies of the child’s birth registration
• an Application form for a birth certificate , along with applicable fees

Cost and delivery

• changing your sex designation: $0
• a birth certificate or birth certificate with parental information: $25
• a certified copy of birth registration: $35

If all of the application requirements are met, 6 to 8 weeks from the date the application is received to complete the change to your birth registration and issue your new certificate(s) by mail.

Mail your package of completed forms and supporting materials to:

Office of the Registrar General 189 Red River Road, P.O. Box 3000 Thunder Bay, Ontario P7B 5W0

Photocopied or faxed forms to change sex designation will not be accepted. Original signed forms must be submitted.

Order a birth certificate with an X

If you or your child have previously changed a sex designation to X (non-binary) and would like to order a birth certificate displaying “ X ” in the sex designation field, you must submit the Request for a birth certificate form , along with applicable fees online or by mail.

• Download and complete a Request for birth certificate form 
• Complete and submit a Request certificate services with payment  ( Download as PDF )
• attach your completed Request for birth certificate form to this request
• submit your fee payment

Note: Do not include credit card information in your application form. Once you have completed your form, you will be directed to a payment page where you can submit your payment information and complete your request. 

Mail your completed Request for Birth Certificate form  and payment to:

ServiceOntario Office of the Registrar General 189 Red River Road, P.O. Box 4600 Thunder Bay, Ontario P7B 6L8

Birth certificate or birth certificate with parental information

• first time: $25
• replacement: $35

6 to 8 weeks

Note: A birth certificate with a sex designation of X is valid and recognized by the Government of Ontario. Ontario does not endorse the rejection of Ontario birth certificates; however, the Government of Ontario cannot guarantee that an Ontario birth certificate with a sex designation of X will be accepted by organizations in Ontario or by other jurisdictions.

Choose not to display the sex designation field on a birth certificate

Anyone with an Ontario birth registration also has the option to request a birth certificate that does not display the sex designation field. This option does not change your birth registration – it just means the sex designation field will not appear on the birth certificate.

You can request a birth certificate or a birth certificate with parental information that does not display the sex designation field by submitting a Request for birth certificate form , along with applicable fees online or by mail.

• Download and complete a Request for birth certificate form
• Complete and submit a Request for certificate services with payment  ( Download as PDF )

Mail your completed  Request for birth certificate form  and payment to:

Note: A birth certificate with no sex displayed is valid and recognized by the Government of Ontario. Ontario does not endorse the rejection of Ontario birth certificates; however, the Government of Ontario cannot guarantee that an Ontario birth certificate with no sex displayed will be accepted by organizations in Ontario or by other jurisdictions.

Accessibility help

If you require a form in an alternate format or with a communication support, please contact ServiceOntario:

• 1-800-461-2156  (outside Toronto but within North America)
• 416-325-8305  (in Toronto or outside North America)
• TTY : 416-325-3408

Transition Related Surgery

As you all know, these are unprecedented times. Currently our Transition-Related Surgery (TRS) Program at Women’s College Hospital is focusing our efforts on catching up on the backlog of cancelled surgeries and consultations after our program was on hold for several months. We recognize that this is an incredibly difficult time and that there will be significant negative impacts on our trans, non-binary and gender diverse communities as a result of this situation.

We believe that TRS is an essential and life-saving service. We are also part of the health care system that must respond to our current situation by doing what we can to keep you, your family, and your loved ones safe. We will be in touch with you when we are able to schedule an appointment. We appreciate your patience with delayed response times.

If you have questions about the referral process, please first review the “For Providers” tab below for detailed explanation of the elements required in a surgical referral.

If you are inquiring about the status of your referral, please first reach out to your referring physician. Upon receipt of any referral, we always send a response to your referring physician indicating that the referral has either been: accepted, declined or incomplete (requires further information). If your referring provider has not received such a response letter, please have them re-send the referral.

Transgender healthcare access issues are prominent in Canada and worldwide, with significant health gaps in access to skilled primary, emergency and specialty care services, which may include, for some individuals, access to medically necessary surgical services.

In response to a significant wait list for surgical referrals and lack of access to surgical services in publicly funded hospitals, Women’s College Hospital (WCH) has partnered with Sherbourne Health Centre including Rainbow Health Ontario (RHO), and the Centre for Addiction and Mental Health (CAMH), along with a group of committed individuals from the community, to form the Trans Health Expansion Partnership (THEx).

THEx supports the expansion of health services for trans individuals and communities across Ontario. Under the umbrella of THEx, the Transition Related Surgery Sub-committee led by WCH, is charged with the goal of creating an accessible, and quality surgical program.

WCH is dedicated to supporting the health and wellness of our transgender and gender diverse clients. The surgical team of the Transition-Related Surgery (TRS) Program includes specialists in plastic surgery, urology, gynecology and anesthesiology as well as nurse practitioners, nurses and other health care providers. This program represents the first public hospital-based surgical program in Canada focused on providing safe and timely access to transition-related surgical care.

At WCH, we are dedicated to offering the safest proven surgical options for TRS. Working in partnership with our patients, we bring expertise, experience and a commitment to the highest quality of care and patient experience.

If you have questions about the TRS Program, the team can be reached at 416-323-6148 or [email protected] .

Surgeries Available

Through training and recruitment of clinical staff with specialized expertise, we are building a comprehensive trans surgical program. At this time, the following surgeries are available at Women’s College Hospital.

• Mastectomy with Chest contouring*
• Breast Augmentation**
• Hysterectomy
• Bilateral salpingo-oopherectomy
• Orchiectomy
• Scrotectomy
• Vaginoplasty
• Vulvaplasty

*currently not covered by OHIP, there is a $1500 +HST cost for this procedure

**currently covered by OHIP following 12 months continuous hormone therapy with no breast growth defined as Tanner Stage 1

Yonah Krakowsky, MD FRCS(C), TRS Medical Director Emery Potter, NP-PHC, BSCN, MN, TRS Program Nurse Practitioner Nahir Anashara, Nurse Practitioner Olivia Drodge, TRS Physiotherapist

Plastic Surgery

John semple md, msc, frcs(c), facs .

Dr. John Semple is Head, Division of Plastic Surgery at Women’s College Hospital and Professor in the Department of Surgery, Faculty of Medicine at the University of Toronto.  Areas of specialty and interest include Breast Surgery, Breast reconstruction, Tissue engineering, Lymphedema, Mobile health technology and high-altitude meteorology and global waning in the Himalaya.

Mitchell Brown MD, MEd, FRCS(C) 

Dr. Mitchell Brown is a Professor of Surgery in the Department of Surgery at the University of Toronto.  Founder and co-course director of the Toronto Annual Breast Surgery Symposium and Breast Reconstruction Awareness (BRA)Day.  Dr. Brown specializes in aesthetic and reconstructive breast surgery, body contouring and facial aesthetic surgery.

Dr. Kathleen Armstrong

Dr. Kathleen Armstrong is an award winning teacher and expert in gender affirming top surgeries. She completed fellowship training with Dr. Hugh McLean at the McLean Clinic and performs over 250 top surgeries per year. She has extensive experience as an educator having participated in medical student and resident education for the last 10 years in various roles. In her role within the Division of Plastic, Reconstructive & Aesthetic Surgery at the University of Toronto, she trains medical students, residents and fellows in top surgery providing core lectures, office based and technical experience. She has a MSc in Health Services Research specializing in Health Economics. Her presentations have garnered various awards and she has published in multiple prestigious journals including CMAJ, JAMA and JAMA Surgery. As an Early Career Researcher at Women’s College Research Institute, she aligns her surgical and research interests to focus on gender affirming surgeries.

Urologic surgery

Ethan grober md, med, frcs(c) .

Dr. Ethan Grober is the Division Head Urology and Assistant Professor at the University of Toronto, Department of Surgery.  Dr. Grober’s clinical activities focus on vasectomy reversal microsurgery, male reproductive and sexual medicine and testosterone deficiency.  His research interests include the assessment of technical competence and operative judgement, the integration and evaluation of new technologies in surgery and the validation of surgical simulation and laboratory-based surgical skills training.

Yonah Krakowsky, MD FRCS(C)

Dr. Yonah Krakowsky is the Division Head of Trans Surgery and a Surgeon-Educator at the University of Toronto.  His clinical and research interests are in peyronies disease, erectile dysfunction, female sexual medicine and increasing access for Trans Surgery in Canada.

Lisa Allen, MD, FRCS(C)

Women’s College Hospital 76 Grenville Street Floor 5 Toronto, ON M5S 1B2

Phone : 416-323-6148 Email : [email protected]

OHIP funded Transition Related Surgery (TRS) is applied for by qualified health care professionals. This includes providers who are trained in the assessment, diagnosis, and treatment of gender dysphoria in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care. This may include a Physician or Nurse Practitioner (NP) as well as a Registered Nurse, Psychologist or Registered Social Worker with a Master’s degree. If you are one of the aforementioned professionals interested in becoming a qualified provider, please see our Community Resource page for more information. 

Making a Referral

To make a referral please submit.

• Transition Related Surgery Referral Form
• Prior Approval Funding Confirmation Letter -   Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf). (unless previously discussed with TRS Program NP)
• Comprehensive   referral template (.docx)  or brief referral with TRS planning visit notes

Before making your referral ensure

The patient meets OHIP eligibility for surgery (unless contraindicated)

You have provided the patient with comprehensive TRS planning visit(s)

Once you receive the OHIP approval form, have completed the referral and have attached a completed cover page, please fax the referral to: 416 323-6310. If you have any questions about the referral or referral process please call: 416 323-6400 x 4339 or x5333.

Once the referral is received, it will be assessed by someone from the TRS team. If incomplete, it will be returned by fax requesting the missing information.

If the referral is complete, it will then be sent to the appropriate surgeon’s secretary and they will be in contact once they have an appointment available.

For OHIP Funding

The TRS Frequently Asked Questions (.pdf) is a guide to the assessment and referral process for Ministry of Health and Long-Term Care Approval for OHIP funding. The resource is intended for persons considering transition-related surgery in Ontario, and the people supporting them.

The Ministry of Health and Long-Term Care’s  website  outlines the Ontario Health Insurance Plan (OHIP) funding criteria for transition- related surgeries. There is a specific form, the  Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf) , you must complete in the current referral system to gain access to OHIP coverage. This form can be found  here.

The form is completed and faxed to the MOHLTC at (613)536-3188 once

• The patient is confirmed to meet the criteria for surgery
• TRS planning visits  have been completed and the patient wishes to move forward with surgery
• A surgeon has been chosen (see Our Team)

Once the form is faxed to the MOHLTC, they will fax back a letter with the decision (typically within 1-4 weeks). This Prior Approval Funding Confirmation Letter will be sent to the patient and the referring provider. The form will not be sent to the surgical team as of November 1st, 2019.

Criteria for Surgery

Criteria for surgery must be met prior to referral to a surgeon/program. The criteria for surgery are outlined in the box below. Please ensure your client has met these criteria, unless contraindicated, and please make comments on your referral letter. Criteria for all surgeries, including what is listed in the table, must include  persistent and well documented gender dysphoria, capacity to make a fully informed decision and consent to treatment. 

Surgery Planned Visits

For upper body surgeries including mastectomy with chest contouring and augmentation mammoplasty, only one provider (physician or nurse practitioner) is required to complete surgery planning visit(s) and complete the  Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf).

For lower body surgeries, including but not limited to orchiectomy, hysterectomy, phalloplasty, metoidioplasty and vaginoplasty, two providers are required to complete separate surgery planning visits and complete the Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf). One of the providers must be a physician or Nurse Practitioner and the other may be any of the listed qualified providers.

