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 (RCH) 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 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.

The overseas-led trend has been to ever younger social transition to medical treatment.  In the US, “gender confirmation surgery” for biological females identifying as male rose 346% 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 suddenly going trans and pleading for testosterone.  At RCH, referrals have risen sharply, from three in 2003-07 to 228 last year.  Dr Telfer, who claims “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 said.  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”.

Source: Compiled by APN from media reports

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