Equality is not negotiable: If you would like to support please email: afantasticwoman@pm.me

What we are asking:

Dear CEO of the Royal Melbourne Hospital (Prof Shelley Dolan), Jodie Geissler (CEO Austin hospital) and the Victorian health minister (The Hon. Mary-Anne Thomas MP)

We are a group of clinicians, educators, medical staff members, researchers,  allies and trans and gender-diverse stakeholders committed to treating every patient with respect and compassion while upholding excellence in medical and mental health care. 

We call on the CEO of the Royal Melbourne Hospital (Prof Shelley Dolan) and the Victorian health minister (The Hon. Mary-Anne Thomas MP), as well as the Austin (Jodie Geissler, CEO) to implement the 2018 report and provide at least 20 surgeries a year for the most vulnerable trans and gender-diverse Victorians who will never be able to afford these surgeries privately even with an increase in the Medicare rebates. If it's not your responsibility, then we humbly ask whose responsibility it is?

Our Reasoning:

The Federal government has always stated that transgender health care is the responsibility of the state Primary Health Networks. Changes to Medicare through the current MSAC review will never result in a publicly funded option. It will only ever marginally increase rebates for those who can afford surgery privately. Leaving marginalised trans and gender diverse Victorians at risk of worsening mental health and suicide.

In 2018, the Victorian Government commissioned a report investigating how to best support trans and gender-diverse people in a bid to lower the 48% attempted suicide rate. The report, which took into account best case practices, stakeholder consultations, relevant research as well as the voices of lived experience consumers, concluded that there should be centres of excellence, surgery, increased workforce capacity, upskilling and a feedback pathway for complaints. This has never been delivered. (Report linked below)

'As Dr Michelle Telfer, Head of Adolescent Medicine
at the Royal Children’s Hospital in Melbourne
and President of the Australian and New Zealand
Professional Association for Transgender Health, noted
in the stakeholder consultations, the key to expanding
access for trans and gender diverse people in Australia to
gender-affirming care is through the primary healthcare
system'

Discrimination on the basis of Sex and Gender:

Conversion therapy is defined as: 'practices that intend to change, alter or suppress a person’s sexual orientation or gender identity'. Not providing and actively working to take-away gender gender-affirming medical interventions suppresses the ability of a trans or gender diverse person to realise their potential. It is a form of conversion therapy under the guise of a trauma-informed or risk-adverse narrative. 

The following surgeries are currently performed for cisgender (non-trans) Victorians regularly, but are denied to trans and gender-diverse Victorians based on their gender and sex. We believe this is discrimination. We ask that the following medical interventions be made accessible to Victorians who suffer from gender dysphoria, thus ending years of discrimination. We can no longer fall prey to the notion that it's 'just cosmetic', when we know it is about saving lives, the social determinants of health and is evidence-based. As an example,cisgender women now get an opportunity for breast reconstruction after mastectomy for this very same truth, creating a glaring double standard that can no longer ignored.

Mastectomies are an important life-saving operation for transgender men who require it. The hospital currently provides mastectomies for cisgender women who have cancer as well as other diagnoses, but is denied to transgender men because it is seen as cosmetic. But this is not the case. Transgender men who cannot attain this surgery can suffer from scoliosis because of binding their chest, they can suffer from severe mental ill health caused by gender dysphoria, as well as co-occurring conditions such as depression, social anxiety and suicidal ideation. (48% of Transgender people attempt to take their lives). This surgery requires no extra workforce capacity or training, as the hospital already performs it.  - New Zealand and the Australian Military provide this surgery for gender incongruence.

Orchiectomies are a common surgery for transgender women. It allows them to affirm their gender, it can be an important stepping stone to other surgeries and allows them to stop taking anti-androgens. In some cases, Transgender women, because of their liver/kidney function, are not able to take anti-androgens, and so an orchiectomy is the only option for them. It is currently performed for cisgender men who have testicular cancer and other diagnosis's but is denied to transgender women based on their sex/gender and under the false claim that it is just for cosmetic reasons. (Remember, 48% of Transgender women attempt Suicide) - New Zealand and the Australian Military provide this surgery for gender incongruence.