TRS planning visits are to be completed as you wish, however, to assist you we have created a list of key topics to discuss and include during these appointments. Documentation should confirm that these topics have been reviewed.

Gender History

Discuss the patients current gender identity and process of transition.

Confirm persistent Gender Dysphoria, the patients experience with transition so far, medical and social steps taken or considered Include Eligibility as per the Ministry of Health and Long Term Care and the World Professional Association of Transgender Health (i.e. duration of hormones, gender role experience)

Goals for surgery

Why does the patient want surgery? How will surgery help the patient achieve their gender goals/reduce dysphoria? Are their expectations for surgery realistic? Aware of alternative non-surgical and surgical options If relevant, discussion around fertility and options for preservation reviewed

Detailed surgery discussion/capacity for informed consent

Description of desired surgery, realistic outcomes, risks, side effects (irreversibility), alternate options. (A more detailed and focused discussion about surgical details will take place between the surgeon and client)

Readiness (medical and psychosocial)

How well controlled are medical and mental health conditions Smoking, alcohol, substance use Supports in place (including financial), and aftercare planning

Criteria for Transition Related Surgery

Criteria for surgery must be met prior to referral to a surgeon/program. The criteria for surgery are outlined in the box below. Please ensure your client has met these criteria, unless contraindicated, and please make comments on your referral letter. Criteria for all surgeries, including what is listed in the table, must include  persistent and well documented gender dysphoria, capacity to make a fully informed decision and consent to treatment. 

Surgery	1st Letter (MD/NP)	2nd Letter (NP/MD/ RN/MSW/ Psychologist)	Hormones	Medical and Mental Health Coniditons	Gender Role Experience
Mastectomy	x		Not a pre-requisite	“controlled”
Augmentation Mammoplasty	x		12 continuous months with no breast development	“controlled”
Gonad: Hysterotomy or Orchiectomy	x	x	12 continuous months	“well controlled”
Vaginoplasty	x	x	12 continuous months	“well controlled”	12 continuous months of living in a gender role congruent with gender identity
Phalloplasty/Medtoidioplasty	x	x	12 continuous months	“well controlled”	12 continuous months of living in a gender role congruent with gender identity

Provider Resources

If you would like more information on how to become a provider qualified to make referrals for Trans Related Surgery please see the  RHO website  for trainings and information

For information on the referral process for surgery in Ontario see  Rainbow Health Ontario’s Frequently Asked Questions.

For information about specific transition related surgeries, please see these surgical info summary sheets.

RHO provides a weekly mentorship call from Wednesday from 12-1. Providers are encouraged to call in to ask any trans related health care questions. Register at the bottom of the page on their website.

If you are looking for a primary or secondary provider to support trans pre-surgical planning visits you can make a referral to CAMH .

Visit the  RHO Newsroom  to be kept up-to-date as our program and website expands to include helpful resources and ensure access to care.

Referral Process for Patients

If you wish to access Ontario Health Insurance Plan (OHIP) funded TRS, please make an appointment with your physician or nurse practitioner. TRS planning visits can occur in a primary care setting, with a specialist or at the CAMH Gender Identity Clinic (or in combination depending on your needs and local resources). TRS planning visits will take place with your health care team. You may be asked to see one or two providers depending on the surgery you are requesting. In addition to a physician or nurse practitioner, this might include a social worker, a registered nurse or a psychologist

Your health care provider will arrange or provide the necessary surgery planning visits prior to referral for surgery. In these appointments the provider will ensure that you have met all the OHIP funded surgery criteria in addition to having an in depth conversation with you about your goals, different surgical and non-surgical options, risks and benefits of surgery and other relevant medical and mental health issues.

Once you have completed your TRS planning visit(s), your health care providers will complete a special medical form seeking OHIP funding for transition- related surgeries. Once this is approved, a referral will be made to your chosen surgeon. If the referral is complete and accepted, you will receive a call to set up an initial appointment with the surgeon. The TRS Frequently Asked Questions (.pdf) is a guide to the assessment and referral process for Ministry of Health and Long-Term Care Approval for OHIP funding. The resource is intended for persons considering transition-related surgery in Ontario, and the people supporting them.

The first appointment is a surgical consultation. At this visit you will meet with your surgeon and possibly the Nurse Practitioner or Social Worker. During this visit, we will take a comprehensive history, there will be a detailed discussion about surgery, a physical exam will take place, photos may or may not be taken and consent to communicate with your primary care team will be sought. A pre-op medical questionnaire will be completed.

After this consult visit, if surgery is the next step, the surgeons secretary will follow up with you in order to book surgery. Once surgery is booked, you will get another appointment for pre-admission clinic. This visit typically occurs in the week or two before surgery.

At the pre-admission visit you will be given more details about your surgery, pre-operative instructions, review an after-care plan and you may be given information to take home. You may also meet with anesthesia and possibly pharmacy or internal medicine at this visit.

You are expected to have someone to pick you up from surgery and stay with you for 24 hours afterwards. If you do not have such a person, we will discuss options available to you including the ARC program at SHC.

Post Surgical Resources – Vaginoplasty

• Consent for vaginoplasty
• VaginoplastyGuidebook
• Vaginoplasty Surgery Timeline
• Post-Operative Vaginoplasty Guide to the First Year
• Digital Care Coach
• The role of pelvic floor physiotherapy
• Pre-surgery exercises
• Dilation instructions
• Dilation assistance
• Getting the pelvic floor ready for dilation
• Hypergranulation tissue
• ILU Abdominal massage
• Kegels and Stretches
• Medication Schedule
• Support from a Social Worker
• Common Vaginoplasty Complications
• Understanding what Recovery may look like
• Accessing Vaginoplasty Surgery in Ontario

Post-Surgical Resources – Chest Surgery

• Chest Surgery timeline
• Track Your Drains
• Chest Masculinization Guidebook
• Accessing Chest Surgery in Ontario

New gender-affirming surgery clinic now accepting patients

• Patients and Visitors
• Healthy Tomorrows
• All articles

• All Articles
• Population Health

Plastic Surgeon Dr. Nicholas Cormier has dedicated nearly his entire career to caring for trans and non-binary patients.

The Ottawa Hospital understands that trans and non-binary people often face barriers accessing gender-affirming care. Faced with long wait times or even lack of access in the communities where they live, they may struggle to achieve their gender-affirming goals.

We are very pleased to announce that The Ottawa Hospital’s new gender-affirming surgery clinic is here to help. Launched in September 2023, it is the only clinic in Ontario and the second in Canada to offer all three of the following gender-affirming procedures:

• Facial surgery to make facial features more masculine or feminine
• Top surgery to remove breast tissue for a more masculine appearance or enhance breast size for a more feminine appearance
• Bottom surgery to transform the genitalia

The clinic’s lead and co-founder, Plastic Surgeon Dr. Nicholas Cormier, has some more wonderful news to share: “We’re currently accepting patient referrals from physicians,” he announces with a smile. “We’re ready to service Ottawa and the surrounding communities.” 

A truly collaborative effort

Before our clinic, patients seeking gender-affirming surgery in Ottawa could only access top surgery but not bottom or facial. Previously, a clinic in Montreal was the only location in Canada offering all three procedures.

“There’s just a massive gap in our health-care system for the treatment of the transgender population and people seeking gender-affirming care,” says Dr. Cormier. “What’s so groundbreaking about this new clinic is that everyone is coming together to address this shortcoming in our system.”

These partners include different surgical divisions at the hospital—plastic surgery, urology, obstetrics and gynecology—as well as trans health programs out in the community, such as the Centretown Community Health Centre’s Trans Health Program , which provides patients with a referral to our clinic, and CHEO’s Gender Diversity Clinic , which provided Dr. Cormier and his team with advice on setting up the clinic and also refers patients who have reached the age of 18.

These community programs are also important for the overall health and wellbeing of Ottawa’s trans and non-binary population. “Accessing gender-affirming surgery is just one small component of gender-affirming care,” says Dr. Cormier. “That’s where these community partners really come into play.”

Years in the making

For Dr. Cormier, the clinic is the culmination of many years of caring for the gender-diverse community.

“In my residency, I was always interested in gender-affirming care, and that led me to seek out a fellowship in San Francisco, where I was able to train with world-renowned experts in gender-affirming care,” he recalls. “And I’m really excited about bringing that to my hometown of Ottawa.”

And Ottawa’s gender-diverse community is (literally) in good hands, says Dr. Daniel Peters, Division Head of Plastic Surgery at The Ottawa Hospital. “Dr. Cormier has dedicated nearly his entire career to caring for this often underserved patient population. He has learned from the best of the best in this field and has the compassion to match his expertise. He joined The Ottawa Hospital’s Division of Plastic Surgery not long ago, and yet he has already shown tremendous leadership by getting this clinic up and running. That’s really a testament to his passion for helping people on their gender-affirmation journeys.”

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This website gives you common facts, advice and tips. Some of it may not apply to you. Please talk to your doctor, nurse or other health-care team member to see if this information will work for you. They can also answer your questions and concerns.

If you are in an emergency, in crisis or need someone to talk to, there is help.

Gender Identity Clinic

The Gender Identity Clinic offers services to individuals and their primary care practitioners in regard to gender identity and expression.

Individuals over 17 who wish to explore issues related to their gender identity, which may include any degree of transgender expression.

Community professionals looking for support and consultation to help their clients reach their goals related to gender identity and expression.

Ask your health care provider to fill out the CAMH adult referral form. Here is a link to the online referral form . Forms should be faxed to Access CAMH at 416 979-6815. If you have any questions about the referral process, call Access CAMH at 416 535-8501 and press 2.

Types of Treatment and Services Offered

For individuals, consultation and support may include:

• diagnostic assessments in support of affirming a diagnosis of Gender Dysphoria in support of transition related surgeries. 
• individual support and treatment *Please note that our clinic does not offer long-term therapy
• surgical and hormone eligibility assessments *Please note that our clinic does not prescribe hormones
• group-based services

If you are interested in accessing LGBTQ2S affirmative psychotherapy, please check the service provider listing at Rainbow Health Ontario to find out options for psychotherapy in your region. 

For community professionals, consultations may include:

• completing a mental health assessment
• consultation with regard to completing a surgery referral assessment
• being a second assessor for surgery referrals

Program Overview

The Gender Identity Clinic at CAMH offers specialty services to both individuals and their primary care practitioners in Ontario with regard to issues related to gender identity and expression, including gender expansive, trans and non-binary identities. The program offers a comprehensive response to the variety of clinical issues experienced by clients. The clinical team is interdisciplinary and includes social work, psychiatry and psychology staff with specialized expertise in trauma-informed mental health and addiction care.

Our Services

For community professionals.

Primary care providers can diagnose for gender dysphoria, prescribe transition-related hormones, and refer for transition-related surgeries. If you are new to the field of trans care, Rainbow Health Ontario provides education, clinical support, and mentorship to primary care providers across Ontario. All courses provided by Rainbow Health Ontario are Mainpro+ certified. Please visit learn.rainbowhealthontario.ca for more information on courses offered at this time.

Rainbow Health Ontario also hosts a free bi-monthly Trans Health Mentorship Call to support clinicians in their practices. To register for this call, please visit learn.rainbowhealthontario.ca

IMPORTANT: Rainbow Health Ontario does not accept referrals or provide direct services of any kind.

Hormone Therapy

We would encourage referring physicians and/or nurse practitioners to consider prescribing hormone therapy (HT) for their trans clients.

