A record number of transgender young people are seeking treatment, and the medical system is not coping with all the questions and the issues that raises. Expensive treatment and long waiting lists are just the beginning of the problems they face.

By MEREDITH CONNOLLY

It is 1999. Tommy is six, wearing a pale blue dress and standing before their* bedroom mirror. They turn to the left, turn to the right and then reach down to rub their legs. They’re tired.

Tommy draws their hair to the top of their head, lifts their chin and asks themselves for the last time:  “Am I a girl?”

Australians who identify as transgender or gender dysphoric account for a small proportion of the population. There are no official figures to back this, as the current census does not ask for information other than gender identity.

But new evidence suggests that whatever the figure may be, it’s on the rise and the current system is struggling to cope.

In 2013, The Royal Children’s Hospital in Melbourne saw more transgender patients undergoing treatment in that one year than they had in the previous 10 years combined. The figure jumped from 1 per year in 2003, to 60 per year in 2013. This record high may represent a positive step in the accessibility of treatment, but it comes at a high price.

Transgender activist and director of Transgender Victoria Sally Goldner says the current waiting list for transgender patients seeking treatment at the Royal Children’s Hospital is about six months.

It's important to address this issue, Goldner says, because delays in treatment can be deadly for young, mentally troubled patients.

“They just can’t wait. For some of them, it’s life or death,” she says.

Goldner’s comments allude to a harsh reality for those within the transgender community. Like most members who fall on the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) spectrum, transgender people are especially likely to suffer from discrimination, harassment and mental health issues.

According to the latest statistics, transgender Australians are 14 times more at risk of committing suicide than the rest of the population.

But waiting lists aren’t the only problem. Those undergoing treatment are also faced with the day-to-day costs of hormone replacement therapy (HRT) as well as a variety of fees for surgical procedures.

Medicare provides basic medical access for transgender people, with rebates for HRT under the Pharmaceuticals Benefits Scheme (PBS) and partial cover for surgeries for both female-to-male (F2M) and male-to-female (M2F) patients.

They just can’t wait. For some of them, it’s life or death.

But there is a gap between what Medicare will cover and what doctors can charge. Other surgeries such as facial feminisation for M2F patients are currently considered cosmetic and are, therefore, not covered by Medicare.

Goldner, a transgender woman who has long undergone hormone and surgical treatment, estimates her costs so far have amounted to more than $18,000.

“It’s not sustainable and frankly, for this kind of medication, we shouldn’t be charged,” she says.

In light of these hurdles, other transgender Australians have taken matters into their own hands and turned to crowd funding to raise money for treatment.

Kai Clancy, a 20-year-old from northern Queensland, recently launched a campaign to raise $8000 for his double mastectomy or “top surgery” as it is known in the transgender community.

Using the crowd-funding website Pozible as a base, Clancy launched his campaign across social media. Pozible is a new breed of crowd funding website that only accepts donations if and when a target goal is met. It also offers the option for fundraisers to offer gifts in return for donations.

Using this incentive, Clancy sang, danced and painted for $4000 worth of his pledges.

“It’s nice to be able to create something knowing that the person it’s for has already opened their heart for me.”

After two months of daily campaigning, Clancy reached his goal.

“I am eternally grateful for every dollar,” he says.

Young Australians like Clancy are not alone. As the figures from the Royal Children’s Hospital in Melbourne suggest, the number of transgender youth who are seeking treatment is climbing.

But undergoing treatment is an advanced stage in the transgender process. For some, like 21-year-old Tommy, the journey to understanding and accepting gender diversity is just beginning.

Tommy, who does not wholly identify with either the male or female gender, is about to broach the topic with their* doctor for the first time. They are keen to begin the process as gender struggles have plagued them from a young age.

“I hated dresses growing up. I hated having long hair,” they said.

Tommy does, however, harbour some doubts for the later stages of the transition.

“I’ve always felt more of a man, always felt like doing manly things and just … felt more comfortable identifying that way. But I don’t want a dick, which makes everything harder.”

A transgender person who wants to receive treatment like hormone therapy must first receive a referral from their doctor to see a psychiatrist. Once it is established that hormone therapy is the best option, patients can begin receiving low levels of hormone therapy.

Tommy’s inability to define their gender won’t prevent them from accessing medical treatment but it could become a roadblock in later stages, especially as they are continually faced with the administrative option of choosing whether or not they are male or female.

In 2013, then federal health minister Tanya Plibersek announced that Medicare would remove its gender discrimination by no longer requiring transgender and intersex people to disclose their gender when seeking medical services.

Prior to the change, individuals of ambiguous or changed gender faced explaining to administrative staff their personal gender history when attempting to access services or rebates at a Medicare office. But this kind of gender awareness is not shared throughout the industry.

I hated dresses growing up. I hated having long hair

John Stewart, a managerial representative of a major private health fund, recalls a recent incident where a transgender individual had their claim suspended after the system rejected it on “illogical” grounds.

“Because they had applied for private health insurance under their transitioned gender of a man, the system viewed their claim for a hysterectomy as illogical,” he says.

Stewart moved to liaise with both the technical team and those in charge of claims in order to suggest a manual override.

He does, however, feel that the industry need not make further structural changes.

“The case of (name removed for privacy) exposed a flaw in our technical database – however, as whole, I don’t believe there needs to be further changes with how we treat our transgender members.

“I don’t feel that a third option is necessary.”

But lack of awareness in gender diversity remains a daily issue for the transgender community. This is especially relevant for those who live in rural Australia and face commuting to larger cities like Melbourne in order to access treatment.

Acton Bell, a 23-year-old resident of Shepparton, makes a fortnightly commute to Melbourne to receive testosterone injections. The drive is a four-hour round trip and often clashes with work rosters.

“Sometimes I only get one day off a week and I spend it driving to get a shot,” Bell says.

Organisations like Transgender Victoria classify this inaccessibility as one of the largest problems faced by the rural community and are campaigning for greater access. But as Goldner says, there are other more baseline issues to work on before accessibility to hormone therapy can be reached.

“We’re currently working on educating rural doctors about trans patients. You know, if you fall over and injure your ankle, you want to see your doctor. And sometimes, if you’re a trans person, you go to see them about your ankle and you spend 20 minutes talking about your gender identity. We want to be able to just talk about the ankle.”

Bodies such as ACON (formerly Aids Council of New South Wales) have advocated for the inclusion of questions that relate to sexual identity in the 2016 census. They hope that this inclusion will give a greater bearing on their attempts to advocate for positive changes to transgender health.

Support groups for transgender and other LGBTQI youth can be found across all states of Australia in both metropolitan and rural areas. Locations for all groups can be found here.

*Note: The pronoun 'their' is used in a singular sense where the person does not identify as male or female.