Breast Surgery for Transgender women is as important to them as it is for cisgender women. It is now accepted that cisgender women should receive breast reconstruction after mastectomy for cancer because it is important to their gender and their mental health. But this is denied to Transgender women. The Hospital denies this based on the idea that it is cosmetic, they assume transwomen's breasts are not real or essential for our wellbeing and internal sense of self. Here is what is on offer if you are not trans or gender diverse:
The Breast Reconstruction Clinic provides information and support to help empower women to make informed decisions regarding appropriate breast reconstruction following mastectomy. Women can access breast reconstruction using either implants or their own tissue. If required, women are also able to access breast reductions and breast lifts to improve breast symmetry between their natural breast and reconstructed breast. Nipple reconstruction and nipple tattooing are also available.. - New Zealand and the Australian Military provide breast surgery for gender incongruence.

Hysterectomies for transgender men are an extremely important medical intervention. Hysterectomies are performed daily at the hospital for cisgender women but denied to consenting adult trans-men for the treatment of gender-dysphoria. We believe this is discrimination. A failure in the duty of care to provide the correct treatment for the diagnosis.- New Zealand and the Australian Military provide this surgery for gender incongruence.

The Following Medical Interventions are not provided as a whole to cisgender people commonly and we accept that there may be a need for some upskilling. This upskilling and increase in workforce capacity was promised in the 2018 report, all we ask is a commitment to a timeline to fulfil this promise.

Facial Feminisation Surgery can mean the difference between life and death for a transgender woman. 100s of thousands of people access plastic surgery in Australia yearly, without any gatekeeping. From what we know of the social determinants of health, this is an especially important intervention for transwomen for their mental health. Facial Surgery is currently performed for survivors of accidents where their facial structure has been damaged or when babies have a birth defect. While the skill set is unique, Surgeons like Dr Flapper in Adelaide can help train surgeons, and we could see this be accessible in less than a year. New Zealand and countries around the world, as well as the Australian Military, provide this surgery for gender incongruence.

Vagionaplasty and Phalloplasty are unique and require a specialised skill set, but Australia has surgeons who are capable of training others and although this would take longer, all we ask is a commitment and a timeline to enact a plan that would see this become accessible. There is no way to describe how deeply meaningful these surgeries are to transgender people. Maybe if you imagine yourself never having sex again because you had the wrong genitals, you may be able to empathise about the severe predicament that Trans people find themselves in. Versions and parts of both these surgeries are available to cisgender people for varying reasons. But denied in whole to trans people currently. To this day these surgeries are forced onto intersex people without their consent (in some places) and yet denied to consenting trans adults who do need and want this.  it makes no sense.- New Zealand and the Australian Military provide this surgery for gender incongruence.

Additional supporting Arguments:

1. Every consultation that has been done in Australia, including the most recent Federal LGBTIQ+ consultation (linked below), all stated categorically that surgery must be provided. But each time, the government has ignored this finding and has not committed to when this may be attained. Without commitment, there is no hope.

2. The Australian Psychological Association has no treatment for gender dysphoria precisely because there are no evidence-based psychotherapeutic interventions for this. A trans or gender diverse person is not considered mentally unwell for being trans or gender diverse.

3. All of the following organisations endorse Gender Affirming Medical Interventions:
The Australian Medical Association, AUSPATH, Australian Psychological Society, ACON, Equality Australia, World Health Organisation, LGBTIQ+ Health Australia, The American Psychological Association and more support informed consent and surgery for those who need it.

3. The average payment to an NDIS participant per year is $54,300. While the Australian base-case reference ICER was estimated at AUD 28,033 per QALY gained. The advantage of Gender Affirming Medical Interventions is that they only happen once in the lifetime of a trans or gender diverse person's life, but continue to provide quality of life year after year. For many people the cost of their intervention will be less than one NDIS yearly average payment.

4. We believe that it costs the Australian taxpayer more not to provide these surgeries. Lost lives, lost potential, lost happiness, but also the unnecessary counselling and psychotherapy that will ultimately fail because it can't provide the correct and evidence-backed treatment the individual requires.