If you are unsure about prescribing HRT:

• We recommend that you review the published Guidelines and Protocols for Comprehensive Primary Health Care for Trans Clients available through Sherbourne Health Centre , and review the WPATH Standards of Care
• If, after reading this document, you feel confident in your knowledge of HT, then you can prescribe in advance of the client’s initial assessment. If HT is your client’s sole gender goal, then there is no need to access the clinic once hormones have been prescribed. 
• If you are aware of complicating medical concerns and these medical concerns have prevented the initiation of hormone therapy, please consider making a referral to endocrinology on the client’s behalf.
• If you are interested in training to develop further competency in health care for trans clients, please contact Rainbow Health Ontario, which will take you to various training opportunities offered by that organization throughout the province of Ontario.

*If hormone replacement therapy is the primary reason for referral, we would ask that you consider these above-mentioned recommendations, as it will help to reduce unnecessary waiting for your client in terms of further medical transition.*

The clinic plays a significant role in training health professionals in culturally competent delivery of mental health assessment and treatment services to trans and gender expansive communities. We train and provide practicum and residency opportunities for social work students, psychologists and people from other health disciplines, including more than 10 PhD-level clinical psychologists over the past five years.

Consultation

Additionally, we provide support and consultations to primary care practitioners and other health care providers to help their clients reach their goals related to gender identity and expression. This may include consultations in regard to completing a mental health assessment, consultation in regard to completing a surgery readiness assessment, or being a second assessor for surgery readiness. The clinic will work collaboratively with you and your organization/practice to help you meet your client’s goals. Clinicians and organizations wanting consultation by the clinic for clients currently on our waitlist can contact our clinic at 416 535-8501 ext. 30985.

We have also launched an ECHO (Extension for Community Healthcare Outcomes) for trans and gender diverse health care . Please consider joining us for free CME-accredited training and consultation.

For Individuals

The clinic offers consultations and support to individuals over 17 years of age who wish to explore issues related to their gender identity, which may include any degree of transgender expression. Clients are seen for an assessment with one of our team members to determine the client’s transition goals, as well as to provide any diagnostic impressions regarding mental health and substance use. Recommendations about how to assist clients in meeting their transition goals are then made. This may include individual support and treatment, group-based support and treatment, as well as recommendations for surgery funding and referrals for clients seeking transition-related surgeries. The clinic follows the World Professional Association for Transgender Health Standards of Care (WPATH),V7 for transition-related surgery (TRS) .

Rainbow Health Ontario has an Ontario Service Provider Directory where you can search for a provider by region. Please go here to find a provider in your area.

If you cannot find anyone in your area after searching the provider directory, you can contact [email protected] . Please note that Rainbow Health Ontario cannot guarantee there will be a provider in your area to prescribe hormones or refer for surgeries.

Additionally, Rainbow Health Ontario’s Trans Health Knowledge Base can provide you with answers to general questions related to navigating the Ontario health care system. Go here for more information . 

For clients living outside the GTA

Given the context of the Covid-19 pandemic, our clinic provides virtual appointments via the Webex platform.

Given our referrals come from across the province, our clinic is equipped to see clients via telemedicine when possible. Typically, the first assessment in our clinic is in person in Toronto, and subsequent appointments for clients who live outside of the GTA may be made using telemedicine.

If you live in the north, you may be eligible for a Northern Travel Grant to cover basic travel costs to and from your appointments with CAMH. If you are an ODSP recipient, you may similarly be eligible to have basic travel costs reimbursed. Please ask your local provider for further details.

Transition-Related Surgery (TRS) - Frequently Asked Questions

T hese FAQ's are designed to provide a brief overview of the assessment and referral process in Ontario for persons considering gender-affirming surgeries funded by the Ministry of Health and Long-Term Care (MOHLTC). For more information on types of surgery, see the TRS Surgical Summary Sheets update .

For specific questions or more detailed information pertaining to gender-affirming surgeries, please don't hesitate to contact our office at 416 535-8501 ext. 30985.

Significant improvement in wait times for assessment

From 2008–2016 the Ministry of Health and Long Term Care (MOHLTC) regulation stipulated that CAMH was the sole assessment site for OHIP-funded transition-related surgery (TRS) (from 1998-2008 TRS was not funded by OHIP). In March 2016, the MOHLTC introduced a regulation change that improves and expands access to assessment for TRS for Ontarians, empowering primary care providers to provide surgery referrals and assessments. CAMH and its community partners championed this expansion of access to assessments for gender-affirming surgery. In anticipation of this important system change, CAMH partnered with Sherbourne Health Centre (including Rainbow Health Ontario) and Women’s College Hospital on a proposal to expand access to surgery-related care. Thanks to funding from the MOHLTC, the Trans Health Expansion (THEx) partnership is working on several key priorities including improving access to assessment, building capacity of primary care providers, and enhancing access to surgery and post-surgical recovery and support.

The funding helped our clinic to hire new staff members and in doing so, we were able to significantly decrease wait times for assessment. Prior to March 2016 the wait for assessment was over 30 months, and to date it is less than one-third of that. We continue to work to see more clients and reduce the current wait times.

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Information on Sex Reassignment Surgery (SRS) and Trans Health Care in Ontario

This resource is currently only available in English. Visit our English resources for 2SLGBTQ health information in English.

Questions? Get in touch with us at [email protected]

Answers to Frequently Answered Questions about SRS and Trans Health Care in Ontario.

The document offers information on the current status of SRS in Ontario and related health care for trans patients under the Ontario’s Health Insurance Plan (OHIP) which has not been readily accessible. We have produced this Frequently Asked Questions document to address these issues.

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How gender-affirming health care for kids works in Canada

Transgender youth and their health-care providers say the field is widely misunderstood.

Social Sharing

Robyn Hodgson says she's watched struggling young people heal, grow and ultimately thrive because of gender-affirming health care. 

"It genuinely is profound," Hodgson, a registered nurse and co-ordinator for the transgender and non-binary program at the InterCommunity Health Centre in London, Ont., said. 

"I'm in my 27th year, and I've worked in a lot of areas — and this has been the most rewarding area that I've ever worked in."

Gender-affirming health care — an approach that affirms a trans person's gender identity instead of trying to change it — is endorsed by medical associations in Canada and around the world, including the Canadian Psychological Association and the Canadian Pediatric Society.

But it's also a type of health care that's widely misunderstood, especially as it pertains to the treatment of young people, say the medical professionals who provide it and the patients who receive it. 

• CBC Kids News Explaining gender-affirming care to kids

"So many people make uninformed opinions," said Silas Cain, a 16-year-old transgender boy receiving gender-affirming care in Saskatoon. "They see a headline or they hear one person talking about it and they take it as fact, which is harmful in so many different contexts."

Here's what transgender youth, their caregivers and their health-care providers want you to know about what affirming care actually looks like for young people in Canada. 

How does it work?

Affirming care ranges from social and psychological support, like using someone's chosen pronouns; to transition-related medical treatments, such as puberty blockers and hormones, or gender-affirming surgeries.

Hodgson likens it to how society accommodates people who are left-handed.

"We've tried changing handedness in the school system, and people were struck in the knuckles with rulers," she said. "Trying to force people to live in a shell that is absolutely foreign to their experience is equally difficult."

What it’s like to fight for health care as a trans teen

Forcing kids into genders they don't identify with can have negative impacts on their well-being, says Rhea Mossman Sims, a nurse practitioner at Trans Health Klinic in Winnipeg.

"They can have a significant decrease in their self-esteem and they can also have a significant decrease in their general mental health, and there is a potential for suicidality," she said.

Do kids get medical treatment before puberty?

Canadian health-care providers broadly follow the World Professional Association for Transgender Health (WPATH) standards of care, which has guidelines for patients at different stages of their development.

For kids who haven't hit puberty, affirming care means letting them explore their gender in a supportive environment. That can mean using different pronouns, trying out a new name, or letting them pick different clothes or try a new haircut. 

"There is nothing medically that is done in a child [before signs of puberty]," Hodgson said.

For Cain, that started not at a health clinic, but at school when he found teachers who supported him as he explored different labels. 

"Trying out different pronouns and different names was affirming care for me at that time," he said. "Having a space to experiment is so important and so vital."

Can minors get surgery?

Surgical options, Hodgson says, aren't considered until "very, very late in care" — and almost never for patients under 18. 

"I can tell you, internationally, I do not know anybody that will perform any type of genital surgery on anyone under 18 years of age."

In some very rare cases, she says, older teenagers may be eligible for chest surgery — also known as top surgery — but only if they've already had "a significant duration of care," she said.

Are kids rushed into treatment?

Before puberty blockers or hormone therapy can be considered, WPATH guidelines recommend that all youth be assessed by a qualified health-care professional who has studied psycho-neurodevelopment in adolescence.

"I think that there is this assumption that people are rushing into medical care and there's no thoughtful contemplation or support," Hodgson said.

"It certainly hasn't been the experience of any of the providers that I know that are doing this care, nor of the trans population that's accessing care."

• Trans teens and youth say gender-affirming care is 'life-changing.' So why is it so hard to find in Canada?

Since 17-year-old Seelie Romard of Sydney, N.S., first started seeking gender-affirming treatment in 2021, he says he's visited a pediatrician, a physician who specializes in gender care, and a psychologist — all before being put on a waitlist for testosterone. 

"It took a really long time … just to make sure that I was, like, OK mentally, that I was in the right place, that I was informed," Seelie said. 

What are the effects of puberty blockers?

Patients in the early stages of puberty may be prescribed puberty blockers, which slow the pituitary gland from stimulating secondary sex hormones, putting puberty on pause.

"One of the nice things about blockers is that they can give you some time to continue to explore, rather than having to go through the puberty changes that would happen otherwise," Dr. Tania Culham, a physician with Trans Care B.C., said. 

Some countries have placed restrictions on puberty blockers until their long-term effects can be better studied.  England has restricted their use to minors enrolled in clinical trials , and the Norwegian Healthcare Investigation Board has recommended they be considered "exploratory" and "experimental."

Culham says they are widely considered safe, noting they have been used for more than 40 years to treat precocious puberty — puberty that starts too early — and about 20 years for transition-related care.

Some research has linked them to decreased bone density over time , so providers may limit how long a patient takes them, Sims said. Doctors also supplement treatment with vitamins and dietary guidance for bone health, Hodgson and Culham said.

Patients can pull the plug any time, Culham said, and their regular puberty will resume.

"The whole point of the puberty blocker is that they are reversible," Culham said.

What are the effects of hormone therapy?

Adolescents further along in puberty may consider taking estrogen or testosterone to help develop sex characteristics that better align with their identities. 

Cain started testosterone in July and says it's already having enormous benefits for his health and well-being. 

"Pretty much everyone that I've talked to — my teachers, my therapist, doctors — they all say that I look so much happier now than I did before," he said. "And I definitely feel much happier than I was before."

Because hormones can have long-term effects on fertility , Sims says health-care providers don't prescribe them until a patient has shown a persistent desire to transition, been fully informed about the side effects and been offered a chance to have their sperm or eggs preserved for future use.

"These decisions, in general, are not taken very lightly," she said.

How involved are parents?

According to WPATH, parents should be involved in decisions to pursue medical treatments whenever possible. In fact, Culham says a "family-centred care" leads to better outcomes in all pediatric care.

"As hard as it is sometimes for people to come out to their parents or caregivers or have these conversations, I know a lot of youth take a lot of great care bringing their families, parents, caregivers along," she said.

But that's not always possible. In Canada, under the Convention on the Rights of the Child and Children's Participatory Rights , some people under 18 may be designated "mature minors," capable of making their own health-care decisions.

