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WATCH ABOVE: CAMH is the only organization in Ontario that can approve OHIP-covered gender re-assignment surgery. Peter Kim reports.

TORONTO — Living honestly comes at a cost for many transgender individuals in the province. Ontario’s Centre for Addiction and Mental Health (CAMH) is the only organization in the province that can approve OHIP covered gender re-assignment surgery.

All of the stringent criteria must be met, including (but not limited to) the following:

The individual must be over 18.

The individual must have received a diagnosis of gender dysphoria.

Mental health or substance abuse issues must be well-controlled.

The individual must have finished a year of medically supervised hormone therapy.

The individual must have completed a continuous Gender Role Experience (or GRE), which is like a documented record of how they’ve lived as their new gender.

A doctor or nurse practitioner must refer the patient to CAMH before the approval process can begin.

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Dr. Philip Solomon is a head, neck and facial plastic surgeon who sees about 40 to 50 patients a year nearing the end of their transformation process.

“They’re happier, their self-esteem is high, they’re more comfortable in their own skin,” said Solomon. Tweet This

As part of the physical transformation, nose jobs are quite common he says.

“A narrower bridge, a lower bridge, a more refined tip and often a narrower base are all noses we see in females, or [at least] our brains are programmed to see that as a more feminine nose.”

Cheek implants and brow reshaping are also very effective ways to “feminize” the face according to Solomon.

“A man’s brow is fuller, often you’ll see a boney ridge just above the eyebrows whereas in a female that’s almost never seen.”

A full range of procedures can range from $15,000 to $20,000 according to Solomon. This will often include reshaping the Adam’s Apple.

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“The outer part of the voice box or Adam’s Apple can be removed completely and flattened. It’s cartilage,” said Solomon. Tweet This

But surgery, both gender re-assignment or plastic, isn’t necessary for the province to legally recognize the change in genders.

“In Ontario, for example, it’s not required to have undergone surgery to have main government documents such as a driver’s licence or passport changed to the non-birth gender,” said Andrew Monkhouse, a lawyer who focuses on human rights and employment issues.

Changing your name and gender with the government of Ontario can be done through an online form and a payment of $137. This change will also alter information under the purview of the federal government, such as your social insurance number.

“The provinces are responsible for keeping track of people. So you would be able to change [the information provincially], and all that would change at the federal level as well. They’re integrated that way,” said Monkhouse.