gender reassignment surgery nz cost

Gender Affirmation Surgery

Gender Affirmation Surgery is performed to change a person’s sexual characteristics to better reflect their gender identity.

These surgeries can give relief from gender dysphoria, increase safety and comfort, and lessen or eliminate the need to take hormone therapies.

Overview of gender affirming surgeries

Gender affirming surgeries are usually categorised as trans masculine or trans feminine. However, gender non-conforming people who do not identify with a binary gender of male or female may also need or choose to have surgery.

There are a number of gender affirming surgeries available at our hospital. These include surgeries for the genitals, chest, face, and other areas of the body. People may choose to get one or more surgeries, depending on their needs and situation.

Types of surgeries available:

For a transwoman

• Orchidectomy
• Penectomy and vaginoplasty
• Breast augmentation
• Facial feminisation
• Thyroid cartilage reduction
• Voice surgery
• Others: hair transplant, gluteal augmentation, lipofilling.

For a transman

• Oophohysterectomy
• Vaginectomy
• Scrotoplasty + implant
• Urethral lengthening
• Metoidioplasty or Phalloplasty + implant
• Chest contouring
• Thyroid cartilage augmentation
• Others: liposuction, pectoral implant.

At Wakefield we are privileged to have Dr Rita Yang perform gender affirmation surgeries at our hospital. Rita has comprehensive training and is New Zealand’s only specially trained Gender Affirmation surgeon.

Gender reassignment

Our surgeons do not have experience in genital reassignment surgery or any laryngeal procedures, which is why we do not offer these procedures. However, they both support the WPATH principles of multidisciplinary care and the need for psychological and endocrine support. Mr Bialostocki and Mr Adams will consider chest, body and facial contouring surgery in appropriate patients where there is a referral from a general practitioner and support from the patient's psychiatrist.

WHAT DO i GET WHEN I PAY FOR PLASTIC SURGERY?

Plastic and reconstructive surgery is a specialised branch of medicine which requires many years of training. Following medical school both Mr Adam Bialostocki and Mr Brandon Adams undertook near 10 years of additional training and were awarded a Fellowship in Plastic and Reconstructive Surgery (FRACS). They both went on to undertake training in aesthetic (cosmetic) surgery and complex reconstructive surgery with leading experts.

IMPLANTS AND GARMENTS

If your surgery requires implants or a special post-operative garment then these will have a cost associated with them.

Your follow up at six weeks, including any wound care and appointments, is included in your surgeon's fees. Costs for revision surgery is not included.

To perform safe surgery a high quality operating facility is required. Extensive surgery requires overnight hospital stays with skilled nurses.

Private hospitals charge for time used in the operating theatre, recovery time and day stay or overnight hospital stays. In addition they charge for all equipment used such as sutures, dressings, disposable instruments and drapes.

Mr Adams and Mr Bialostocki only operate at private hospitals with highly trained nursing staff who care for you after your operation in recovery, and on the ward if you stay overnight.

SKILLED ANAESTHESIA

Any surgery requiring a general anaesthetic (going to sleep for surgery) or sedation requires a skilled anaesthetist. Anaesthetists are skilled doctors who require at least seven years training after medical school to achieve the highest standards of skill and safely.

Your comfort and safety is the result of team work between all of the doctors and nurses who will care for you. If you have complex medical conditions you may need additional assessments prior to surgery.

WHAT IF I NEED REVISION SURGERY OR HAVE A COMPLICATION?

Most of the time surgery goes well and wounds heal without problems. However, no surgical treatment is completely risk free. So, if you are having elective or cosmetic surgery it is especially important that you understand this. The general complications of surgery which occur with some regularity include:

Allergic reactions

Complications of sedation or general anaesthetic.

If there is a complication that requires further surgery – you or your insurer will be responsible for any further costs.

FINANCIAL CONSENT

The estimates of cost provided are estimates only and are not based on what is needed by any particular patient. If surgery is unexpectedly complex it may take longer then hospital and anaesthetic costs will increase. If a complication occurs and requires surgery there will be costs associated with repeat surgery. Mr Bialostocki and Mr Adams do not control the hospital or anaesthetic costs.

Breast reduction

Breast reconstruction, skin cancer surgery, abdominoplasty (tummy tuck), facial cancer surgery, gynaecomastia, scar revision, microsurgery, nerve surgery (carpal tunnel), parotidectomy, acc surgery, gender reassignment, hand surgery, brazilian butt lift, surgical buttock lift, otoplasty (ear reshaping), breast enlargement, breast lift (mastopexy), blepharoplasty (eyelid lift), rhinoplasty (nose job), neck lift surgery, labiaplasty, inverted or large nipples, contouring after weight loss surgery, facial contouring surgery, small volume fat grafting to lips or cheeks, brachioplasty (arm lift), thighplasty (thigh lift), liposuction, learn more about .

The decision to undertake surgery to change body appearance to a gender different from birth gender is important and complex.

Mr Adams does not have experience in genital reassignment surgery or any laryngeal procedures and does not offer these procedures. He supports the WPATH principles of multidisciplinary care and the need for psychological and endocrine support. Tauranga and Rotorua-based Mr Adams will consider chest, body and facial contouring surgery in appropriate patients where there is a referral from a general practitioner and support from the patient's psychiatrist.

how long does  the operation take?

Time will depend upon the extent of the procedure.

WHAT DO I GET WHEN I PAY FOR PLASTIC SURGERY?

Plastic and reconstructive surgery is a specialised branch of medicine which requires many years of training. Following medical school, Tauranga hand surgeon Mr Adams undertook an additional 9 years of training and was awarded a Fellowship in Plastic and Reconstructive Surgery. He then undertook 18 months training in Aesthetic (Cosmetic) surgery and complex reconstructive surgery with leading experts.

IMPLANTS AND GARMENTS

If your surgery requires implants or a special post operative garment then these will have a cost associated with them.

Your follow up for 6 weeks, including any wound care and appointments are included in your surgeons’ fees. Costs for revision surgery are not included.

To perform safe surgery a high quality operating facility is required. Extensive surgery requires overnight hospital stays with skilled nurses.

Private hospitals charge for time used in the operating theatre, recovery time and day stay or overnight hospital stays. In addition they charge for all equipment used such as sutures, dressings, disposable instruments and drapes.

Tauranga plastic surgeon Mr Adams only operates at private hosptials with highly trained nursing staff who care for you after your operation in recovery and on the ward if you stay overnight.

SKILLED ANAESTHESIA

Any surgery requring a general anaesthetic (going to sleep for surgery) or sedation requires a skilled anaesthetist. Anaesthetists are skilled doctors who require at least 7 years training after medical school to achive the highest standards of skill and safely.

Your comfort and safety is the result of team work between all of the doctors and nurses who will care for you. If you have complex medical conditions you may need additional assessments prior to surgery.

WHAT IF I NEED REVISION SURGERY OR HAVE A COMPLICATION?

Most of the time surgery goes well and wounds heal without problems. However, no surgical treatment is completely risk free - if you are having elective or cosmetic surgery it is especially important that you understand this. The general complications of surgery which occur with some regularity include:

• Infection Delayed healing
• Bruising Problematic or unsightly scars
• Infection Injury to nerves, blood vessels, or surrounding structures
• Pain Distortion of surrounding skin or other structures
• Allergic reactions Poor cosmetic result
• Complications of sedation or general anaesthetic Further surgery or other treatments

If there is a complication that requires further surgery – you or your insurer will be responsible for any further costs.

FINANCIAL CONSENT

The estimates of cost provided are estimates only and are not based on what is needed by any particular patient. If surgery is unexpectedly complex it may take longer then hospital and anaesthetic costs will increase. If a complication occurs and requires surgery there will be costs associated with repeat surgery. Mr Adams does not control the hospital or anaesthetic costs

How much will this procedure cost?

Private hospital, the estimated costs of having, with mr adams at grace hospital is approximately, individualised estimates required.

* In addition to surgical fees, these figures include an estimate of hospital and anaesthetic costs.

private clinic

With mr adams at the da vinci clinic is approximately, just a thought.

"We can't direct the wind but we can adjust the sails"

"Life isn't about finding yourself, it's about creating yourself"

"Just remember that you're never to old to be young"

start your journey today

Tick the boxes of the procedures that you are interested in., reconstructive surgery, cosmetic surgery, appearance medicine, i'm here to help.

Before committing to any form of reconstructive or cosmetic surgery it’s important to understand the whole process. If you’re thinking about plastic surgery but don’t know where to start or what questions to ask, Tauranga plastic surgeon Brandon Adams is here to help you.    Working privately at Da Vinci Clinic or publicly at Grace Hospital in Tauranga, as well as at Central Health in Rotorua, Brandon is a trusted professional who prides himself on offering considered consultations. He will listen carefully to your goals and explain what cosmetic or plastic or cosmetic surgery procedures will help you achieve them.

DA VINCI CLINIC Ground Floor Vantage Building 359 Cameron Road  Tauranga 3110 P +647 578 5350 F +647 578 5354 www.davinciclinic.co.nz

CENTRAL HEALTH 1181 Amohia Steet  Rotorua 3010 P +64 7 578 5350 F +64 7 578 5354 www.rotoruamedical.co.nz

Gender reassignment

Mr Bialostocki does not have experience in genital reassignment surgery or any laryngeal procedures, which is why he does not offer these procedures. However,  he supports the WPATH principles of multidisciplinary care and the need for psychological and endocrine support. Mr Bialostocki will consider chest, body and facial contouring surgery in appropriate patients where there is a referral from a general practitioner and support from the patient's psychiatrist.

WHAT DO I GET WHEN I PAY FOR PLASTIC SURGERY?