That's how Tristen Roscoe, 17, of Halifax was able to access testosterone.

"I did tell her about it, but my mom wasn't happy," he said. "She didn't have to, like, sign anything or give the OK, which was good because I don't think she would have."

Roberta Cain, mother to 16-year-old Silas, says helping her son navigate the health-care system has been a "a real balancing act" between respecting his privacy and making sure she has the information she needs to support him. 

Ultimately, she says, it's worth it.

"My feeling is that the staff involved want the best for the kid," she said. "There's no other agenda than that."

ABOUT THE AUTHOR

Sheena Goodyear is a web journalist with CBC Radio's As It Happens in Toronto. She is equally comfortable tackling complex and emotionally difficult stories that hold truth to power, or spinning quirky yarns about the weird and wonderful things people get up to all over the world. She has a particular passion for highlighting stories from LGBTQ communities. Originally from Newfoundland and Labrador, her work has appeared on CBC News, Sun Media, the Globe & Mail, the Toronto Star, VICE News and more. You can reach her at [email protected]

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Resource Library

• Self Advocacy
• Community Members
• Families & Caregivers
• Service Providers
• Organizational Trans Inclusion
• Inclusive Language
• Clinical Resources
• Transition-Related Surgery
• Hormone Replacement Therapy
• Reproductive Options
• Sexual Health
• Legal Name and Gender Marker Changes
• Financial Support
• Harm Reduction

Support and Education for Trans Youth (SAEFTY) developed a short zine to support trans youth in better understanding their rights, healthcare needs and opportunities for self-advocacy.

Trans Care BC has created a self-advocacy tipsheet to support trans and gender diverse people to advocate for themselves within healthcare contexts.

Starting a conversation with your primary care provider about trans health can be difficult. RHO offers some quick and clear conversation starters that trans and gender diverse people can use to start this discussion.

The Champlain Regional Planning Table for Gender Diverse Health has developed a list of resources available for primary care providers that can help them build their knowledge, confidence, and competence in transition-related healthcare, most notably in regards to hormone replacement therapy.

Parents and families play an important role in supporting their trans and gender diverse children, youth and family members. The Families in Transition guide, created by Central Toronto Youth Services (CTYS) is a phenomenal resource for families and caregivers looking to learn more about trans people and how to support their trans loved ones.

It is important for trans, gender creative and gender diverse children and youth to see themselves reflected in the books they read, or that are read to them. It is equally important for all children and youth to understand diversity. Finally, it is important for parents, caregivers, and other caring adults to learn about trans and gender diverse communities. The RPT developed a list of picture books, chapter books/middle grade books, and youth and young adult books that touch upon issues relating to trans and gender diverse identities.

The Gender Spectrum website hosts a variety of resources, online groups, and programs for parents and families as well as their trans and gender diverse youth. Their resources for families can be used to further your understanding of gender and learn the value of parental and adult support.

Trans Care BC created an organizational assessment tool. Through this assessment, organizations can review their current capacity to serve and support trans communities, and identify viable next steps to improve trans inclusivity.

Trans Care BC created a service provider self-reflection tool to help service providers in exploring their knowledge and attitude towards gender diversity, along with their personal approach to supporting trans, non-binary, and gender diverse Two-Spirit individuals.

Wisdom2Action and the Canadian Public Health Association created a brief guide to support organizations in the development and implementation of trans inclusion within health and social services. The guide provides a flexible process that organizations can use to inform their approach to trans inclusion.

Creating inviting and trans inclusive clinic and care environments is an important way to model inclusivity and demonstrate your commitment to trans inclusion. Wisdom2Action and the Canadian Public Health Association created a guide on creating an inclusive care environment.

Trans Care BC has created an introductory guide to gender-inclusive language for service providers and primary care practitioners.

For a short review of terms best avoided, or to only be utilized in particular circumstances, Wisdom2Action and CPHA’s guide on harmful terminology can be accessed here.

Wisdom2Action and CPHA Developed a short guide to adopting gender-neutral language to help you avoid making assumptions and create safer spaces for trans and gender diverse communities.

Created by Trans Care BC, this resource provides a practical guide to how to address mistakes, such as the use of an incorrect name or pronoun.

Implementing inclusive intake forms is integral to creating a trans inclusive environment, while ensuring medically necessary information is collected accurately and appropriately. Wisdom2Action created a guide on trans inclusive intake forms, which you can access here.

The World Professional Association for Transgender Health promotes the highest standards of health care through the articulation of Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. To access in-depth clinical guidance relating to assisting trans and gender diverse people, you can download the WPATH Standards of Care v.7.0 here.

The Endocrine Society developed this clinical practice guideline on endocrine treatment of gender dysphoric/gender incongruent persons. The essential points and summary of recommendations can be found here.

This Best Practice Guideline from the Registered Nurses’ Association of Ontario provides nurses and other members of the interprofessional team with evidence-based recommendations on foundational, inclusive, and affirming care practices for Two-Spirit, lesbian, gay, bisexual, trans, queer, and intersex people. To learn more and download the guideline, click here.

Intended for use by primary care providers, these summary sheets about transition-related surgeries (TRS) provide information to facilitate discussion of TRS between primary care providers and patients. (Please note that they are not exhaustive and do not replace the informed consent process between surgeon and patient.)

The Ministry of Health and Long-Term Care Request for Prior Approval for Funding of Sex-Reassignment Surgery form, must be completed by a primary care provider (nurse practitioner or physician) following Transition-Related Surgery planning visits.

Rainbow Health Ontario developed a resource for persons considering transition-related surgery in Ontario and the people supporting them. The resource discusses the frequently asked questions relating to transition-related surgery.

The Rainbow Health Ontario quick reference guide for gender-affirming primary care with trans and non-binary patients includes pertinent information for primary care providers on feminizing and masculinizing hormones, assessing hormone readiness and monitoring dosage.

The Rainbow Health Ontario Guidelines and Protocol for Hormone Therapy and Primary Health Care for Trans Clients provides detailed information about hormone replacement therapy. You can view the full Guidelines here.

The Rainbow Health Ontario Guide to Caring for Trans and Gender Diverse Patients offers a detailed walk through of key information and steps to beginning a client on hormone replacement therapy, you can access the guide here.

Patient-ready overview documents on the expected risks and benefits of feminizing or masculinizing hormone replacement therapy, created by Rainbow Health Ontario, can be accessed here.

This Rainbow Health Ontario Fact Sheet offers information about reproductive options for trans people interested in hormone therapy or surgeries. Knowing and discussing reproductive options is a necessary component of informed consent to transition-related care.

This 34 minute video, created by the Hamilton Trans Health Coalition, offers a guide for service providers to provide gender affirming PAPs. It reminds service providers the importance of trans-inclusive practice in cancer prevention services. Click here to watch the video.

This booklet, created by Rainbow Health Ontario, helps service providers understand the social determinants of health as relating to trans people and their risk of getting cancer as well as their ability to benefit from cancer prevention services. To download the booklet, click here.

This statement from the World Professional Association for Transgender Health Board of Directors to denounce ROGD as nothing more than an acronym created to describe a proposed clinical phenomenon. They argue for adolescents receiving gender-affirmative, evidence-based care. To read the full statement, click here.

Physicians, psychologists, and psychological associates can support their clients in changing the sex designation on their Ontario Birth Registration. Rainbow Health Ontario provides a template letter in support of an application for change of sex designation on an Ontario birth registration.

Physicians, psychologists, and psychological associate can support their clients in changing the sex designation on their Ontario driver’s license. Rainbow Health Ontario provides a template letter in support of an application for change of sex designation on an Ontario dricer’s license.

Physicians can support their clients in applying for a legal name change by acting as a guarantor. To learn more about the adult name change process, you can download a guide published by Positive Space Network and Pro Bono Students Canada here.

To download the most recent version of Ontario’s Application to Change an Adult’s Name, click here. Physicians acting as a guarantor will complete Form 8 of the application.

Primary care providers can submit support letters for trans and gender diverse patients applying for employment insurance through the just cause mechanism. Rainbow Health Ontario has developed this template to support you in writing this letter.

For patients covered by the Ontario Drug Benefit Program, injectable testosterone is covered with the submission of an Exceptional Access Program (EAP) form. Rainbow Health Ontario provides a sample request for the unlisted drug product, testosterone enanthate (Delatestryl) which you can access here. [It is recommended that if submitting this EAP form, physician should also submit a request for testosterone cypionate (Depo-Testosterone)]

For patients covered by the Ontario Drug Benefit Program, injectable testosterone is covered with the submission of an Exceptional Access Program (EAP) form. Rainbow Health Ontario provides a sample request for the unlisted drug product, testosterone cypionate (Depo-Testosterone) which you can access here. [It is recommended that if submitting this EAP form, primary care providers should also submit a request for testosterone enanthate (Delatestryl)]

Often trans and gender diverse clients need to travel in order to obtain their transition-related surgeries. If the person demonstrates financial need and the surgery is covered by OHIP+, they might be eligible for free air travel and/or accommodations through Hope Air. Primary care providers can submit a Hope Air request on their client’s behalf.

This handbook, developed by Fraser Health, will provide you with in-depth information on the best practices in providing care to Two-Spirit patients. You can download the handbook here.

This paper, developed by the National Collaborating Centre for Aboriginal Health provides an overview of the health of Two-Spirit people including an introduction to Two-Spirit roles and identities, the impact of colonization on aboriginal gender and sexuality, social determinants of health in the colonial context, the health status of Two-Spirit people, resilience and resurgence, as well as additional educational resources.

This peer support manual, developed by the Native Youth Sexual Health Network, is written by and for Indigiqueer, Two-Spirit, and LGBTQ+ Indigenous Youth. It provides some tips, strategies, and resources to manage mental health and wellness.

This resource from Fenway Health provides a step by step guide with visuals to giving yourself an intramuscular or subcutaneous hormone injection. To access this guide, click here.

This video from Veterans Health Administration, provides step by step instruction to give yourself an intramuscular injection. You can watch the video here.

Rainbow Health Ontario and their FAQs working group have gathered answers in response to questions they are commonly asked by trans and non-binary folks in Ontario. You can browse the trans knowledge base here.

The RHO Service Provider Directory is designed to help you find health and social service providers who have expressed a commitment to providing competent and welcoming care to LGBT2SQ people in Ontario. To visit the directory, click here.

SPECTRUM Waterloo partnered with Wisdom2Action to develop a Trans Mental Health, Wellness and Suicide Prevention Toolkit. This toolkit synthesizes pertinent knowledge and research on trans mental health and suicidality in Canada, alongside concrete tools and resources that trans people, friends and families of trans people, and service providers who work with trans communities can put to use.

This guide was developed by the Champlain Regional Planning Table for Trans, Two Spirit, Intersex, and Gender Diverse Health. It lists medical, mental health, and community-based services that are accessible to trans and gender diverse folks in Ottawa and throughout the Champlain region.

This guide builds on the Champlain Region Gender Diverse Health Resource Guide developed Champlain Regional Planning Table for Trans, Two Spirit, Intersex, and Gender Diverse Health. It lists medical, mental health, and community-based services as well as some additional resources that might be helpful for parents and families of trans and gender diverse youth in the Champlain region. To access the guide, click here.

This guide builds on the Champlain Region Gender Diverse Health Resource Guide created by the Champlain Regional Planning Table for Trans, Two Spirit, Intersex, and Gender Diverse Health. It lists medical, mental health, and community-based services that are accessible to trans and gender diverse youth throughout the Champlain region. To access the guide, click here.

