Kavitha Sivasamy, a 27-year-old Canberra lawyer, is one of many transgender Australians forced to seek gender-affirming surgeries abroad. Sivasamy has decided to travel to Thailand to have a peritoneal pull-through, a type of vaginoplasty, as she found that the wait in Australia was too long. While she is fortunate enough to have enough money to finance the trip, most transgender people in Australia do not.
The lack of surgeons performing lower body gender-affirming procedures in Australia is leading to more and more transgender people traveling abroad for surgery. Medicare offers no item numbers for medical procedures specifically for gender incongruence, causing confusion about what, if any, aspects of gender-affirming surgeries are eligible for government subsidy.
Gender-affirming surgeries in Australia are often prohibitively expensive, leaving people out of pocket by up to $20,000 for a vaginoplasty performed in the country. Private health insurance coverage for gender-affirming surgery is also often too expensive. Most states and territories have elective surgery policies that explicitly restrict access to surgical interventions for trans people through public health systems, forcing trans people into local private care or surgery abroad.
The lack of comprehensive gender-affirming healthcare in Australia may be because this care is misunderstood as simply cosmetic or solely related to genital surgery, and because trans people are “seen through a lens of being mentally ill, as opposed to just being a natural part of human diversity”. This situation has led to a healthcare access crisis for the transgender community, and many trans people are now choosing to travel to Thailand for gender-affirming surgeries, despite the risks.
Medical tourism for gender-affirming surgeries, even in a country that pioneered these procedures, comes with warnings of caution. Reports of trans women suffering vagina narrowing or urethra complications after surgery, both in Australia and overseas, raise questions about who corrects the error once the patient is back in Australia. Trans health advocates say Medicare is woefully inadequate and failing to offer any item numbers for medical procedures specifically for gender incongruence.
Associate Prof Nicola Dean, the president of the Australian Society of Plastic Surgeons, says the federal government must create a dedicated suite of Medicare rebate item numbers for procedures for people with gender incongruence. This would encourage more surgeons into the field, giving the surgeries a stamp of legitimacy. In the meantime, transgender Australians continue to face an uphill battle for access to gender-affirming healthcare.