At Catalyst Surgical there are three kinds of referrals we accept for top surgery:

• I already have OHIP pre-approval:
  • Please ask your gender-affirming practitioner to fax us a referral. Please note that chest contouring is currently required and that there is an additional cost of about $ 5,300 + HST.

• I don’t have OHIP pre-approval and don’t want it or am not eligible for it. I am going to pay out of pocket:
  • To meet the WPATH standards for surgery, your referring practitioner should fax a referral letter verifying the diagnosis of gender dysphoria.

• I don’t have OHIP pre-approval but I want to get it:
  • To meet the WPATH standards for surgery, your referring practitioner should fax a referral letter verifying the diagnosis of gender dysphoria.

If you meet the OHIP eligibility requirements for funding, you will need a referring practitioner to complete the pre-approval form from the Ministry of Health of Ontario:

If your healthcare provider cannot, will not, or is uncomfortable with being your referring practitioner for top surgery, you should find a practitioner who can do it for you. This can be challenging to find.

The Rainbow Health Ontario is a good place to start:

Unfortunately, we don’t keep a database of practitioners accepting clients for pre-approvals because waiting lists open and close frequently.

Wait times from consultation to surgery vary dramatically, depending on your schedule. Part of your consultation with Catalyst Surgical involves discussing this timing.

If you are a student in a high-stakes program (e.g. the final year of an intensive fine arts program), it’s probably not a great idea to put your surgery in the academic year. Booking “the first available” date can be anywhere from weeks to a couple of months away.

There are also times of the year more in demand than others. For example, April and May can be highly requested as the academic year ends for colleges and universities. During those times, our surgery date wait times can be longer.

We want you to have surgery as soon as possible. We also want you to schedule surgery around your life, and not your life around surgery.

Surgery is a stressful experience and we know it’s urgent. However, we don’t want you to experience unnecessary turmoil, especially when stressors can be predictable or scheduled. We will work with you to find the date that works best for you.

Additionally, there are health issues that can cause your surgery day to be postponed. For example, we might need to follow up on abnormal blood work or verify with a specialist that it’s safe to do your surgery at the Catalyst facility, as opposed to a hospital. Unforeseen health issues need to be treated or managed so that they pose as little risk as possible to your results and safety.

Yes. Since Catalyst Surgical is not a full hospital, we must follow safety guidelines:

• If your BMI is over 35: Additional testing may be required to ensure safe surgery in our facility.
• If your BMI is over 40: Surgery may not be possible at Catalyst, and we will assist in referring you to a surgeon who can operate in a hospital setting.

This does not mean you cannot have surgery or that you must lose weight. We are committed to helping you explore all available options, though most alternatives are outside Canada.

There are a few key things you can do to prepare:

If you use nicotine: Try to cut back or quit as soon as your provider submits your OHIP application. Don’t wait—quitting early helps with healing. Ask your provider about support and resources to help you quit.

Chest exercises: You don’t need to build chest muscles before surgery unless you were planning to anyway. It’s not required.

Start planning your recovery:

• Who can stay with you for the first 24–72 hours after surgery?
• Where will you stay if you can’t recover at home?
• Who will drive you to and from surgery and follow-up appointments?

Check your health card: Make sure it’s not expired. It won’t affect your surgery date, but it helps us avoid paperwork delays.

Arrange time off work or school: You’ll need between 2 weeks to 2 months off, depending on your job or daily activities. Talk to your employer, teacher, or professor early, and ask about any paperwork or forms you’ll need.

Protect your health before surgery: As your date gets closer, consider limiting social contact or wearing a mask to avoid getting sick. If you have any symptoms of illness on surgery day, your procedure will be rescheduled.

We understand that seeing results from other patients can feel reassuring when you’re considering surgery. Here’s why we approach before-and-after photos differently than many other clinics:

Public photos only show the best outcomes.

Most clinics share their most “ideal” results online—but that can create unrealistic expectations. Surgery isn’t one-size-fits-all. You’re not a product being custom-made, and outcomes vary based on many personal factors.

At Catalyst Surgical, we perform around 20 top surgeries each month and have trained with some of the top gender-affirming surgeons in the world. Your result will be uniquely yours.

Your journey isn’t marketing content.

We’ll never pressure you to share your story or photos. We take routine surgical photos for your medical record, and if we ever request permission to use your images in educational or marketing materials, we will always ask first.

If you want to share your results and help others, we welcome that! Tag us at @catalystsurgical or use the hashtag #catalystsurgical. Just keep in mind we don’t control what appears under that hashtag.

Photos don’t tell the whole story.

Even if someone’s body looks like yours in a “before” photo, things like skin elasticity, anatomy, and healing response all impact results—and they’re not visible in photos. What might look like a “bad” outcome to one person could be a great result for that person’s unique body.

Everyone has different preferences.

You might see an after photo and think “That’s not for me”—but the person in that photo may love their result. Use those feelings to help define your own aesthetic goals and communicate what you want, not what others have.

We want you to have full control over your photos.

Photos we take for your medical record stay in your record only. If you give us consent to share photos publicly, we’re required to co-own those images. When you post your photos, you retain control over how and where they’re used (aside from platform rules).

We get it—some folks feel uneasy moving forward without seeing examples. And that’s reasonable. If this approach doesn’t feel like the right fit for you, we respect that. You deserve a surgeon and a process you feel fully comfortable with.

It’s a great question—and a common one. Some medications used around the time of surgery, like tramadol (a pain medication) and ondansetron (used for nausea), have been linked to serotonin syndrome in rare cases when combined with SSRIs like Sertraline.

However, serotonin syndrome is extremely rare, especially at the low doses we use.

Here’s what we do to keep you safe:

• We do not prescribe high doses of tramadol—the kind linked to serotonin syndrome.
• We only give you a limited amount, and many people don’t even end up needing it.
• Typically you’ll take ondansetron once before surgery, and sometimes once after. We do not send you home with a prescription for it.

We always review your medications during your pre-op planning and adjust accordingly. If you have any concerns, we’re happy to talk about them in your consultation.

Recovery time depends on what your daily activities look like.

• If your job or schoolwork is mostly desk-based or remote, you might feel ready to ease back into things around 2 weeks after surgery.
• If your work involves physical labour, lifting, or movement, expect to wait up to 2 months before returning to your full duties.

Even if you’re not in much pain, surgery takes a toll on your energy, focus, and ability to handle stress. Most people take about 2–4 weeks off to give themselves proper time to rest and recover.

We usually recommend planning for more time off than you think you’ll need. If you’re feeling better sooner, you can always return to work or school early or adjust with your employer or instructor.

We’ll go over the timing during your consultation so you can choose a surgery date that works best for your life and schedule—because we know that for many, the ideal time for surgery would’ve been yesterday.

At first, most people find that sleeping on their back is the most comfortable, and sometimes the only pain-free option.

You can switch to sleeping on your side or front as soon as it doesn’t hurt to do so:

• Side sleeping is generally fine if it’s comfortable and does not cause any pain.
• Front sleeping is okay if it feels comfortable and you’re not raising your arms in front of you. Be careful as most front sleepers naturally do it.

If sleeping on your back affects your sleep quality, try propping a pillow under one side of your body so you’re slightly tilted. Just know that this may cause more swelling on the lower side, but for many people, the better sleep is worth it.

Listen to your body—comfort is your best guide.

The main limiting factor to having sex after surgery is pain. If it doesn’t hurt your surgical site during sexual activity, you’re probably fine to do it.

Most forms of masturbation are usually feasible after the first week. Partnered sex can be quite varied and if you participate in any kinks or fetishes, you might need discussions to avoid affecting your surgical result.