This resource was developed to help trans and gender diverse people best advocate for themselves and their needs in health and social services. The resource includes information aimed at supporting trans and gender diverse people to prepare for a health or social service-related appointment, advocate for themselves during an appointment, and advocate for themselves after an appointment.

Positive Space Network collaborated with Pro Bono Students Canada to develop this Youth Name Change Guide for transgender, non-binary, and gender-nonconforming youth in Ontario looking to change their name. The guide provides you with document checklists, important tips, and additional information about the process of changing your name on a variety of different documents.

The 519 and CATIE worked together to develop this safer sex guide providing updated sexual health and safer sex information for trans women and their partners. Brazen 2.0 covers disclosure, negotiation and consent, sex work, safer sex, transition-related surgeries, and provides up-to-date information on advances in HIV prevention and treatment, the realities of online dating and internet culture, and access to trans-inclusive health care.

This resource, produced by Egale Human Rights Canada Trust, was designed to answer common questions that parents of intersex children often have, while empowering parents and their children to make informed decisions based on current research from intersex activism. The resource includes general guidelines for navigating the healthcare system, navigating conversations with your child, your family, and schools, a guide on the distinction between intersex and gender identity, and resources for further information.

This brochure was created by interACT Youth, a group of intersex advocates in their teens and twenties working to raise intersex awareness. The brochure was created to show their friends the best ways to support them on their intersex journeys

Prepared by interACT Youth’s Advocates for Intersex Youth, this brochure covers what intersex youth wished their doctors knew.

interACT Youth created this brochure as a way to prepare other families with intersex kids for the journey ahead of them.

This toolkit, developed by the City of Toronto Seniors Services and Long-Term Care features content and resources to aid in delivering respectful, inclusive and affirming care to 2SLGBTQI+ seniors. It includes resources on individual knowledge and skills (language, information about 2SLGBTQI+ seniors and their experiences, and how to practice allyship) as well as organizational capacity building (assessing capacity, working with stakeholders, updating policies/procedures, promoting training opportunities, and developing new and inclusive programming).

Les parents et les familles jouent un rôle important dans le soutien de leurs enfants, de leurs jeunes et des membres de leur famille qui sont trans ou de sexe différent. Le guide Families in Transition, créé par le Central Toronto Youth Services (CTYS), est une ressource phénoménale pour les familles et les aidants qui cherchent à en savoir plus sur les personnes trans et sur la façon de soutenir leurs proches trans.

Trans Care BC a créé un guide d'introduction au langage inclusif du genre pour les fournisseurs de services et les praticiens de soins primaires.

Ce guide pratique, créé par Trans Care BC, vise à offrir des solutions pour corriger certaines erreurs, comme l'utilisation d'un nom ou d'un pronom incorrect.

L'Association professionnelle mondiale pour la santé des transgenres promeut les normes les plus élevées en matière de soins de santé par l'élaboration de normes de soins pour la santé des personnes transsexuelles, transgenres et non conformes au genre.

Ces fiches récapitulatives sur les chirurgies de transition sont destinées aux prestataires de soins primaires et fournissent des renseignements pour faciliter la discussion sur ces chirurgies entre les prestataires de soins primaires et les patients. Veuillez noter qu'elles ne sont pas exhaustives et ne remplacent pas le processus de consentement éclairé entre le chirurgien et le patient.

Souvent, les clients trans et de genre divers doivent voyager pour obtenir leurs chirurgies liées à la transition. Si la personne démontre un besoin financier et que la chirurgie est couverte par OHIP+, elle pourrait être admissible au transport aérien et à l'hébergement gratuit par le biais de Hope Air. Les fournisseurs de soins primaires peuvent soumettre une demande à Hope Air au nom de leur client.

Ce document, élaboré par le Centre de collaboration nationale de la santé autochtone, donne un aperçu de la santé des personnes bispirituelles, y compris une introduction sur les rôles et les identités bispirituelles, l'impact de la colonisation sur le sexe et la sexualité des Autochtones, les déterminants sociaux de la santé dans le contexte colonial, l'état de santé des personnes bispirituelles, la résilience et la résurgence, ainsi que les ressources éducatives supplémentaires.

Le Répertoire de prestataires de services de SAO est conçu pour vous aider à trouver des prestataires de services sociaux et de santé qui ont exprimé leur engagement à fournir des soins compétents et accueillants aux personnes LGBTQ2S+ en Ontario.

Ce guide a été élaboré par la Table de planification régionale de Champlain pour la santé des personnes trans, bispirituelles, intersexes et non binaires. Il présente les services médicaux, de santé mentale et communautaires ainsi que d’autres ressources qui pourraient être utiles aux parents et aux proches de jeunes trans et de jeunes non binaires de la région de Champlain.

Wisdom2Action et l'Association canadienne de santé publique ont créé un court guide pour soutenir les organisations dans le développement et la mise en œuvre de l'inclusion des trans dans les services sociaux et de santé. Le guide fournit un processus flexible que les organisations peuvent utiliser pour guider l'inclusion des personnes trans dans leur approche.

La création d'environnements cliniques et de prestations de soins invitants et inclusifs pour les trans est un moyen important de donner l'exemple de l'inclusivité et de démontrer votre engagement envers l'inclusion des trans. Wisdom2Action et l'Association canadienne de santé publique ont créé un guide sur la création d'un environnement de soins inclusif.

Pour un bref examen des termes à éviter ou à n'utiliser que dans des circonstances particulières, le guide de Wisdom2Action et de l'ACSP sur la terminologie préjudiciable peut être consulté ici.

Wisdom2Action et l'ACSP ont élaboré un court guide sur l'adoption d'un langage neutre pour vous aider à éviter les suppositions et pour favoriser la création d'espaces plus sûrs pour les communautés trans et diversifiées.

La mise en œuvre de formulaires d'admission inclusifs fait partie intégrante de la création d'un environnement inclusif pour les trans, tout en veillant à ce que les informations médicalement nécessaires soient recueillies de manière précise et appropriée.

La Table de planification régionale de Champlain pour la santé de personnes de diverses identités de genre a dressé une liste de ressources disponibles pour les prestataires de soins primaires afin de les aider à renforcer leurs connaissances, leur confiance et leurs compétences en matière de soins de santé liés à la transition, notamment en ce qui concerne le traitement hormonal substitutif.

Ce guide s'appuie sur le Guide de ressources pour la pluralité des genres de la région de Champlain créé par la Table de planification régionale de Champlain pour la santé des personnes trans, bispirituelles, intersexes et de genre divers. Il liste des services médicaux, de santé mentale et communautaires offerts aux personnes trans et non binaires à Ottawa et dans la région de Champlain.

Cette ressource a été développée pour aider les personnes trans et de genre différent à mieux défendre leurs intérêts et leurs besoins dans les services sociaux et de santé. La ressource comprend des informations visant à aider les personnes trans et de diverses identités de genre à se préparer à un rendez-vous lié à la prestation de services de soins de santé ou de services sociaux, à défendre leurs intérêts pendant un rendez-vous et à défendre leurs intérêts après un rendez-vous.

This guide, developed by interACT Advocates for Intersex Youth and Lambda Legal provides a set of model hospital policies aimed at promoting best practices to ensure appropriate, ethical, and quality care is being provided to intersex patients, and to address bias and insensitivity toward intersex patients and their families.

Developed by interACT Advocates for Intersex Youth, this tool provides people-centered, educational definitions about a wide variety of intersex variations and how they can manifest in people’s bodies.

Developed by interACT Advocates for Intersex Youth, this brochure provides insight into what intersex people wish their therapists knew.

This resource, created by Intersex Campaign for Equality, explores the critical impact of language in creating safe and welcoming environments for intersex community members.

Developed by the National LGBTQIA+ Health Education Center, this is a community-informed clinical guide on primary care for intersex people. The guide provides an overview of intersex terms and concepts, the health concerns of intersex people, intersex-affirming practices, and resources for further learning.

In this AAFP accredited webinar, organized by the National LGBTQIA+ Health Education Center, Dr. Katie Dalke defines intersex terminology, discusses diverse sexual development, and presents an affirming approach to providing medical and behavioural health care for people with intersex traits. (Credits can be claimed through CFPC).

Hosted by the Human Rights and Social Justice Program at Icahn Mount Sinai, in partnership with the Intersex Justice Project and interACT: Advocates for Intersex Youth, this recorded lecture covers intersex basics, human rights violations within medicine, medical and surgical research, diverse personal narratives of navigating the medical system as an intersex person, current Congenital Adrenal Hyperplasia (CAH) medical treatments, problems with “nerve-sparing” clitoroplasties, affirming, and gender inclusive and trauma-informed alternatives to the current standard of care.

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Assessing Claims About Project 2025’s Proposed Cuts to Veterans Benefits

A viral graphic reflects an actual proposal from the Heritage Foundation, but it’s distinct from Project 2025.

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Project 2025, a presidential transition project organized by the Heritage Foundation, has been at the forefront of national political discourse in recent weeks as celebrities, politicians, and everyday Americans highlight many of the controversial policy recommendations found in the plan. While some claims about the document’s contents are correct, other widespread assertions have proven false or misleading.

One claim that has spread widely this week concerns the plan’s supposed curtailing of veterans benefits. A graphic listing several supposed recommendations has popped up across Facebook , Instagram , Reddit , Threads , and X . “Project 2025 Veterans Cuts. Y’all better wake up” reads the caption on many versions of the image.

This will screw everyone who got out and never filed a claim. Veterans will be hurt by this Project 2025 garbage as well. Wake up folks. pic.twitter.com/MBF4OwdOf8 — Richard N. Ojeda, II (@Ojeda4America) July 5, 2024

The graphic is based on actual proposals from the Heritage Foundation, but they are not included in Project 2025. The policy proposals are from the Heritage Foundation’s Budget Blueprint for Fiscal Year 2023 , a separate project.

What the Budget Blueprint says .

The Heritage Foundation, a conservative think tank that has long influenced Republican administration policy, has released a federal budget blueprint each year since at least 2016. The blueprints offer recommendations for annual congressional budgets and typically cover a comprehensive range of policy issues. While Project 2025’s Mandate for Leadership, the 922-page document that has been the source of both controversy and false claims, was created by a broad coalition of conservative organizations and focuses primarily on the executive branch and administrative state, the Budget Blueprint is produced entirely by the Heritage Foundation and targets congressional policymaking.

The posts about Project 2025’s veterans policies include four of the 229 policy recommendations made in the Budget Blueprint for Fiscal Year 2023. Even though these policies do not appear in the Mandate for Leadership , the graphic lists them beneath a headline reading “PROJECT 2025 VETERANS CUTS.” 

The first recommendation would eliminate the simultaneous receipt of both retirement pay and disability compensation. Since 2003, some veterans have been eligible to receive both disability and retirement pay concurrently. This recommendation would return concurrent pay rules to their pre-2003 state.

The second recommendation would remove VA enrollment for veterans who have no compensable service-connected disabilities and annual incomes above a certain national threshold. Because the VA can only add as many new enrollees each year as its funding allows, veterans are sorted into eight different enrollment priority groups depending on factors including their service history, disability rating, income level, and qualification for Medicaid. The Budget Blueprint recommends ending new enrollments for veterans in the lowest two priority groups and disenrolling those who are already in the VA system.

A third policy change would exclude seven conditions from disability compensation that the U.S. General Accounting Office determined are not likely to be caused or made worse by military service, such as multiple sclerosis and Crohn’s disease.

Fourth, the blueprint recommends implementing a 10-year time limit on initial disability compensation applications. There is currently no limit on how long after retiring from military service a veteran can apply for disability benefits, which, according to Heritage, may lead to the VA covering disabilities that occurred after military service was completed.

