Accessing trans healthcare in Australia that’s appropriate, safe, timely and affordable is practically impossible, even in 2022.
“There’s a perception that there’s something abject or extreme in changing your body that’s still pervasive in the medical community,” Melbourne resident and trans woman Angel Connolly told PEDESTRIAN.TV.
“We’re so used to having people position themselves as the guarantors of our own lives and our bodies that it comes as no surprise doctors participate in that as well.”
Connolly said she only felt doctors saw her as “certifiably trans” three years into her gender affirmation journey — a status of sorts she said she had to earn.
“The longer you’ve been on the journey the easier it is for people to trust that you are genuine and sure.
“There’s still a great deal of caution even at a trans-friendly gender clinic. There’s still a perception that the doctor needs to feel they’re satisfied that we’ve considered it enough.
“I understand that, but I don’t think there’s any world where a trans person goes to a doctor [without knowing what they want]. I went through years of deliberation before I went to a doctor.”
She said the many delays and hurdles that many trans people experience along the way, including stigma, diagnostic requirements and long waiting lists to see doctors skilled and knowledgeable in trans health, could have significant negative effects on mental health.
Non-for-profit LGBTQIA support organisation Switchboard Victoria, which runs two helplines, receives a high number of calls relating to poor mental health associated with delays and unnecessary or invasive steps in the gender affirmation process, CEO Joe Ball said.
“We talk to parents of transgender kids and adults themselves who are seeking advice on how to navigate the system and something we hear from people is the wait times. People are either waiting for GPs or they’re struggling to find them, particularly in regional areas,” he said.
Ball, who is trans, told PEDESTRIAN.TV some said they were stuck on waiting lists of 18 months or more for gender affirmation surgeries, while others were waiting a month or more for their very first appointments.
“Once you’ve made up your mind at any age people just want to start that journey. Having to wait for that first initial appointment, which might be at your GP to get your bloods taken, and not being able to get in for a month or locate a GP who’s experienced, that’s quite distressing.
“People are coming to us who are feeling quite desperate and saying ‘what are our other options?’ and I would say there isn’t a lot of options, which is a concern,” he said.
Demand for services in Victoria in particular has ballooned since 2017 when the State Government introduced the informed consent model.
The model allows people to access hormone replacement therapies (HRT) by simply signing a consent form, whereas previously patients were required to undergo a mandatory mental health assessment or receive a doctor’s diagnosis of gender dysphoria.
But finding or booking an appointment with a GP who can implement the model can be a challenge.
The Monash Health Gender Clinic in Melbourne, one of the state’s leading clinics, advises new patients on its website that it has “very long wait lists”.
As of May 27, 2022 it was booking appointments for clients whose GP referrals were received in March 2021.
Melbourne’s Equinox Gender Diverse Clinic has a similar disclaimer about high demand and wait times on its website, while the Austin Health Gender Clinic only opens for appointments two days a week.
PEDESTRIAN.TV has seen social media posts that suggest the wait time for an appointment at the Royal Children’s Hospital Gender Service could be as much as 11 months. The RCH declined to comment.
Demand for trans healthcare has risen worldwide as awareness and information has grown in the last decade, Austin Health endocrinologist Ada Cheung said.
“It’s not an increase in people that realise that they’re trans, but more so people realising that ‘Oh, I’m trans, I can actually do something about it’. And a lot of that’s come from information,” she told the ABC.
Some hormone therapies and gender affirmation procedures were also first subsidised under Medicare in 2014, but they must be deemed medically necessary by a doctor and even then there can still be huge out of pocket costs.
But Victorian Pride Lobby committee member Nic Holas told PEDESTRIAN.TV there were many factors that can traumatise LGBTQIA people and turn them off engaging with private health insurance services.
The lobby released a report last week that revealed three out of four trans or gender diverse people had experienced some form of discrimination or exclusion from insurance providers. Holas said being asked unnecessary and invasive questions about gender or lifestyle could throw up an immediate barrier.
“A lot of people jump off at that point of application thinking that this provider is not going to be able to effectively support someone going through a really important life-affirming time. So then they switch off and they’re not getting cover.”
Many insurance policies also come with a 12-month exclusion time in which clients can’t make any claims on treatments or procedures.
“It can prolong and delay the process that’s already really really protracted and delayed and prolonged because of all the other factors that come into someone’s transition journey, like raising money.”
Ball said the availability and quality of healthcare for trans people was slowly improving but the overwhelming demand at gender clinics showed a dire need for more of them.
“It takes time, it takes a strategy and it takes investment,” Ball said.
“There’s no easy fix but I think there’s a lot of good will. We need to keep pushing to make this a priority.”
If you’d like to talk about the issues raised in this story, you can call the QLife LGBTI peer support hotline on 1800 184 527 or chat online.
QLife operates between 3pm and midnight daily.
Under 25? You can reach Kids Helpline at 1800 55 1800 or chat online.