Plastic and reconstructive surgery is a specialised branch of medicine which requires many years of training. Following medical school Mr Adam Bialostocki undertook near 10 years of additional training and was awarded a Fellowship in Plastic and Reconstructive Surgery (FRACS). He went on to undertake training in aesthetic (Cosmetic) surgery and complex reconstructive surgery with leading experts.

IMPLANTS AND GARMENTS

If your surgery requires implants or a special post operative garment then these will have a cost associated with them.

Your follow up for six weeks, including any wound care and appointments are included in your surgeon's fees. Costs for revision surgery are not included.

To perform safe surgery a high quality operating facility is required. Extensive surgery requires overnight hospital stays with skilled nurses.

Private hospitals charge for time used in the operating theatre, recovery time and day stay or overnight hospital stays. In addition they charge for all equipment used such as sutures, dressings, disposable instruments and drapes.

Mr Bialostocki only operates at private hosptals with highly trained nursing staff who care for you after your operation in recovery, and on the ward if you stay overnight.

SKILLED ANAESTHESIA

Any surgery requiring a general anaesthetic (going to sleep for surgery) or sedation requires a skilled anaesthetist. Anaesthetists are skilled doctors who require at least seven years training after medical school to achieve the highest standards of skill and safely.

Your comfort and safety is the result of team work between all of the doctors and nurses who will care for you. If you have complex medical conditions you may need additional assessments prior to surgery.

WHAT IF I NEED REVISION SURGERY OR HAVE A COMPLICATION?

Most of the time surgery goes well and wounds heal without problems. However, no surgical treatment is completely risk free. So, if you are having elective or cosmetic surgery it is especially important that you understand this. The general complications of surgery which occur with some regularity include:

Allergic reactions

Complications of sedation or general anaesthetic.

If there is a complication that requires further surgery – you or your insurer will be responsible for any further costs.

FINANCIAL CONSENT

The estimates of cost provided are estimates only and are not based on what is needed by any particular patient. If surgery is unexpectedly complex it may take longer then hospital and anaesthetic costs will increase. If a complication occurs and requires surgery there will be costs associated with repeat surgery. Mr Bialostocki does not control the hospital or anaesthetic costs.

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• Merchandise

The following is a list of recommended surgeons who perform various sex and gender affirmation and transition surgeries in New Zealand and internationally.

Each have different requirements of patients, changing costs, etc. Please see the websites linked for more info. There is also a link to a larger international database at the end of this section – please seek reviews and be sure the surgeon you choose is recommended.

Dr Rita Yang – GRS Surgeon Counties Manakau Auckland

David Glasson MB ChB, FRACS (Plastic) Bowen Hospital Churchill Drive Wellington

Christopher JW Porter St Georges Hospital Papanui Road Christchurch

Dr Julian Lofts Remuera Clinic 6 St Vincent Avenue, Remuera, Auckland

Chris Adams Hutt Vally DHB (public funded top surgeries in 2016)

Palmerston North Public Hospital Richard Coutts Other general surgeons (public funded top surgeries in 2016)

Dr. Chettawut Tulayapanich M.D. Chettawut Plastic Surgery Center Bangkok

Dr. Greechart Pornsinsirirak M.D. Yanhee International Hospital 454 Charansanitwong Road, Bang-O, Bangplad Bangkok

Dr. Kamol Pansritum M.D. MtF Surgery Center Kamol Cosmetic Hospital Bangkok

Dr. Juta Jansi Bangkok Beauty Surgery Center 37/4-6 Sukhumvit 13, Paknam, Muang, Samutprakan Thailand

Dr. Paiboon Chitprapai M.D. Bangkok Hospital Bangkok, Thailand

Dr. Pichet Rodchareon M.D. Bangkok, Thailand

Dr. Preecha Tiewtranon, M.D. Preecha Aesthetic Institute Bangkok, Thailand

Dr. Ruch Wongtrungkapon M.D. Ramkhamhaeng Hospital Bangkok, Thailand

Dr. Sanguan Kunaporn M.D. Phuket International Aesthetic Center (PIAC) Phuket, Thailand

Dr. Saran Wannachamras M.D. Saran Cosmetic Surgery Clinic Bangkok, Thailand

Dr. Somsak Kunachakr M.D. The Cosmetic Surgery Clinic Bangkok, Thailand

Dr. Suporn Watanyusakul M.D. The Suporn Clinic Chonburi, Thailand

Dr. Witoon Wisuthseriwong Clinic Soi 1 Bangkok, Thailand

The Samui Gender Reassignment Clinic Koh Samui, Thailand

Dr. Peter Haertsch M.D. Sydney, Australia

Dr Andrew Ives M.B. Ch.B(UK), FRACS (Plast.Recon.Surg.) Melbourne, VIC

Dr. Ceber Simon Victoria, Australia

Dr. Toby R. Meltzer M.D. 7025 N. Scottsdale Road Scottsdale, AZ

Dr. Marci Bowers, M.D . PO Box 1044 Trinidad, CO

Dr. Curtis N. Crane, M.D. Dr. Michael L. Brownstein, M.D. Brownstein & Crane Surgical Services 1001 Mariposa St., Ste. 101 San Francisco, CA 94107