While these budget-cutting proposals were made by the Heritage Foundation, they are not included in Project 2025’s Mandate for Leadership . Project 2025 is organized by the Heritage Foundation and leverages many of its policy experts, but the project is distinct from the think tank’s Budget Blueprint.

What does Project 2025 say about veterans?

The plan’s chapter on the Department of Veterans Affairs (VA) was written by Brooks Tucker, a former Marine lieutenant colonel who served in the VA during Trump’s presidency. First appointed as the acting chief of staff for the department in April 2020, Brooks also served as the assistant secretary for the VA’s Office of Congressional and Legislative Affairs and as a policy adviser in Trump’s presidential transition team.

In his chapter, Brooks lays out several policy proposals that he claims would advance a “veteran-centric” philosophy in the VA. These include rescinding departmental policy directives that are “contrary to conservative governance starting with abortion services and gender reassignment surgery,” preparing for demographic shifts in the veteran population, strengthening the VA’s Community Care program, and ensuring that standards established by the 2018 VA MISSION Act are achieved.

The chapter also advocates for reforms to the Veterans Benefits Administration (VBA). These include automating the claims adjudication process to provide benefits more quickly and using new tools and training to prevent fraud. As part of these reforms, Brooks argues that the next administration should explore ways to accelerate the review and removal of disability ratings that are unrelated to military service. This review process already exists within the VA, but its acceleration could eliminate benefits for conditions that the VA determines are not linked to military service sooner than would happen otherwise.

The plan also seeks to increase political control over the VA. Brooks argues that career civil servants in presidentially appointed positions should be transferred from those posts and replaced with appointees that align more closely with the incoming administration’s policy objectives.

If you have a claim you would like to see us fact check, please send us an email at [email protected] . If you would like to suggest a correction to this piece or any other Dispatch article, please email [email protected] .

Alex Demas is a fact checker at The Dispatch and is based in Washington, D.C. Prior to joining the company in 2023, he worked in England as a financial journalist and earned his MA in Political Economy at King's College London. When not heroically combating misinformation online, Alex can be found mixing cocktails, watching his beloved soccer team Aston Villa lose a match, or attempting to pet stray cats.

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Meet Canada’s Best Employers For Diversity 2024

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The Hershey Canada building in Mississauga, Ontario.

“Come with me and you’ll be in a world of pure imagination,” sang fictional chocolatier Willy Wonka, ushering a group of kids and their parents into his chocolate factory. “Anything you want to, do it. Want to change the world? There’s nothing to it.”

But it was real-life confectioner Milton Hershey who actually changed the world when he founded his chocolate company in Pennsylvania in 1894. With the dual purpose of making quality chocolate and improving the lives of others, Hershey created an iconic brand and became one of the most generous philanthropists of his day. In 1909, he founded a cost-free boarding school for underprivileged children, and later donated his entire fortune to it. During the Great Depression, Hershey not only built his chocolate factory, generating jobs for 600 workers, he created a model community that afforded those workers housing, public schools, parks, a bank, a theater, a sports arena, and a trolley system.

At the company’s Canadian headquarters in Ontario, his mission lives on. “I feel truly honored to keep that genuine legacy going in ways that support our people and our communities,” says Herjit Bhalla, vice president of Hershey Canada and AMEA (Asia-Pacific, Middle East and Africa). The company’s employees seem to agree, as their votes helped the Hershey Company rank No. 1 on Forbes list of Canada’s Best Employers For Diversity 2024 .

To determine the third annual ranking, Forbes partnered with market research firm Statista to survey approximately 40,000 Canadian workers at companies with at least 500 employees. (The government services sector was not included.) Participants anonymously rated their companies on diversity-related issues, including age, gender, ethnicity, disability and LGBTQ+ equality. Survey respondents were also asked to evaluate companies they knew through industry experience or through family and friends who worked there. Responses from the past three years were considered. Additionally, each company’s diversity-related best practices were researched and analyzed, and that data was combined with the survey results to produce each organization’s score. Ultimately, the 200 companies with the highest scores landed on our final list. (For more details on the methodology, see below.)

The Hershey Company, which also scored the No. 1 spot on Canada’s Best Employers this year, prides itself on having “a lively, engaging culture focused on goodness with an emphasis on our value of togetherness,” says Bhalla. But it’s more than just a vibe. In 2020, the company developed the Pathways Project , which includes a five-year plan for achieving a range of diversity, equity and inclusion (DEI) goals (known as “EDI” goals among Canadians), including increasing representation and advancement of women, people of color, those with disabilities, and LGBTQ+ individuals. By 2025, the company aims for a workforce comprised of 50% women and 30-40% people of color, and a leadership made up of 40-42% women and 15-22% people of color.

Hershey has also prioritized pay transparency (providing each salaried employee with metrics to illustrate how their base salary compares in the marketplace), employee resource groups, or ERGs (enabling employees to develop and influence company policy), a leadership accelerator program (which develops talent from within the company), and increased supplier diversity.

Such initiatives are part of a larger trend among Canadian employers, according to our analysis. Statista’s researchers found that the share of women in executive positions in Canada has increased from 35% last year to 38% this year. Notably, women occupy only 34% of executive positions in the United States. And while the share of female CEOs in Canada has remained consistent at 21% since we began producing this yearly analysis in 2022, it eclipses the share of female CEOs in the U.S., at 15.8%.

Other findings include: 10% of the Canadian companies evaluated this year had an executive dedicated to EDI issues, 42% of companies had ERGs, 30% of companies had a supplier diversity program, and 16% of companies had an official hiring initiative geared toward Indigenous people.

Ranking at No. 2 on Forbes ’ list this year was Microsoft (up from No. 6 in 2023). Kathleen Hogan, Microsoft’s chief people officer, says that the company is committed to creating “an exceptional place to work” by “not only meeting the foundational needs of our employees , but helping them to also feel valued and fulfilled at work.”

To this end, Microsoft fosters diversity and inclusion both within and outside the company through partnerships with such organizations as: Technolochicas, which exposes young Latinas and their families to opportunities and careers in technology; Girls Who Code, which aims to close the gender gap among computer scientists through coding education, internships, and clubs for girls and young women; and the National Center for Women and Information Technology’s (NCWIT) Aspirations in Computing, which works to improve diversity in the computing field by offering education, scholarships, internships and community support to girls, young women and people who are gender nonconforming. Additionally, Microsoft offers a neurodiversity hiring program, training programs for people entering the tech industry from nontraditional backgrounds with diverse experiences, and a system of accountability that includes evaluating each partner’s and executive’s progress on EDI measures.

Brock University employees, students and community members celebrated a Pow Wow hosted by the Hadiya’dagénhahs First Nations, Métis and Inuit Student Centre this year.

Rounding out the top five spots on Forbes’ ranking were three other large multinational corporations: Adidas (No. 3), Google (No. 4) and Apple (No. 5). In fact, almost all of the organizations in the top 10 were global companies except for BC Hydro (No. 8) and Brock University (No. 10).

Brock—celebrating its 60th anniversary this fall—is known as much for its stunning location at the center of Canada’s Niagara Peninsula as it is “for its caring campus environment, its commitment to inclusivity, accessibility, reconciliation and decolonization, and its strong ties to the Niagara community, all of which the university’s employees take great pride in,” says Amanda Villella, acting associate vice president of people and culture.

Among the myriad EDI-focused initiatives at Brock are: recruitment processes that encourage participation from a diverse pool of job candidates; an employment equity plan focused on representational hiring and promotion; employee trainings in topics such as compliance with the Accessibility for Ontarians with Disabilities Act (AODA); and numerous cultural programs, such as a recent performance of Inuit drum dancing and throat singing, a deer hide rattle-making workshop, and a sage plant medicine talk—all of which were offered last month during Indigenous Peoples Awareness Week at Brock . Brock also provides opportunities for staff to support its community, as with its Food First program , which helps students impacted by food insecurity with offerings such as grocery store gift cards and pay-what-you-can farmer’s markets .

Like many of the employers on this year’s ranking, the organizations that value EDI tend to provide employees with an abundance of purpose . As Villella says: “Working at Brock brings with it the potential to make a difference.”

For the full list of Canada’s Best Employers For Diversity 2024, click here .

Methodology

To determine Canada’s Best Employers For Diversity 2024, Forbes teamed up with market research firm Statista to survey approximately 40,000 Canadian workers at companies with at least 500 employees. (The government services sector was not included.) Participants anonymously rated their companies on diversity-related issues, including age, gender, ethnicity, disability and LGBTQ+ equality. Survey respondents were also asked to evaluate companies they knew through industry experience or through family and friends who worked there. Responses from the past three years were considered.

Additionally, each company’s diversity-related best practices were analyzed and incorporated into the rankings. These key performance indicators (KPIs) included: the presence of employee resource groups, hiring programs geared toward Indigenous people, the publication of diversity data, the creation of an accessible workplace for people with disabilities, the percentage of women in board and executive positions, and external practices such as supplier diversity. Each employer’s score was based on the organization’s KPI data and survey results. The survey responses from current employees were weighted more heavily than those from past employees and from people who knew the company second-hand. Responses from people belonging to underrepresented groups were weighted significantly higher than the responses from people outside those groups. Recent data received a heavier weight than older data. Ultimately, the 200 companies with the highest scores landed on our list.

As with all Forbes lists, companies pay no fee to participate or be selected. To read more about how we make these lists, click here . For questions about this list, please email listdesk [at] forbes.com.

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What Is Project 2025? Inside the Far-Right Plan Threatening Everything from the Word 'Gender' to Public Education

Trump's allies started Project 2025 as a blueprint for marrying church and state at the highest levels of government if he's elected

JIM WATSON/AFP via Getty

A sweeping proposal for how Donald Trump should handle a second term in office has sparked concern for its implications on the role of federal government and its calls to eliminate a number of basic human rights.

The 2025 Presidential Transition Project, more commonly known as Project 2025, released a 900-page manifesto last year titled "Mandate for Leadership: The Conservative Promise." The policy guidebook — compiled by the conservative think tank Heritage Foundation in partnership with more than 100 other conservative organizations — lays out a far-right, Christian nationalist vision for America that would corrode the separation of church and state, replace nonpartisan government employees with Trump loyalists and bolster the president's authority over independent agencies.

Heritage Foundation President Kevin Roberts, a rumored candidate for Trump's chief of staff in a second term, promoted his group's extreme positions during a July interview , saying, "We are in the process of the second American Revolution, which will remain bloodless if the left allows it to be."

MANDEL NGAN/AFP via Getty

Shortly after Roberts' controversial interview, Trump attempted to distance himself from Project 2025, saying on Truth Social that he knows "nothing" about it and has "no idea who is behind it," before adding that he disagrees with some of its propositions.

While Project 2025 is not formally a part of Trump's campaign platform, it has been led and supported by several influential people in his orbit. The project's top leaders all worked in Trump's White House and a number of the manifesto's contributors also served in the Trump administration, including but not limited to former Housing and Urban Development Secretary Ben Carson and imprisoned former trade adviser Peter Navarro .

Equally damaging to Trump's claim that he is unfamiliar with Project 2025 is that he worked closely with the Heritage Foundation when he was first elected president. He was provided a similar "Mandate for Leadership" back in 2016, and enacted nearly two-thirds of the group's proposals within his first year in office.

The Heritage Foundation also reportedly played a behind-the-scenes role on Trump's presidential transition team and had a significant hand in staffing the administration.

Olivia Troye, a former adviser to Mike Pence , called Trump's denial of Project 2025 "ludicrous" in a CNN interview . “I think what this is telling us is that Donald Trump knows that what is written in this plan is so extreme that it is damaging to his possibility of getting elected,” she said.

