For the first time in Australia, an independent committee is considering whether Medicare should fund gender-affirming surgery for trans adults (those aged 18 and over).<\/p>\n
Gender-affirming surgery is any surgical procedure that helps trans and gender-diverse (trans) people align their bodies with their gender. For example, a double mastectomy<\/a> can create a masculine-appearing chest.<\/p>\n Having better gender alignment (sometimes called \u201ccongruence\u201d) allows trans people to feel more like themselves. The evidence shows it has significant benefits<\/a> for body image, wellbeing, quality of life<\/a> and mental health<\/a>.<\/p>\n Not every trans person wants surgery<\/a> (or hormone therapy<\/a>). But new Medicare items would allow those who can afford private health insurance to receive up to 75% in rebates for certain procedures. Surgeries are not currently available in the public system.<\/p>\n The Medical Services Advisory Committee is currently considering an application<\/a> by the Australian Society of Plastic Surgeons for about 30 new Medicare items. Some authors of this article were part of a group which supported preparation of the application. The committee will assess whether the items are effective and whether they are value for money.<\/p>\n However, earlier this month<\/a> the committee said it needed more evidence before making a decision on funding. Specifically, it is seeking more information about the long-term impact of surgery on trans adults.<\/p>\n What does gender-affirming surgery involve?<\/p>\n Procedures can include chest, genital, facial and voice surgery. These can be complex and require multiple operations.<\/p>\n For example, phalloplasty<\/a> is a procedure that creates a penis using tissue from the arm, leg or abdomen. It can involve several separate procedures, including shaping the penis, allowing urination while standing and sometimes creating a scrotum.<\/p>\n Each surgery has a long recovery, which may require leave from work and\/or caring duties. Like all surgeries, gender-affirming surgeries also have some risks, including infection<\/a>, blood clots<\/a> or poor healing<\/a>. <\/p>\n We don\u2019t have data about how many people have gender-affirming procedures in Australia. But research from the United States shows the average age for first surgery<\/a> is 29.<\/p>\n Guidelines<\/a> from the World Professional Association of Transgender Health do not recommend any gender-affirming surgery before the age of 16. <\/p>\n Why do people get gender-affirming surgery?<\/p>\n The positive impact on trans people\u2019s mental health and wellbeing can be substantial<\/a>. <\/p>\n For many trans people, simply leaving the house may mean being called by the wrong name or pronouns, being treated unfairly or facing violence. Australian research<\/a> show one-third have faced discrimination when seeking employment and more than 60% have experienced verbal abuse. <\/p>\n Surgeries such as facial feminisation<\/a> \u2013 reshaping the brow or jaw bones to create a more traditionally feminine appearance \u2013 can change the experience dramatically. <\/p>\n Having surgery can reduce distress about the mismatch<\/a> between someone\u2019s body and their gender (gender dysphoria), increase confidence<\/a> and help people blend in<\/a>. This can improve their physical safety and reduce harassment<\/a>. <\/p>\n Surgery is also linked to lower suicide risk<\/a>. Conversely, not being able to access surgery increases the risk of suicide attempts<\/a> and limits social participation<\/a> including employment. <\/p>\n This makes access not just a matter of choice, but a crucial equity<\/a> issue.<\/p>\n How do people pay for surgery now?<\/p>\n Access to surgery in Australia remains extremely difficult<\/a> due to cost<\/a>, lack of surgeons, and no public hospital services. This means there is significant unmet need<\/a>. <\/p>\n For example, one Australian study found<\/a> 63% of trans people recorded male at birth wanted facial feminisation surgery, but only 6% had had it. Trans people who want<\/a> gender-affirming surgery but haven\u2019t had it yet have a 71% higher chance of reporting a suicide attempt.<\/p>\n At present, most Australians pay out-of-pocket or travel overseas<\/a> to have the surgery with costs<\/a> ranging from A$20,000 to more than $100,000. <\/p>\n Some people are so desperate to access surgery they drain their superannuation<\/a>. This can increase financial insecurity for people who are already at higher risk of economic disadvantage<\/a>.<\/p>\n The cost of surgery may also mean people forgo essentials such as healthy food or social connection, adding to health risks. <\/p>\n Do people regret surgeries?<\/p>\n The Medical Services Advisory Committee has acknowledged a clear unmet need for subsidised gender-affirming surgery. But it has asked for stronger evidence, including on rates of regret after having a procedure.<\/p>\n Contrary to common misconceptions<\/a>, regret is very rare. Less than 1%<\/a> of people decide it was the wrong choice to undergo gender-affirming surgery and even fewer request surgery to return their body to what it was (so-called \u201cdetransition<\/a>\u201d).<\/p>\n Some studies show the proportion of people who regret surgery is higher after a knee<\/a> operation (10%) or cancer<\/a> procedure (24%) than gender-affirming surgery. <\/p>\n As with all surgery, good information beforehand and shared decision-making<\/a> between the patient and their health-care team improves satisfaction<\/a> and reduces regret<\/a>. <\/p>\n So, what is the review still considering?<\/p>\n There have been more than 2,700<\/a> public submissions to the review, with more than 92% in favour of public funding. The evidence highlights the low regret rates<\/a> after surgery and the benefits for mental health<\/a>. <\/p>\n The Medical Services Advisory Committee has requested further work<\/a> over two stages. <\/p>\n The first stage is an assessment of the evidence on clinical outcomes to understand: <\/p>\n