Dr. Harold M. Reed, M.D., F.I.C.S. 1111 Kane Concourse Bay Harbor, Florida

Dr. Charles Garramone M.D. Aesthetic Plastic Surgery Institute PA 12651 W. Sunrise Blvd. Suite 102 Sunrise, FL

Dr. Sherman Leis, D.O., F.A.C.O.S . The Center For Plastic And Reconstructive Surgery 19 Montgomery Avenue  Bala Cynwyd PA

Dr. Toby G. Mayer, M.D. Beverly Hills Institute of Aesthetic & Re-constructive Surgery 416 N. Bedford Dr. Suite 200 Beverly Hills, CA

Dr. Christine McGinn, D.O . Papillon Center New Hope, PA

Dr. Daniel A. Medalie, M.D. Multiple Locations Cleveland, Ohio

Dr. Pierre Brassard M.D. Dr. Maud Belanger M.D. 995, De Salaberry East Montréal, Québec

Dr. Eric Bensimon M.D., FRCS 1003 boul. St-Joseph est Montréal,Quebec

Dr. Cameron C. Bowman, M.D., FRCSC Fairview Plastic Surgery Centre  Vancouver, BC, Canada

Dr. Hugh McLean McLean Clinic  50 Burnhamthorpe Road West Mississauga, Ontario  Canada

Mr. James Bellringer, MB, BChir, FRCS Bupa Cromwell Hospital 162-174 Cromwell Road London SW5 0TU United Kingdom

Mr. Chris Inglefield, BSc, FRCS St Olaf House London Bridge Hospital 13 Tooley Street London

Mr. Phil Thomas FRCS Nuffield Health Brighton Hospital Brighton East Sussex

Dr. (Col) S. V. Kotwal, M.S, M.Ch Sitaram Bhartia Institute of Science and Research New Delhi

Netherlands

Drs. MB Bouman Drs. ME Buncamper VU medisch centrum Amsterdam

Dr. RCJ Kanhai Medisch Centrum Alkmaar  Wilhelminalaan 12 hoofdingang Alkmaar

Dr. J. W. Mulder, MD VU Medisch Centrum Amsterdam, Netherlands Dr. FB Niessen Esthetisch Centrum Amsterdam Concertgebouwplein 11 1071 LL Amsterdam

Sava Perovic Foundation Surgery Serbia

South Korea

Yeson Voice Center Gangnam-gu, Seoul South Korea

Dr. Jesús Sáenz Dr. Jorge Sáenz Dr. Sáenz de Cabezón Barcelona, Spain

Dr. De Cat Marijke E. Cavellstraat 32  1180 Brussel

Dr. Stanislas Monstrey   Universitair Ziekenhuis Gent De Pintelaan 185 9000 Gent, België

Dr. Paul Daverio M.D. Klinik Sanssouci Helene-Lange-Strasse 13 14469 Potsdam, Germany

Here is a link to TransHealthCare SRS surgeon directory – which is an amazing resource that lets you search by area or by procedure.

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Trans-gender reassignment surgery

There is no public funding for gender reassignment surgery (GRS) in the public health system within New Zealand. Patients either self-fund or apply for funding from the nationally managed special high cost treatment pool (SHCTP). The current position of the Ministry of Health is that GRS does not meet criteria for the provision of funding through SHCTP. The Ministry of Health has requested this review with the aim of determining the level of evidence supporting the effectiveness of GRS in a subgroup of patients. This will better inform guidelines for the further consideration of applications under the SHCTP exceptional circumstances criterion.

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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A transition with a never-ending cost.

For trans* youth, finding support is hard and getting funding for surgery is even harder.

Oliver Rabbett was born with a female parts but began telling people he identified as a male when he was 16.

His family were supportive, he says, but for a while stumbled over the little things like pronouns and his new name.

Oliver’s face turns grim for a moment as he explains that his best friend couldn’t come to terms with his plan to transition and is no longer a part of his life.

“There are always going to be people that don’t understand, but if they don’t respect you then you don’t need them in your life.”

This story is true to the terms used by the people interviewed to describe themselves. Others may describe themselves using different language .

Oliver and his mum were going for a walk when he decided to tell her he no longer identified as a girl. “I turned to her and said, ‘Mum, I feel like a boy’.”

She began telling him stories from when he was a child, how he would scream and cry when she put him into a dress. T he stories proved to them both that he should have been born male. His mum wasn’t surprised and said “it all made sense”.

Oliver has since been diagnosed with gender dysphoria, a term used to explain that he doesn’t identify with the biological sex he was born with.

Support for trans* youth isn’t always easy to come by in New Zealand and funding for surgeries is even harder.

Surgeries like mastectomies are available for those transitioning from female to male but the cost is restrictive, but there is currently no one in New Zealand capable of performing sex reassignment surgery.

Oliver’s grandma took a little time to come to terms with his transition, but once she did she has provided unwavering emotional and financial support. She paid $13,000 for him to have his breasts removed by a private surgeon in Christchurch three years ago.

The surgery involved cutting into his chest and removing the breast tissue. His nipples were cut off, resized and then stitched back into place.

Oliver shortly after having his breasts removed. Photo: Supplied

The surgery was followed by two months of recuperation during which he couldn’t move his arms above his head due to pain and stiffness.

Having his breasts removed went a long way for Oliver’s confidence. He becomes animated as he describes being able to wear tight t-shirts and wear what he wants.

For this, Oliver considers himself one of the lucky ones but he is aware the process isn’t so easy for other trans* people in New Zealand due to the cost of surgery.

Oliver began taking testosterone treatments three years ago. The hormone comes in vials and is injected into the top of his hip every two weeks.

To start hormone therapy he needed a letter from a psychiatrist saying that his biological gender was impacting his mental health and clearly doesn’t match how the gender he identifies with.

Before he was given his first injection of testosterone, Oliver was assessed by two hospital psychiatrists, who he describes as intimidating and scary.

“They’d only seen about two other trans people in their whole career. I felt like I was trying to prove myself, which was not a nice feeling.”

They’d only seen about two other trans people in their whole career. I felt like I was trying to prove myself, which was not a nice feeling.

The cost of transitioning gender is never-ending. Trans* people wanting hormone treatment are required to see a specialist at least once a year for the rest of their lives and each appointment costs up to $200.

Earlier this year, Oliver had his ovaries and uterus removed at the Christchurch Women’s Hospital. Gas used in the surgery escaped to under his lungs, leading to days of pain.

Despite going through two invasive surgeries and so far paying over $13,000, Oliver is considering getting genital reassignment surgery in the future.

There are currently 72 people on the waiting list for genital reassignment surgery. Only three surgeries for male to female reassignment and one female to male are funded by the Health Ministry every two years. There is currently no doctor qualified to do the operation in New Zealand.

The best someone wanting gender reassignment surgery can hope for right now is that they’ll be placed on the waiting list to have the operation done overseas.

To get on the list they must provide two psychiatric reports by senior psychiatrists and one report from a psychologist or social worker with experience in transgender people. They also have to prove they have undergone more than 12 months of continuous hormonal treatments, and document that they have been living and working fulltime for at least two years as a man/woman.

Four people are almost there, but the Health Ministry still needs to approve a surgeon overseas.

The Health Ministry says the male to female surgeries will continue to be provided overseas until a surgical team is able to provide the procedure in New Zealand.

Oliver was diagnosed with gender dysphoria, a term used to explain that he doesn’t identify with the biological sex he was born with. Photo: Supplied

One of the people on the waiting list is 20-year-old Katelyn Thomas.

Katelyn was born with a male parts but has lived as a woman for the past two years. She lives in Tauranga where she is studying to become a nurse.

Katelyn says there is no trans* community in Tauranga and has to rely solely on mutual friends to find other trans* people.

“If you know someone that knows someone who is trans it’s just like, ‘hook a sister up, let’s be friends’.”

Katelyn takes oestrogen pills and has had Botox and lip fillers in order to look more feminine, but she wishes to take her transition the whole way, including having genital reassignment surgery.

For people with male parts, this surgery means using the skin from their penis and scrotum to form a vaginal lining and labia. Surgeons can also create a fully functioning and sensitive clitoris from the penis glans.The surgery can cost up to $30,000.

Katelyn believes she is about number 60 on the waiting list.

“It’s so frustrating because you get so far in your transition and then hit a wall.”

It’s so frustrating because you get so far in your transition and then hit a wall.

Katelyn has been on hormones for two years. The oestrogen she takes causes her body fat to redistribute, giving her breasts and curves.

Hormones don’t have the magic effect that trans* people want, but they go a long way to help her look like a female, she says.

It wasn’t until she was standing in her underwear with a male friend in a full length mirror at Farmers that Katelyn realised what a difference the hormones had made to her body.

“I thought ‘that’s what my body would have looked like without the hormones’.”

Katelyn began her transition while she was still attending an all-male boarding school in Tauranga. She had to drive four hours to New Plymouth to see a hormone specialist.

Her high school’s dean drove her to the appointments and he advised her to freeze some of her sperm before she started taking oestrogen.

Despite having support from her dean, Katelyn’s school friends quickly became distant and stopped talking to her.“I would walk down the hall with another friend and people would yell names and throw fruit at us.”

Katelyn eventually left the boarding school after she attempted suicide. Despite all this, she is adamant that she will get the reassignment surgery.

“A lot of people think that being transgender is just playing dress up, but for many trans people the surgery is a key part of our transition.”

Katelyn believes that getting the surgery will change her life for the better. She says that people generally lose interest in her after she explains she is trans*. She believes this will change once she has had the reassignment surgery.