Below, a breakdown of the most noteworthy policy proposals in Project 2025's "Mandate for Leadership."

Christian nationalism

Project 2025 establishes a framework for guiding the federal government through a biblical lens. Across nearly 1,000 pages, the mandate pushes an unpopular interpretation of the Christian agenda that would target reproductive rights, LGBTQ+ people and people of color by effectively erasing mention of all related terms, protections and troublesome historical accounts.

Though the mandate accuses the "woke" left of infringing on people's religious freedoms, its policies are rooted in a singular, extremist view of how society should function based on its authors' own Christian nationalist values. It repeatedly calls for the punishment, even imprisonment, of people who do not conform to the think tank's platform.

The proposed policies in Project 2025's mandate stem from four stated goals. In its words: restoring the family as the centerpiece of American life, dismantling the administrative state, defending the nation's sovereignty and securing God-given individual rights.

Through a holistic approach to restructuring the government, it would seek to give Trump heightened authority to enact his backers' platform in every city and state — often encouraging the president to creatively subvert congressional approval.

Firing disloyal government personnel

One of the most concerning expansions of presidential authority would come if Trump found himself in a position to reinstate an executive order titled Schedule F , which is strongly endorsed by Project 2025. Trump introduced Schedule F at the end of his first term and it was quickly reversed by President Biden.

If Trump wins this time around, he could use Schedule F to transform the U.S. government into a MAGA machine by reclassifying thousands of nonpartisan federal employees into "at-will" workers who can be replaced via political appointment.

Project 2025 suggests that Schedule F be applied to discharge career civil service workers whom Trump deems "nonperforming," or those who get in the way of the administration's attempts at reform.

In practice, Schedule F could easily purge qualified subject experts from advisory positions at the first sign of disobedience and turn federal agencies into ultra-partisan arms of the Heritage Foundation's mission.

Rolling back reproductive rights

Project 2025 encourages Trump to "push as hard as possible to protect the unborn in every jurisdiction in America," by targeting abortion, contraceptives and transforming the Department of Health & Human Services into the "Department of Life."

"Conservatives should gratefully celebrate the greatest pro-family win in a generation: overturning Roe v. Wade , a decision that for five decades made a mockery of our Constitution and facilitated the deaths of tens of millions of unborn children," the document reads. "But the Dobbs decision is just the beginning."

The mandate suggests that Trump should lobby Congress to pass nationwide abortion restrictions and gives him guidance on how he can use his federal agencies to limit abortions in the meantime. It also calls for the FDA to reverse its approval of abortion pills and criminalize their distribution, and directs the CDC to back anti-abortion studies.

In an effort to stop "woke culture warriors," Project 2025 demands that the terms abortion, reproductive health and reproductive rights be deleted from "every federal rule, agency regulation, contract, grant, regulation, and piece of legislation that exists."

Eliminating LGBTQ+ protections

The Project 2025 mandate — which diminishes LGBTQ+ labels as a "bullying" product of "woke" politics — calls to allow discrimination on the basis of "sexual orientation, gender identity, transgender status, sex characteristics, etc.," by "refocusing" enforcement of sex discrimination laws so that they only apply to the "biological binary" of sex.

The document takes specific aim at the transgender community. Aside from using a variety of dehumanizing terms, the mandate signals an intent to attack trans women in sports , end gender-affirming care for minors, decrease accessibility for gender-confirmation surgeries and reinstate Trump's trans military ban . Trump has already incorporated those views into his 2024 platform.

The following related terms would be blacklisted in legislation and on every federal document: sexual orientation and gender identity (SOGI), gender, gender equality, gender equity, gender awareness, and gender-sensitive.

Helen H. Richardson/MediaNews Group/The Denver Post/Getty

Banning broadly defined pornography

Project 2025 says that pornography should be outlawed, and that anyone who produces or consumes it should be imprisoned. That restriction, though seemingly unrelated to LGBTQ+ rights, carries larger implications based on how Project 2025 defines pornography.

The authors write that the "omnipresent propagation of transgender ideology" is a modern-day example of pornography, claiming without merit that it has caused children to suffer by invading school libraries. It also says that the "sexualization of children" — a favored Christian nationalist phrase for anything related to gay or trans people — counts as pornography.

The group's broad definition of pornography suggests that the Trump administration could seek to imprison LGBTQ+ people, drag queens, authors, librarians, teachers and allies with little cause. Their proposed Justice Department reforms, described next, would make prosecution of that nature easier.

"[Pornography] has no claim to First Amendment protection," the manifesto reads. "Its purveyors are child predators and misogynistic exploiters of women. Their product is as addictive as any illicit drug and as psychologically destructive as any crime."

It continues: "Educators and public librarians who purvey it should be classed as registered sex offenders. And telecommunications and technology firms that facilitate its spread should be shuttered."

Politicizing the Justice Department and FBI

Project 2025 suggests that Trump take partisan control of the Department of Justice and Federal Bureau of Investigation to oversee a "top-to-bottom overhaul."

The DOJ is traditionally insulated from the White House, and while attorney general appointees are likely to share a number of the president's views, they are expected to act in the best interest of the U.S. government as a whole. A section of the Project 2025 mandate authored by a former Trump official calls for increased communication between the White House and DOJ, because "litigation decisions must be made consistent with the President's agenda."

Project 2025 says that the FBI is currently ineffective and should be refocused to increase federal law enforcement presence in select areas of the U.S. where the administration believes laws aren't being enforced strictly enough. It advises that the administration sue local government officials who don't prosecute crimes to the administration's liking.

The mandate adds that the Trump administration should immediately review all ongoing federal investigations and terminate the ones that the president doesn't approve of, including those related to the Jan. 6, 2021, insurrection. And it encourages Trump to work with Congress on ending the FBI director's 10-year term limit, so that the president can replace them at will if they refuse to serve the president's agenda.

Trump has already used veiled "retribution" language on the campaign trail that implied he would consider using the Justice Department to retaliate against his political rivals.

New immigration and border control practices

Project 2025 calls for a consolidation of the various border enforcement and immigration agencies, and for Trump to greatly increase their power if elected so that he can accomplish more than he did in his first term.

Under the mandate, the Mexico-U.S. border wall would receive extra funding to get completed, and Trump's administration would be urged to militarize the border.

Temporary protected status would also be stripped from nearly 700,000 individuals , many of whom settled in the U.S. decades ago, putting them at risk of deportation. And Trump would be advised to dismantle the DREAM Act, limit the DACA program , reduce visas of various kinds and try again to get a citizenship question on the national census.

American citizens would not be allowed to get federal housing subsidies if they live with any non-citizen.

AP Photo/Charlie Riedel

Education reform and student loans

Project 2025, which partnered with the far-right "parental rights" group Moms for Liberty , calls for the Department of Education to be eliminated, if Congress allows it, and it also calls for the elimination of every teachers union, which was likely influenced by the group's anti-union partner, the Institute for Education Reform.

It guides the president on actions they can take to dismantle the public education system and privatize education with or without congressional approval.

Currently, federal education funding is provided to states with regulations on how it can be used, to ensure that the funds benefit a variety of vulnerable groups, including students in low-income school districts and children with special needs. It also prevents discriminatory institutions from receiving federal funding.

Project 2025 calls for removing federal oversight from that funding, allowing states to dole the money out as they see fit, including by prioritizing private and religious schools over public schools.

The mandate also suggests shuttering the Office of Federal Student Aid and ending student loan forgiveness , including income-driven repayment plans. The Public Service Loan Forgiveness program — which was signed into law by George W. Bush in 2007 to make college more accessible — would also be targeted, affecting teachers, health care workers, law enforcement officers and other government and nonprofit professionals who have counted on having their remaining loans forgiven after 10 years.

Updating school curriculum and axing DEI

Along with encouraging private education, Project 2025 calls for school curriculum to be purged of anything related to "critical race theory" and "gender ideology" in public schools.

From the mandate: "These theories poison our children, who are being taught on the one hand to affirm that the color of their skin fundamentally determines their identity and even their moral status while on the other they are taught to deny the very creatureliness that inheres in being human and consists in accepting the givenness of our nature as men or women."

"States, cities and counties, school boards, union bosses, principals, and teachers who disagree should be immediately cut off from federal funds," the Project 2025 manifesto reads.

It's a similar strategy to what Gov. Ron DeSantis has done in Florida, where references to racial disparities and LGBTQ+ identities have been prohibited, educators must now teach that enslaved people benefitted from slavery , and many Black history lessons have been banned.

Project 2025 also brands diversity, equity and inclusion (DEI) efforts — which seek to mitigate discrimination and promote fair treatment of all Americans — as discriminatory and "racist."

The mandate says that in addition to squashing DEI programs around the nation, the Justice Department's Civil Rights Division should spent its first year of the Trump administration "using the full force of federal prosecutorial resources to investigate and prosecute all state and local governments, institutions of higher education, corporations, and any other private employers" who engage in DEI efforts.

Federal rules and legislation would also be scrubbed of the term diversity, equity and inclusion.

Rejecting climate change

Heritage Foundation President Kevin Roberts writes in the manifesto's foreword that environmental protections are "anti-human" and part of a "pseudo-religion" that puts the "god of nature" above human activity.

Project 2025 translated that argument into policy by suggesting that the Environmental Protection Agency be shrunk and that three offices in the Department of Energy be closed to stop investing in clean and renewable energy. Instead, the mandate suggests, the U.S. should "stop the war on oil and natural gas" by resuming oil drilling in the Arctic, expanding existing drilling projects and expanding coal mining to the western U.S.

The Trump administration would be encouraged to cut off funding of any "woke" climate change prevention efforts, pulling back from the 2015 Paris Climate Agreement.

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May 19, 2015

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How can Trans Persons Change the Sex Designation on their Birth Certificate?

This guide is focused on issues relating to how trans persons can change the sex designation on their birth certificates. For information on how trans persons can legally change the name used on their identification documents,  see this guide .

This page is intended to help trans persons with issues related to changing the sex designation on their birth certificates. As such, some of this information may not be helpful to those seeking to change their birth certificates for another reason.

Note: Every effort has been made to ensure comprehensiveness and accuracy (as of May 2015). However, this FAQ may not fully reflect the current state of the law.

We use the term “trans” to include anyone who does not identify with the sex designation they were assigned at birth.

Questions addressed in this FAQ:

Why might I want to change the sex designation on my birth certificate?

Should i have to have surgery in order to change the sex designation on my birth certificate, are sex designations on birth certificates even necessary, how can i change the sex designation on my birth certificate, where do i apply to change the sex designation on my birth certificate, what proof do i need to show in order to change the sex designation on my birth certificate do i need to show proof of surgery, can i apply if i am younger than 18 or 19, can i apply even if i was born outside of my current province/territory.

You can download a PDF of this document here:  CCLA Change of Sex Designation FAQ .

Many trans persons consider the sex they were assigned at birth to be inaccurate. If this is you, changing the sex designation on your birth certificate may be important for your well-being. It is also important for legal reasons as well.

In order to enjoy a greater degree of safety and freedom from discrimination, you may want to have identification documents that match the gender with which you identify and present yourself. The information on most identification documents is drawn from birth certificates, so changing your birth certificate is often a necessary first step. “Sex” is a category on most driver’s licenses, passports and health cards, and so you may find yourself being forced to discuss your gender identity – sometimes even your genitals – with a stranger. This is even worse when that stranger is empowered to make decisions that greatly affect you, such as whether to write you a traffic ticket, offer you a job, refer you for medical treatment, or let you enter the country.

