I begin my day with a breakfast of champions: oestrogen pills, testosterone blockers and black coffee. The first two are the basic routine for medically transitioning transgender women. But you would think they’re anything from basic looking at the price; there are no specific Medicare provisions for transgender access to either of them.
When I came out as a transgender woman in my late 20s, I made a detailed plan to shape my transition. I knew I wanted to legally change my name and my gender, I knew I wanted to medically transition through hormone replacement treatment (HRT) and I knew that there were decisions to make about whether I would pursue gender reassignment (genital), breast and facial feminisation surgical procedures.
But, in almost every circumstance, I am going to be paying out of pocket, with very little — if any — support from the public health system that I help contribute to.
Trans women will pay $50+ for testosterone blockers and oestrogen every few months. Testosterone for trans men can be as much as $140 for a 10-14 week dose, depending on delivery and brand. Depending on who you talk to, facial surgery begins at the $5000 mark and gender reassignment surgery is over $30,000. Many doctors in this country won’t perform a mastectomy on trans men, even if they can pay for it.
If I want to go down the surgical path, I am going to be paying for it in cash. While I am looking for a private health fund that would agree to pay a rebate, I will still need to cover the often significant upfront costs and then make an application.
There are some grey areas. For example, oestrogen pills are covered by a Medicare concession for cis women going through menopause so they can often be extended to trans women, but there is no specific trans coverage. This is not enough. This leaves me, and many other trans women, men and non-binary people in a difficult situation: we have to pay thousands of dollars in medication and specialists to live as who we really are.
For many, the lack of access to surgical and medical health care is an existential threat. To be blunt, I can live quite happily as a woman who has a penis. It might not be my preferred anatomy, but I can make it work. For transgender women who experience dysphoria, that is not going to be an option. If they’re blocked from surgery because of their financial situation, it’s a huge source of distress and pain.
I sometimes talk about the joy of being trans — being transgender is an absolute joy. I love who I am. I am confident in who I am. Looking at the strength of my community and the women who have gone before me, I am incredibly proud to be transgender. But there are weights that we carry.
Those weights aren’t intrinsic to the transgender experience, they are weights that are placed on us: the transphobia we experience from other people; the negative campaigns in the press; the ignorant comments from politicians such as Scott Morrison, calling our access to safe bathrooms “over the top”.
But above all else, we carry the weight of our healthcare, and we it carry alone, without the support of our system or the wider community. In a world where we have acknowledged that transgender people are real, and that transgender people deserve respect, how can we keep denying them universal healthcare?
This needs to change. Yes, I want to see top surgeries covered for trans men. Yes, I want to see facial feminisation surgeries covered for trans women. Yes, I want non-binary people to access whatever procedures they need to be comfortable and safe in their own bodies. And yes, these procedures are going to cost money, and they will cost money to the public health system. While the UK’s public health system isn’t ideal, and the wait times can be extremely long, they do at least provide for complete transgender healthcare.
I could argue that there are not that many trans people out there, and the cost would be small, but that’s an argument that misses a far more important point: we aren’t burdens. We are citizens.