A lot of people think that being transgender is just playing dress up, but for many trans people the surgery is a key part of our transition.

“I get rejected by guys all the time. Trans or not, if I just had a vagina then it would be none of their business - they would never know.”

Dr Sue Bagshaw says everyone is waiting for a surgeon capable of performing the operation. As a doctor at the 198 Youth Clinic in Christchurch, she has seen first-hand the effects of the lack of funding and support going into trans* health care.

The clinic is one of the few places in New Zealand that trans* youth can go to for  counselling and medical help.

Dr Bagshaw says she believes the cost is one of the main things preventing trans* youth from having surgery. She believes surgeries such as mastectomies and hysterectomies can make a huge difference to people’s lives and should be cheaper. 

“It’s touch and go as to what’s cheaper: going overseas and paying for both the travel and the operation, or getting it done here.”

She explains that suicide, anxiety, social phobias and depression are among the effects of trans* youth not getting the support that they need. “Some of them won’t face people because they just can’t face living a lie.”

There needs to be a “one-stop” clinic where people can come for their counselling, medical advice, hormone treatments and surgeries, Dr Bagshaw says.

“It just makes their lives turn around and be so much better if they can get these things done.”

This content is brought to you with funding support from  NZ On Air .

Copyright © 2015 , Radio New Zealand

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New Zealand Lifts Gender Reassignment Surgery Cap, Reduces 30-Year Waiting List

The New Zealand government has lifted the cap on gender reassignment surgery after building up a 30-year waiting list and plans to dramatically increase the number of surgeries available to transgender patients, reports the Guardian .

The number of publicly funded surgeries was previously capped at three male-to-female surgeries and one female-to-male every two years, resulting in a 100-person waiting list spanning multiple decades. The new Labour coalition government will flip the policy on its head, and make the previous cap the new minimum, no longer implementing a cap for the maximum number of surgeries.

In the 1990s, New Zealand was a world leader in gender reassignment surgeries, offering low-cost procedures and welcoming patients from around the globe with a progressive and open attitude. However, when the country’s only specialist in the surgery retired in 2014, the waiting list increased exponentially and patients were forced to risk accepting low-rate surgeries overseas.

Click here to continue and read more...

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• In short: Only a handful of Australian surgeons offer certain gender-affirming procedures, meaning transgender people are waiting for years or seeking options overseas
• What's next? An application has been made to list gender-affirming surgeries as specific Medicare items, to help address high costs and low availability

For trans woman Abbie Clark, feelings of gender dysphoria have been coming and going since she was a kid.

She didn't initially know what it meant to be trans, but she knew she would rather be a woman than a man.

"When I wanted to transition, I didn't know where to go," the 30-year-old Ballarat woman said.

"I didn't know what service I needed to look at, I didn't know who I needed to talk to."

Ms Clark had surgery on Trans Day of Visibility last year, three years after starting hormone treatment and a year-and-a-half after her consultation with the surgeon.

Transgender Australians are spending years waiting for gender-affirming surgery, which is still required in some states to change birth certificate gender markers.

Gender-affirming surgery refers to a variety of procedures, including mastectomies, breast augmentation, facial feminisation and vocal chord surgery, as well as genital surgery.

Genital surgeries, such as vaginoplasty (creation of a vagina) and phalloplasty (creation of a penis), are known in the trans community as bottom surgeries.

Doctors in the field and trans people say there are only five Australian surgeons regularly performing these procedures. 

Ms Clark's out-of-pocket surgery costs were $25,000, which would have been much higher had she not had private health insurance, which covered around $15,000 in hospital expenses.

Medicare contributed about $2,000 to the surgeon's fees.

"A lot of it's considered cosmetic. It's not, because in many cases, it is literally life-changing," Ms Clark said.

Now, for the first time, an application has been made to the commonwealth health department to list gender-affirming procedures on Medicare by the Australian Society of Plastic Surgeons. 

Trans people, surgeons and advocates argue a better system of public funding for the surgeries could cut costs for patients and hospitals, as well as address availability concerns.

Australia 'behind other countries' on gender-affirming care

The president of the Australian Society of Plastic Surgeons, Nicola Dean, said the society made the Medicare application to the Department of Health as part of a collaborative effort with trans organisations and other health professionals to improve access to the surgery.

Dr Dean said this could incentivise more surgeons to join the field and provide better data on how many surgeries were taking place in Australia.

"A lot of it goes on a bit under the radar," she said.

"I think Australia is really quite behind other countries."

A Department of Health spokesperson confirmed it had received an application requesting the Medical Services Advisory Committee (MSAC) consider publicly funding gender-affirmation surgery and consultations under Medicare.

The department is currently considering if the request is suitable to be considered by MSAC.

A spokesperson said some Medicare rebates were already available "if the services are deemed by the treating practitioner to be clinically relevant to the care of their patient".

Surgeons have told the ABC the lack of specific Medicare item numbers for gender-affirming surgeries means costs are unpredictable and not transparent, and some procedures aren't covered.

