While it is not the goal of all trans people, many to undergo gender affirmation surgery to realise their true identity and improve their quality of life and wellbeing.
For trans men and women this can mean various surgical procedures, including “top” and “bottom” surgery. The diversity in gender affirmation surgery can mean that people may also opt for facial specialist plastic surgery so they appear more feminine or masculine.
Trans people are so much more than their physical looks. If they can access an experienced specialist plastic surgeon, it has significant social and psychological benefits.
However, they may face issues accessing surgery.
Barriers to Gender Affirming Surgery
While some trans people find a highly skilled surgeon to do their surgery, others face significant barriers. The impact of cultural perspectives on gender identity and being unable to access surgery can mean ongoing psychological issues as well as gender dysphoria.
Gender affirmation surgery is a long process. Unlike what the term implies, this surgery is actually a series of procedures that occur in phases over several years. For every one trans person wanting surgery, each procedure is unique. This includes the complexity of each procedure as well as the experience a specialist plastic surgeon has in this area, and the care required before and after each surgery.
Also, it is worth noting that transgender Australians under the age of 18 usually cannot choose to have surgery unless they meet certain criteria. In some cases they need a court’s permission before undergoing gender affirmation surgery.
Financial Obstacles
The cost of surgery is another huge barrier to accessing gender affirming surgery. While it is possible to access some procedures through the public health system, most people need to go through the private health sector. This makes costs prohibitive for many as the fees specialist plastic surgeons charge vary.
Where people seek multiple surgeries, such as bottom and top surgeries, to completely transform to their chosen gender, it can cost anywhere from between $20,000 to upwards of $100,000. This does not always include the prerequisite costs before surgery, such as a referral or referrals from mental health professionals. These costs add up and financially restrict may trans people from medically transitioning. High unemployment rates among transgender people also magnify the cost of gender affirming surgery.
What it comes down to is that many transgender people simply cannot afford the surgery even if they have private health insurance.
Government Policies
Inconsistent government policies for Medicare rebates and publicly funded surgery further complicate the situation.
Also, uncommon and complex surgeries are more suitable for the private sector than the public health system. While there are Medicare item numbers for some gender affirming surgical procedures, Medicare does not cover others.
There are many inconsistencies in the public health system. For example, non transgender males can access as breast reduction surgery through the public health system while trans men do not have the same access. This is because the system considers a breast reduction for trans men to be “discretionary” rather than being necessary.
It also appears that some state and territory governments have policies for elective surgery that specifically exclude trans people from accessing surgical interventions through the public healthcare system.
Transgender Healthcare
Transgender healthcare can be a negative experience for some. Visiting some healthcare providers can produce high levels of anxiety in trans people. This is often because these providers lack knowledge and understanding. Attitudes like this can cause trans people to avoid medical providers altogether. Others may bounce from one provider to another in search of empathetic practitioners to provide the gender affirming health care they need.
It can come down to relying on word of mouth on which health providers will treat them appropriately. A bad experience with a provider can have negative effects so when they find someone who treats them well, they spread the word to prevent others having negative experiences.
Transgender Rights
The rights of transgender people are legally protected under federal and the relevant state and territory laws. However, to change the gender on identification documents varies depending on where someone lives. For example, to make the change on a birth certificate and driver’s licence comes under State or Territory law, whereas passports and Medicare is a matter for the Commonwealth.
The Federal Government only requires a letter from a treating medical practitioner to make these changes. The States and Territories make it more difficult to alter the gender on a driver’s licence and birth certificates. Some still require proof of gender affirmation surgery. However, advocacy in this area focuses on reforms to allow people legal recognition of their gender based on how they see themselves instead of going through surgical intervention.
This can be a legal barrier that makes life even more difficult for trans people, and negatively affects their wellbeing, health and safety. This is especially true for marginalised people such as trans people with disability and mental health issues, and for those who do not speak English or come from culturally diverse backgrounds, and for trans people ineligible for Medicare.
As community support in gender affirmation increases across Australia, surgery has become more accessible but it is a long, costly journey for many transgender people.
Drs Steve Merten and Robert Knight at Pure Aesthetics are empathetic, knowledgeable and highly experienced in gender affirming surgery. Make an appointment to see them to discuss the way forward.
