By: Katie Fraser, Communications Advisor, Strategic Communications, Women’s College Hospital​

Every day the team at Women’s College Hospital (WCH) sees patients heal, grow and ultimately thrive because of gender-affirming health care. WCH’s Transition Related Surgery (TRS) program was the first hospital-based TRS program in Canada. It began in 2019 and continues to highlight the importance of offering life-saving care to transgender and gender-diverse individuals.  

Masculinizing chest surgery, now available at WCH, is a frequently sought gender-affirming procedure that improves quality of life among its recipients, though access to this surgery is often restricted based on body mass index (BMI).   

Top surgeries in the United States, which include both masculinizing and feminizing chest surgeries, increased steadily from 2013 to 2022; so too has the average BMI of those seeking this care. While no such data is available in Canada, study results from 2019 found that 41 per cent of participants were on a waitlist for gender-affirming care and 82 per cent of whom were waiting for a gender-affirming surgery. 

High BMI is prevalent among transgender and gender diverse individuals, possibly due to the use of gender-affirming hormone therapy and documented economic and social disparities within this population. BMI is often used to determine if an individual is a surgical candidate, given that there have been documented associations with infection and wound healing complications when administering anesthesia to patients with higher BMI.  

Recognizing this reality, centers of excellence in gender-affirming surgery, like WCH, have developed perioperative practices to increase safety among higher-risk patients (like those with high BMI).  

Recently, clinical researchers at WCH published their findings in the Journal of Plastic, Reconstructive & Aesthetic Surgery comparing postoperative complications among patients receiving masculinizing chest surgery based on BMI and American Society of Anesthesiologists Physical Status Classification System. In the study, WCH’s clinical researchers retrospectively reviewed 530 patients receiving the surgery from between August 2021–October 2024, from one surgeon at WCH. 

WCH’s gender-affirming surgery program applies a comprehensive multidisciplinary team approach that includes urologists, plastic surgeons, gynecologists, psychiatrists, a nurse practitioner, an advanced practice nurse, and physiotherapists.  

The program includes defined and consistent pathways to provide preoperative and postoperative support to patients. At the preadmission clinic, patients receive nursing counselling, anesthesiologist assessment, and pharmacy evaluation to prepare for surgery. There are also options to further support those with social complexities, as well as to provide increased perioperative evaluation and monitoring for those with comorbidities, which sets WCH apart from typical ambulatory institutions.  

Postoperatively patients are categorized into four streams depending on the length of which they require recovery from postoperative anesthesia – most only need regular postoperative care be cause of the extensive preoperative care and evaluation they received. 

“Over the past seven years, we began with lower-risk patients and progressively expanded access to individuals with higher medical complexity. That intentional growth allowed us to develop specialized teams, refined perioperative pathways, and deep collective experience. Today, we function like a high-performance team — well practiced, highly coordinated, and focused on delivering safe, equitable access to gender-affirming surgery for all bodies,” shares Dr. Kathleen Armstrong, surgeon and clinical researcher. 

“Patients with higher BMI, like some transgender and gender-diverse individuals, have long been strong advocates for themselves. The challenge they face is that policy and regulation often lag behind the best available evidence,” Armstrong went on to explain. 

Ultimately the researchers found that there were no differences in the rates of postoperative complications after masculinizing chest surgery based on BMI or American Society of Anesthesiologists classification system. This demonstrates that with appropriate and comprehensive perioperative protocols, like those developed by WCH, higher-risk patients can access this vital gender affirming procedure safely in other ambulatory facilities.