In 2021, a petition to federal parliament for gender-affirming surgery to be included on Medicare gained nearly 150,000 signatures — the fifth most-signed petition on the Australian parliament website.

Surgeons inundated with hundreds of booking requests

Clinical guidelines written by the Royal Children's Hospital Melbourne and endorsed by the Australian Professional Association for Trans Health (AusPATH)  advise delaying genital surgery for trans people until adulthood . Surgeons spoken to by the ABC said they would only perform bottom surgeries for people over the age of 18.

Kieran Hart, a surgeon at ACT Urology in Canberra, said he had been swamped with requests for vaginoplasty and orchiectomy (removal of testicles) procedures. 

In Dr Hart's first year in 2018, he performed three gender-affirming surgeries. Last year, he did 60.

He has about 150 people booked in for surgery, and 100 for consultations. His waiting list has only recently reopened.

"There's been hundreds who have been trying to get consults while I closed the books for a while," he said.

The wait time is around two years, and about 90 per cent of his clients come from interstate.

He said private hospitals doing gender-affirming surgery "almost lose money" because the procedures were not listed on Medicare, meaning surgeons have to use different item numbers that   don't quite line up with the procedure.

But Dr Hart said seeing the outcomes for trans women made it some of the most rewarding work a surgeon could do.

"It's just quite remarkable how resilient they are, but also what difference you make to their happiness and mental health," he said.

Advocates point to numerous studies which back the mental health benefits of gender-affirming surgeries for adults.

In a 2014 peer-reviewed study of 188 trans Australians, the 42.5 per cent of respondents who had undergone gender-affirming surgery reported higher levels of physical and mental health than those who had not had surgery . The difficulties in accessing surgery in Australia mean post-surgery survey sample sizes tend to be small.

A peer-reviewed analysis of the 2015 US Transgender Survey , which had 27,715 respondents, found the 13 per cent who had undergone gender-affirming surgeries in the preceding two years experienced a 42 per cent reduction in psychological distress and a 44 per cent reduction in suicidal ideation, compared to those who desired surgery but had not had it.

Not all trans people wish to undergo surgery, and for many of those who do, it is not financially viable — with nearly all surgeries taking place in the private system due to state government policy settings on elective surgery.

For trans men, getting a phalloplasty in Australia is even more difficult, with only two surgeons offering the procedure.

One is Brisbane-based Dr Hans Goossen, whose new patients might expect to wait six to 12 months for an initial consultation.

After completing surgical training in urology and reconstruction, he spent two years overseas learning the skills to do gender-affirming surgeries.

"It's still a relatively new field in Australia," he said.

"Until recently, most patients had to travel overseas."

Bottom surgeries for trans men include metoidioplasty and phalloplasty.

An insured patient might expect to pay $80,000 out-of-pocket, for what is a complicated and lengthy series of three or more operations. This includes costs associated with the surgery, anaesthetic, hospital stay, preparation and recovery.

"I understand people's frustration with the fact that it's currently not available in the public hospital system, and that it costs a lot of money and it's therefore not affordable for everyone," he said.

Dr Goossen wants to see federal or state governments fund a certain amount of surgeries per year, like in New Zealand , reducing the need for patients to spend tens of thousands of dollars on the procedures.

Another surgeon, David Caminer, started regularly performing phalloplasty and vaginoplasty procedures this year at his practices in Sydney and Wollongong.

Dr Caminer said even if the procedures ended up being listed on Medicare, patient costs would still be high due to Medicare not keeping up with inflation.

"The only way to get it cheaper, or for nothing, is to do it through the public hospitals," he said.

He said some private hospitals were religious, and did not permit gender-affirming surgeries to be performed or taught there.

"They won't allow you to do it, because it's not really keeping with their religious belief," he said.

After a religious hospital told Dr Caminer he could not perform a phalloplasty on a patient there, he's struggled to find another hospital with an intensive care unit to do the procedure. The patient has pre-existing health conditions so would require close monitoring.

"There's not that many intensive care units in the private sector," he said.

"It's taking me a lot of time and effort, we're still trying."

Official training and support needed, surgeons say

To address the surgeon shortage, Dr Hart said the relevant medical societies and colleges could do more to introduce trainees to gender dysphoria theory and basic gender-affirming procedures.

"The College of Surgeons, we don't have a formalised training pathway for it at this point in time," he said.

"It's not really recognised in the curriculums for the Urological Society or the plastic surgeons' society."

A spokesperson the Royal Australasian College of Surgeons (RACS) said gender-affirming surgery was complex and required multidisciplinary consultation.

"While RACS supports the training of gender-affirmation surgery, it is important to note that the limited number of cases and the highly specialised nature of this field requires specific focus for a limited number of surgeons," they said.

Dr Dean from the Australian Society of Plastic Surgeons said in conjunction with RACS, her organisation provided plastic and reconstructive surgery training which was applicable to gender-affirming surgery, but there should be funding to send surgeons overseas to learn.

