Call for Medicare to pay for transgender surgery and a ‘meaningful life’

Transgender surgery should be made available in public hospitals and subsidised by Medicare, says a report to Victoria’s government.

Victorian Health Minister Jenny Mikakos. Picture: AAP

 

EDITORIAL: We will not shy away from uncomfortable topics that deserve attention. This is particularly so when the health and wellbeing of vulnerable children are at stake.

Transgender surgery, such as ­“facial feminisation” with a price tag of up to $70,000, should be made available in public hospitals and subsidised by Medicare, says a report to Victoria’s government.

A “critically low” supply of trans-skilled surgeons is driving people overseas for costly surgery that sometimes fails and is difficult to repair in Victoria, says the 2018 report feeding into what Premier Daniel Andrews unveiled in April as Australia’s first Trans and Gender Diverse Health Care ­Initiative.

The report cites the “rapid ­increase” of patient demand in Victoria’s gender clinics at the Royal Children’s Hospital and Monash Health. It urges more surgical training and says Medicare should recognise that “gender ­affirming” surgery is not cosmetic but helps a trans person lead “a productive and meaningful life”.

The report says: “Many pharmaceutical and surgical procedures (for trans people) are not listed on Medicare/PBS schedules and require private funding, which can be expensive,” and gives the example of “craniofacial reconstruction” (facial feminisation, costing $50,000-$70,000) after puberty for trans females born male.

A spokeswoman for the federal health department said Medicare “does not specifically fund” trans surgery but there are rebates for some procedures if a practitioner “deems (them) clinically relevant,” a spokeswoman for the federal health department said.

The RCH clinic for children and adolescents, directed by paediatrician Michelle Telfer, ­offers puberty blockers and cross-sex hormones, and once patients turn 17, they are on track for the Monash adult clinic. But Dr Telfer told ABC News last year that RCH should consider “top surgery”, such as a double mastectomy claimed to make a girl feel more like a boy and reduce suicide risk.

“The evidence that we have from a medical perspective is that it can be really helpful, it’s therapeutic,” she said. “When you still have prominent breasts, it’s very distressing and actually leads to quite a lot of discrimination, stigma, bullying at school.”

RCH and Health Minister Jenny Mikakos would not comment when asked about any plans for enabling under-18s trans surgery.

Ms Mikakos has said last year’s clinical guidelines issued by Dr Telfer’s RCH team represent “the most stringent safety standards”.

Those standards, also hailed as “the world’s most progressive”, say top surgery is regularly performed overseas where a 16-year-old can consent. Later this month, gender clinicians can attend a workshop titled “Medical and surgical: preparing for the next wave” in the lead-up to their professional body’s conference in Perth.

The overseas-led trend has been to ever younger social transition (hair, clothes and pronouns) and medical treatment. In the US, “gender confirmation surgery” for biological females identifying as male rose 346 per cent from 1497 operations in 2016 to 6691 last year, the American Society of Plastic Surgeons reported. It gave no age breakdown.

Physician Johanna Olson-Kennedy, the high-profile director of the largest US youth gender clinic, at the Children’s Hospital in Los Angeles, told a conference last year that people under 20 made all kinds of life-altering decisions successfully. “Here’s the thing about chest surgery — if you want breasts at a later point in your life, you can go and get them,” she said.

Critics of the “child-led” affirmation approach say its pro-trans bias may not serve the welfare of the often troubled teenage girls ­reported in several countries as suddenly going trans and pleading for testosterone. Some clinicians cite social media and peers as factors.

At RCH, referrals have risen sharply, from three in 2003-07 to 228 last year. The hospital refuses to give a breakdown by birth sex.

Dr Telfer, who has claimed “gender is mostly a biological ­entity”, said people did ask how very young children could know they were trans. “We have two- or three-year-olds who verbalise very clearly how they feel about their gender, and we listen,” Dr Telfer told a Medical Journal of Australia magazine last year.

She said research clearly showed that “if you support the child to express themselves and be who they are, their long-term mental health outcomes are very good”. Under-18s trans surgery ­appears rare in Australia to date but there is no national data.