Trans persons face widespread discrimination and high rates of violence. Of trans Ontarians  surveyed  by the Trans PULSE Project, 26% reported being hit or beaten up because they were trans, 73% reported being made fun of, and 39% reported being turned down for a job. In 2010, Trans PULSE  estimated  that 50% of trans Ontarians had seriously considered suicide at some point in their lives because of the discrimination they faced. Involuntary outing on a regular basis, such as by having an inaccurate gender specified on your identification documents, eliminates one of the few mechanisms you may have to protect yourself from transphobia.

In 2014, a judge in Alberta considered the constitutionality of the provincial law that regulated gender markers on birth certificates. The judge  struck down  that law, because it was contrary to the  Canadian Charter of Rights and Freedoms . In doing so, the judge cited a  prior decision  of the Ontario Human Rights Tribunal. That decision detailed some of the discrimination faced by trans persons (referred to here as “transgendered” [sic]):

“[T]ransgendered persons as a group tend to face very high rates of verbal harassment and physical assault and are sometimes even murdered because of their transgendered status. […] [I]t is very difficult for a transgendered person to find employment, […] there are very high rates of unemployment among transgendered people generally, and […] many transgendered people are fired once they are exposed in the workplace as being transgendered.”

These concerns also extend to young trans persons, who may be forced to endure bullying by their peers if the sex designation on school records does not match their gender identity.

Many trans persons want the benefits of official documents that correspond to their identity but may not want to undergo surgery. They may be content with the use of hormones or simply by presenting themselves consistently with their gender identity.

Gender reassignment surgery can be expensive, difficult to access, and carries the risks associated with any surgery. In addition, it has been reported to  typically cause sterility . Gabrielle Bouchard of the Montreal-based Centre for Gender Advocacy has said the surgical requirement in order for official documents to be changed  amounts to mandatory sterilization.  The surgery requirement also emphasizes biological sex characteristics rather than gender identity. Even after surgery has been performed, a second doctor must sometimes “confirm” the surgery. C.F., the plaintiff in the  Alberta  court case mentioned earlier,  told the  Edmonton Journal :

“What this legislation requires is that you not only submit to dangerous, risky surgery, but then actually attend for a humiliating genital inspection before two separate physicians, both of whom will make a value judgment about whether your genitals are sufficiently female[.] It’s like something from ages gone by. It’s very disturbing stuff.”

Due to these types of concerns, there have been and continue to be legal challenges to the various provincial legislation that require reassignment surgery in order to change sex designation. In the  Ontario  and  Alberta   decisions discussed earlier, the requirement for gender reassignment surgery was found to be discriminatory. As a result of these rulings, several provinces, including Alberta, British Columbia, Manitoba, Ontario, and Quebec, have taken steps to amend their laws to remove reassignment surgery from the requirements necessary in order for you to change your sex designation. Nova Scotia has also indicated that it plans to amend its legislation to remove the surgery requirement.

Some activists have argued for the removal of sex designations from identification documents altogether, on the basis that gender identity is not a binary classification. The binary does not accommodate people who do not identify with a binary gender classification.

Ongoing cases challenging legislation in  British Columbia ,  Saskatchewan  and  Quebec  are seeking the removal of sex designations from birth certificates. So far, although several provinces have removed the surgery requirement, no province has taken the step of removing sex designations altogether or providing for a third non-binary option.

In contrast, several countries, including  Australia and Germany , now allow persons to designate their sex on their passport with an “X”. However, some trans rights advocates argue that the “X” continues to out trans persons, and is used as an excuse for not eliminating the surgery requirement. An  Australian  court has ordered the government to register a third category of sex designations on birth certificates and name change certificates.

For more on the possibility of non-binary gender designations, see the BC Law Institute’s  report , where the Institute highlights the implications and consequences of different solutions to providing a non-binary sex designation in Canada.

All provinces and territories except Nunavut have procedures for changing sex designations when a person has undergone gender reassignment surgery.

The rules for changing the sex designation on a birth certificate vary from province to province. They are also changing rapidly. In all provinces except Quebec, where the  Civil Code  governs these issues, the law concerning birth registration is found in the provincial  Vital Statistics Act  and associated regulations. These laws and regulations can be consulted for free on  http://canlii.org . Note that a province may have policies that are not in the legislation. For more information about requirements, check with the government agency responsible for birth certificates in your province or territory (listed below), or with a trans advocacy organization, such as  Egale Canada .

Many provinces require letters from a mental health professional in order to change a person’s gender marker or name. Such a letter may also be required to access sex reassignment surgery.

Online government information is limited outside British Columbia, Manitoba and Ontario. Where specific information regarding change of sex designation is unavailable on a province’s website, the links below provide contact information for the appropriate agency.

Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec	(in English, see bottom of the webpage)
Saskatchewan
Northwest Territories
Nunavut	(only general information is available; Nunavut does not have a law that allows for changing the sex designation on your birth certificate)
Yukon

Until recently, all provinces and territories required you to have gender reassignment surgery if you wanted to change the sex designation on your birth certificate. Ontario became the first province to drop this requirement in 2012 when, as mentioned previously, its human rights tribunal  ruled  the requirement was discriminatory. The Alberta Court of Queen’s Bench handed down a similar  ruling  in April 2014. Ontario has not officially amended their legislation, but are now registering changes without proof of surgery as a matter of policy. British Columbia, Alberta and Manitoba are the only provinces that have formally amended their legislation to eliminate the surgery requirement. In Alberta, the new requirements are set out in  regulations .

New Brunswick, Newfoundland and Labrador, PEI and Saskatchewan   all require applicants to document that they have undergone gender reassignment surgery, usually by having at least two physicians – the surgeon who performed the surgery and another who did not – certify that fact. Quebec and Nova Scotia also currently require proof of surgery, but changes to the law are on their way (see below). In Quebec, the second physician must practice medicine in Quebec. In New Brunswick and the Northwest Territories, the second physician must be licensed in any Canadian jurisdiction.

The law in this area is changing rapidly as legislation is amended and court challenges are brought regarding surgery requirements. Consulting the relevant statutes will not always give a full picture of the current requirements or upcoming amendments. For current information, contact a trans advocacy organization, such as  Egale Canada .

Alberta

No proof of surgery required;

You must provide:

A declaration, which provides your date of birth, and states that you identify with and maintain the gender identity that corresponds with your desired sex designation; and

Confirmation from a licensed doctor or psychologist licensed in Alberta or another jurisdiction that the sex designation on your birth certificate does not correspond with your gender identityBritish ColumbiaNo proof of surgery required;

A declaration, which states you have assumed, identify with and intend to maintain the gender identity that corresponds with your desired sex designation; and

Confirmation from a doctor or psychologist licensed in BC or the province or territory where you live that the sex designation on your birth certificate does not correspond with your gender identityManitobaNo proof of surgery required;

A declaration, which states you identify with the requested sex designation, you are currently living full-time in a manner consistent with the requested sex designation and you intend to continue doing so; and

A supporting letter from a health care professional licensed in Canada or where you live that your gender identity corresponds with the requested sex designationNew BrunswickProof of surgery requiredNewfoundland and LabradorProof of surgery requiredNova ScotiaProof of surgery still required, but a bill to eliminate the requirement has received royal assent. Under the new law, which is not yet in force, you will written statements from themselves and a member of a profession to be prescribed in the regulations that confirm your gender identity.OntarioNo proof of surgery required;

A declaration, which states your gender identity); and

A note from a doctor or psychologist licensed to practice in Canada that confirms your gender identityPrince Edward IslandProof of surgery requiredQuebecProof of surgery required, but change is pending;

The requirements under the new law have not been set yet.SaskatchewanProof of surgery requiredNorthwest TerritoriesProof of surgery requiredYukonProof of surgery requiredNunavutThere is no provision in the  Vital Statistics Act  for changing sex designation, even with surgery

Sex reassignment surgery is generally not performed on those under the provincial age of majority, as all clinics in Canada that currently perform reassignment surgery conform to the recognized  Standards of Care . These Standards, which are regarding health care for trans persons, forbid irreversible interventions (such as surgery) on patients before they reach the age of majority. As a result, if you are a minor in Canada, you generally cannot change your sex designation in provinces or territories where proof of surgery is required.

In provinces that do not require surgery, the age requirements vary:

Note that legal challenges to the minimum age requirements are currently proceeding in several provinces, including  Quebec  and  Saskatchewan . Click  here  to listen to an interesting radio interview with a 10 year old who would like to change the sex designation on her birth certificate.

Alberta	No age minimum, but if you are under the age of majority (18), you must have parental/guardian permission
British Columbia	No age minimum, but if you are under the age of majority (19), you must have parental/guardian permission
Manitoba	No age minimum, but health care professional must attest to your capacity to make health care decisions
New Brunswick	No age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permission
Newfoundland and Labrador	No age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permission
Nova Scotia	: No age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permission.

Under new law (not yet in force) : No age minimum, but if you are under 16, you must have parental/guardian permission or apply to the Supreme Court of Nova Scotia for an order dispensing with the requirement of parental consent.OntarioNo age minimum, but if you are under 16, you must have parental/guardian permissionPrince Edward IslandNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (18), you must have parental/guardian permissionQuebecAge minimum is 18.SaskatchewanNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (18), you must have parental/guardian permissionNorthwest TerritoriesNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permissionNunavutThere is no provision in the  Vital Statistics Act  for changing sex designationYukonNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permission

British Columbia, Ontario and Northwest Territories will change sex designations only for births registered in their respective provinces. Some provinces will register a change of sex and then transmit it to the jurisdiction where the birth was registered.

Alberta	No explicit requirement that the applicant was born in Alberta
British Columbia	Legislation requires that the applicant was born in British Columbia
Manitoba	Legislation requires that the applicant was born in Manitoba. Changes permitting applications from Canadian citizens who have resided in Manitoba for at least one year (the latter will receive a “change of sex designation” certificate, not a new birth certificate) are not yet in force.
New Brunswick	No explicit requirement that the applicant was born in New Brunswick
Newfoundland and Labrador	No explicit requirement that the applicant was born in Newfoundland and Labrador
Nova Scotia	: Applicants born outside of Nova Scotia may apply, and the province will transmit their request to the jurisdiction where their birth was registered.

Under new law (not yet in force) : Legislation requires that the applicant was born in Nova Scotia.OntarioLegislation requires that the applicant was born in OntarioPrince Edward IslandApplicants born outside of Prince Edward Island may apply, and the province will transmit their request to the jurisdiction where their birth was registered.SaskatchewanNo explicit requirement that the applicant was born in SaskatchewanQuebec Under the new law (not yet in force) : Legislation requires that the applicant was born in Canada and resides in Quebec, or that the applicant was born in Quebec and resides in a place where change of sex designation is unavailable or impossibleNorthwest TerritoriesLegislation requires that the applicant was born in Northwest TerritoriesNunavutThere is no provision in the  Vital Statistics Act  for changing sex designationYukonApplicants born outside of Yukon may apply, and the province will transmit their request to the jurisdiction where their birth was registered

For more information:

The Trans PULSE Project prepared a report for the Canadian Human Rights Commission on sex designation in federal and provincial IDs in 2012. The report was prepared for hearings on Bill C-279, a proposal to add gender identity and expression to the  Canadian Human Rights Act  and to hate crime provisions of the  Criminal Code . The report can be found  here .

In 2014, the British Columbia Law Institute prepared a report for the Uniform Law Conference of Canada on the state of the Canadian law regarding change of sex designation, and regarding options for reform in 2014. The report can be found  here .

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