I finally have my date for surgery (February 21st). I live in Montreal, and the process to get surgery used to be very complicated. I had to go through 5 years of therapy and satisfy all the protocols and requirements. The government pays for surgery, but the newer more open approval process is quite long and includes review by several medical bodies.
Even after finally getting the letters from the Montreal General hospital's adult psychiatry unit signed by a psychologist and a psychiatrist, another hospital (the Chum) had to review my file before approving surgery, which was nerve racking. Dr. Brassard is the only doctor allowed to perform surgeries on trans people within the system here. He may not be top choice worldwide, but I found him to be super nice, and his hospital is a short cab ride from where I live.
So: five years of therapy, three months to meet Dr. Brassard, three months to get the ok from the Chum and now five months until surgery.