Australian transpeople seeking gender reassignment surgery (GRS) in Australia are disadvantaged by two major factors.
The first is cost: transmen in Australia have not been able to access mastectomies and hysterectomies on Medicare; vaginoplasty is covered, but it is unclear how many transwomen are able to access this through Medicare or private health insurance due to the provision of certain coverage to only patients of one sex. Furthermore, many surgeons insist on working only from private hospitals (particularly cosmetic surgeons, so most top surgery for both transmen and transwomen) which result in large hospital costs. The costs related to surgery not covered by Medicare, such as anaesthetists, must also be considered.
The second and most fundamental factor is the lack of surgeons both willing and able to perform genital GRS — I have been able to confirm only two surgeons in Australia currently performing bottom surgery for transwomen, and none at all performing bottom surgery for transmen. This means that Australian transmen must travel to Thailand, the US or Europe to access surgery. It becomes apparent how isolated Australia is, geographically, when the potential travel and accommodation costs must be calculated on top of surgeries that will probably cost upwards of US$30,000. There is no assistance for Australian transpeople seeking surgery abroad and most have no hope of affording it. Surgery for transwomen in Australia may cost between AU$10,000 and $30,000.
Is surgery necessary?
Surgery can be a difficult topic in the transgender community, particularly bottom surgery. This is in part because, in the public imagination being trans has often been all about “having the operation” i.e. genital surgery. Some transgender persons have few issue with their bodies, and others, after hormone therapy, will find they can accept and live in their bodies without surgery or, for transmen, with only top surgery. Hence not all transgender persons want surgery and pretty much all believe that surgery should not be part of what defines us as trans. It is also always important to stress that not all GRS is genital surgery: top surgery is an important part of their transition for most transmen and many transwomen.
But with that pointed out, genital reconstruction is important for many Australian transpeople. In all states and territories, excepting the ACT, WA and, from this year, South Australia, some form of surgery is required to change one’s legal sex on birth certificates. The inclusion of a third gender designation on Australian identification is a welcome move and will benefit many, particularly the intersex and wider gender-diverse communities, but many transgender persons wish to be legally recognised in their correct gender. For transwomen in particular this involves undergoing difficult and costly invasive surgery that some would otherwise choose not to have.
Does not compute
Beyond this legal issue, there is the considerable distress experienced by many trans persons due to physical dysphoria. Most transmen experience dysphoria related to their breasts, and many transpeople experience dysphoria associated with their genitals that can range from mild to extreme, leading to depression, self-mutilation and thoughts of suicide. This is not a socially produced body-image issue, it is produced by the clash between the brain’s internal map of the body and the body’s physical reality.
The only way we have to alleviate this distress is through surgery and the difficulties of accessing surgery have a negative impact upon the lives of many transpeople. My own experience is that the lack of surgical options in Australia and the inability to access surgery overseas due to prohibitive costs leads to a hopelessness and sense of a lack of control over what happens to my own body contributing to depression already being fuelled by physical dysphoria.
I have been suicidal, and at times feel that I cannot endure the knowledge that I will have to suffer this distress, this extreme physical discomfort, for the rest of my life. I cannot be certain that surgery would alleviate it, but it is the only thing that could, and I, like most Australian transmen, have very little hope of ever finding out.
Derek Hamilton is a 37 year-old autistic transman who deals with severe chronic depression aggravated by social isolation, chronic illness, and, most of all, the physical aspects of gender dysphoria. The image above is a stock image sourced from pexels.com and not intended as a representation of Derek.