Gender-affirming surgery should be covered by Medicare

My social media sites are crammed with fundraising pages for trans peoples’ healthcare. Every week, new pages pop up, with titles like ‘Help Aiden get the chest of his dreams!’ On one hand, there is something powerful and beautiful about watching queer people and their allies help pitch in and help each other. But there is a darker side. Medical fundraising is something trans people are doing because they’ve run out of other options. It requires them to drag deeply personal, intimate needs into the public eye to attract donations. This kind of fundraising can be hard and time-consuming work, and it can feel exposing, even humiliating. It invites unwelcome opinions from those who are not supportive. Trans people shouldn’t have to beg for what can be lifesaving healthcare, but in Australia they do.

The fact that this is the status quo feels even more unfair when you consider the fact that trans and gender diverse community are one of the most socioeconomically disadvantaged groups in the country. One in three trans people have experienced employment discrimination due to their identity, which contributes to their 19 per cent unemployment rate. Factors like family rejection and rental discrimination feed into high rates of housing instability, with one in five young trans people having experienced homelessness.

Those who are able to fundraise are often the luckier ones. How could you raise thousands of dollars if you’re not from a community with those kinds of resources? Trans people who experience discrimination or disadvantage from multiple angles experience greater hardships. For Aboriginal and Torres Strait Islander people, disabled, mentally ill, incarcerated and rural trans people, as well as those from non-English speaking or refugee backgrounds, the barriers to accessing appropriate healthcare can be insurmountable.

The reality is that a huge proportion of trans people in Australia can’t access or afford gender-affirming care, and won’t be able to any time soon. There are a lot of problems, including discrimination in healthcare settings, a lack of doctors trained in trans health issues, and pathways to access hormones being confusing and difficult. But the largest financial barrier for trans people to overcome is access to gender-affirming surgeries, which are currently almost entirely performed through the private health system. The cost of the surgeries—which may include the need to travel to a distant facility, mandatory psychology appointments, and time off work needed to recover—is staggering, and people who get both ‘top’ and ‘bottom’ surgeries can end up paying over $100,000 in some cases. The people who can afford this are more likely to be white, middle class, well-resourced and well-supported. It isn’t fair, and it isn’t right.

From a medical point of view, there’s overwhelming evidence that gender-affirming surgeries significantly improve the wellbeing of a person who wants one (and not every trans person does). Study after study has demonstrated marked improvements in reducing psychological distress and suicidal ideation. By contrast, desiring but not being able to access gender affirming surgery is psychologically hazardous. An Australian study conducted in 2021 found that people in this situation had a 71 per cent higher chance of reporting a suicide attempt. Many other countries, including the UK, Canada and Sweden, took note of this kind of evidence and have been publically funding these surgeries for years.

A lot of attention has been devoted to the notion that trans people may regret their surgeries. I think this reflects a difficulty on the part of cisgender people to understand on an emotional level why someone might want them. In actuality, the regret levels are extraordinarily low, in the order of 1 per cent. We need to pay greater respect the autonomy of trans people when making decisions over their own lives and bodies.

It’s difficult for studies alone to capture the full extent of what these surgeries can mean for people. I don’t believe trans people should be defined by gender dysphoria, but for some, dysphoria is unbearable. It can destroy the joys of getting dressed, eating, having sex, going to the pool, even just being in public. It can make people want to die. The fact that gender reassignment surgeries are so effective at reducing this psychological distress could make them among the most effective mental health interventions in existence.

The government should be taking urgent and decisive action to improve the mental health of trans people in this country, because its current state is nothing short of a national emergency. 43 per cent of trans people in Australia have attempted suicide at least once. Every year or two, I hear of another young trans person around my social circles who has died.

Poor mental health is sometimes framed as an intrinsic part of being trans, but it isn’t. We are not the issue. There are two key driving factors, and both could be changed: the denial of appropriate healthcare for our needs, and the dehumanising transphobia that we experience everyday.

The lack of accessible trans healthcare in this country isn’t because of a lack of medical evidence of effectiveness, or a lack of need. Rather, it’s ideologically driven. Trans people are small minority, but we’ve been turned into a societal scapegoat, a political football in a bigger game. We’re used by conservatives to incite moral panic and fear. Many sympathetic politicians and policymakers are currently scared to truly advocate for us. The memory of the Safe Schools outrage, and the disastrous way marriage equality was legislated in this country, loom large in political memory.

Posie Parker’s recent Nazi-supported, anti-trans rally marked a cultural tipping point, an unmasking the ugliness of Australian transphobia to those who were not previously aware. We need to use it as an opportunity to get organised. The campaign for marriage equality showed us that we can’t rely on either major political party to stand up for LGBTQI+ Australians unless we and our supporters get organised and demand it.

The message we’ve been hearing for too long is that we’re not worthy of the healthcare that would help us. That we’re on our own. That we’re not valued. Transphobia is coming from the top.

The restricted access to gender-affirming care is a discrimination issue, and it’s a human rights issue. It’s causing unnecessary suffering and death in a group already subject to intense discrimination and marginalisation, in a country that could and should afford to stop it. We need to change the story. We’re not alone—together with our supporters, there’s a lot we could achieve. Our lives are valuable, and we are worthy of care. It’s time to get gender-affirming surgery covered by Medicare.


If you want to do something to help, you could donate to The Trans Justice Project, which at the time of writing has raised over $90,000 to fight for trans rights issues in a very short time period. For cisgender allies that can, talk to friends and family who you know might not already be onside. Make sure you’re at the relevant rallies that are popping up to support trans people. Or write to the Minister for Health and Aged Care, Mark Butler, or to your local MP, in favour of funding gender-affirming care.

Felix McIntyre

Felix McIntyre is non-binary, trans masculine doctor living on unceded Wurundjeri country. Their views are their own.

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