"We do have the basics of how to do the genital surgery, but it does need expertise to be built up," she said.

"And I think that it will take quite some time for people to learn off the few Australian surgeons that are doing this surgery."

Thailand a better option for some trans Australians

About one in five patients access their superannuation to pay for surgery at Dr Hart's clinic, he said.

Sav Zwickl, a director with AusPATH, said this could put a financial strain on trans people.

"They spend years saving for surgery, and there's often no option but to access their super and, of course, that has long-term implications down the road for their financial situation," the researcher, who is trans and non-binary, said.

Dr Zwickl said many trans people went to Thailand for surgery, where surgeons were generally "very skilled and experienced in performing gender-affirming surgeries".

"That's a case of a lack of surgeons [in Australia], but also some procedures that people are looking for are not available in Australia at all," they said.

Anne *  went to Thailand for her bottom surgery in 2012, after being quoted $30,000 for surgery in Australia.

"Surgery in Thailand was a lot more affordable than what it was in Australia," she said.

"Thailand has been performing these surgeries over there for thousands of trans women for decades."

To fund the surgery and overseas trip, she spent more than two years living in financial hardship.

Without surgery, she wouldn't have been able to change her gender marker on her Queensland birth certificate, a requirement that only changed in June.

"I wanted to make sure that all my legal documentation was consistent," she said.

"Without having a birth certificate and official documentation, you're always having to explain yourself."

New South Wales and Western Australia are the only states still requiring gender diverse people to undergo medical procedures to update their birth certificate gender marker.

In WA, a "gender reassignment board" judges applications by trans people to change their gender, although the state is in the process of repealing these laws.

Surgery and the approval of a panel is required to legally change gender in NSW, but a spokesperson for the attorney-general said during the election campaign, Labor had committed to reviewing the legislation in consultation with trans and gender diverse communities.

The spokesperson said work had not yet started on reviewing the legislation.

Post surgery and legal recognition, life's a bit easier

Anne said she had no regrets about her decision to get surgery.

"It stopped the gender dysphoria, the thoughts of self-harm and suicide that I was experiencing," she said.

It's not lost on her that many trans people struggle to access surgery, but she's grateful to have a body she feels more at home in.

"I finally felt complete," Anne said. 

Ms Clark can breathe a sigh of relief having overcome the hurdles of surgery.

"I've honestly never been happier, now that it's finally all sorted," she said.

"I occasionally catch places where I've forgotten to change my name, but by and large, it's so simple now."

*Name has been changed.

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Girl Suffering Gender Dysphoria Attempts to Remove Breasts After Watching YouTube

Friends Read Free

A New Zealand teenage girl suffering from gender dysphoria has attempted to conduct a self-mastectomy after watching a tutorial video on YouTube.

According to the report, an 18-year-old girl with gender dysphoria tried to cut off her breast at home after watching a “how to” video on YouTube, preparing the equipment, and marking the incisions.

She also reportedly considered analgesia (pain relief medicine) and haemostasis, a process to stop bleeding.

At the time, the teenager was already on testosterone and was on a gender transition surgery waiting list.

When she rushed to seek medical attention several hours later, health professionals conducted complete breast removal surgery.

The report noted that the surgery came following discussions about the risks, including irreversible damage, poor cosmetic outcome/asymmetry, and loss of both nipples.

It also, however, described the incident as “an act of desperation” due to “long wait times of referral in the public healthcare system, an inability to afford a private consultation, and the significant psychological stress of having breasts at an upcoming pool party.”

It claimed that the operation was “uncomplicated” and the girl was discharged after one day.

Self-Attempted Mastectomy Or Self Mutilation?

“In Aotearoa New Zealand, limited access to gender-affirming surgery due to resources is an increasing issue. Currently, there is only one surgeon performing gender-affirmation operations,” it stated.

New Zealand’s local media has also adopted a similar tone when reporting on the issue.

But Rachael Wong, CEO of Women’s Forum Australia, a women’s rights think tank, argued such an angle distorted the truth.

She said the case should be looked at as a “teen girl told lies she’s a boy, self mutilates.”

“It should be triggering urgent action against a dangerous ideology that’s disproportionately harming teen girls.”

Risks Of Mental Illnesses

However, the 18-year-old girl was among a few cases of people who self-mutilated and “did not have a psychiatric disorder.”

There were 11,621 young people on puberty blockers in 2022 (3,143 females, 8,406 males, and 72 people of “unknown” gender) compared to 6,181 people in 2012 (1,013 females, 5,158 males, and 10 people of “unknown” gender).

• Lifeline 0800 543 354
• Youthline 0800 376 633
• Suicide Crisis Helpline 0508 828 865 
• Lifeline: 13 11 14
• Kids Help Line: 1800 551 800
• Beyond Blue: 1300 22 4636

‘Needs to Be Made Sustainable’: PM to Lower Future NDIS Funding Increases