A Personal Story:  'I have been in and out of mental health services for years which is costly , If I had of been able to access surgery when I transitioned, I would never have had to use those services. And I will continue to be forced to use these psychotherapy treatments for years to come, but at what cost? How does CBT fix gender dysphoria? How is this any different to conversion therapy? 
Our public health system is designed to support all Australians who pay tax and who need it. Transgender people have a right to expect a minimum standard of care, they shouldn't be denied evidence-based care any longer' - Cloe  

5. Tragically, many trans and gender diverse individuals will go overseas looking for affordable surgeries and then die or nearly die because of lower medical standards abroad. These deaths and near misses could have been avoided if there were options here in Australia. It also poses the question where does the accountability fall in these cases?

6. All mental health organisations such as Mind Australia, headspace, Uniting, Orygen and more, have as their fundamental pillar of mental health and recovery, HOPE.  Commissioning the 2018  report and then not delivering on the findings, not only withholds HOPE it also erodes HOPE.

7. Many trans and gender-diverse people cannot afford private surgeries. It has become commonplace for them to use their superannuation, foregoing later stability in life to achieve this essential care. No one should have to do this.

8. European countries have the added advantage that travelling abroad is far less expensive than in Australia, which lowers the barriers to people seeking treatment. But leaving Australia adds a huge increase in price to private surgeries sought overseas. It puts them out of reach of many trans and gender diverse Victorians.

9. Trans and gender-diverse people also regularly sacrifice their bodies and minds, working up to 3 or more jobs at a time, trying to save up while living with the betrayal that the hospital system and the government have abandoned them.

10. The Royal Melbourne Hospital has already created guidelines and treatment plans and pathways for medical Interventions for transgender children, but has not provided any such clinical guidelines and pathways for transgender adults. We believe this to be inadequate. These are two sides of the same coin. Duty of care demands support across all ages. 

11. Surgeons here often want to provide these surgeries but have been forced to stop, as recently happened at The Adelaide Royal Hospital by the acting CEO, Kathryn Zeitz and SA health minister Chris Picton when they shut down a successful facial feminisation program run by the craniofacial unit. It had run for two decades, providing a means of training less experienced surgeons as well as helping transgender women. It was shut down for no apparent reason. This demonstrates the power that CEO's and health ministers hold in this area.

The fact is, we can never reach 0% attempted suicide without this change. So whether it's now or in the future. It must be done.

We thank you for taking the time to think deeply about this letter and reading the resources below. We have faith you will do what is evidence-based and in accordance with the lived experience guidelines that Victoria upholds and is legally bound to.

IF NEW ZEALAND CAN DO IT, WE CAN DO IT!

Resources: 

2018 Report by the Victorian Governement that promised centres of excellence, surgery and a feedback channel that the Victorian Government has failed to act on. 
https://www.health.vic.gov.au/publications/development-of-trans-and-gender-diverse-services-in-victoria-final-report

ACON Gender Affirming Surgery in Australia - An Evidence Brief
https://www.acon.org.au/wp-content/uploads/2021/11/Gender-Affirming-Surgery_Evidence-Brief_FINAL_Nov21.pdf

National Consultation on health care for LGBTIQA+ communities that categorically state Surgeries must be made available.
https://www.thinkchangeresolve.com/_files/ugd/0245e3_e4f5c6011c0a43cead4d22958558b9a4.pdf

Latrobe University Writing themselves in report shows that 80% of Trans and gender divers people need to medically-affirm themselves with at least one medical intervention. 
https://opal.latrobe.edu.au/articles/report/Writing_Themselves_In_4_The_health_and_wellbeing_of_LGBTQA_young_people_in_Australia_National_report_/13647860?file=26375119

Auspath Evidence Brief for Transgender Health Care:
https://auspath.org.au/wp-content/uploads/2022/06/GenderAffirmingSurgery_EvidenceBrief.pdf

AMA Position Statement on LGBTQIASB+ Health
https://www.ama.com.au/articles/lgbtqiasb-health-position-statement

RANZCP position statement on gender dysphoria
https://auspath.org.au/wp-content/uploads/2022/07/Zwickl-et-al.2022-Re-the-RANZCP-position-statement-on-gender-dysphoria.pdf

Brief by endocrine society:
 https://www.endocrine.org/advocacy/position-statements/transgender-health

ACON - A Blueprint for improving the health and wellbeing of the Trans and gender Diverse Community in NSW
https://www.acon.org.au/wp-content/uploads/2020/09/ACON_TGD-Blueprint_SEPT-2020_web.pdf

While this is research is about adolescent health it applies equally to adults: