There's a massive price tag on being transgender in Australia.

For some, the cost of surgery and treatment for gender dysphoria will crack $100,000.

The ABC's new podcast The Signal has been following one woman's effort to find the money she needs to transition, while living below the poverty line.

Stand-up comedy has been Cassie Workman's main income for the past seven or eight years.

Normally, it's just enough cash to scrape by, but recently she's also been diverting as much as she can towards an estimated $85,000 in medical, administrative and incidental costs associated with her transition to a woman.

That includes everything from surgery to taxis home at night, because of the elevated risk of assault for trans women.

So far she's cleared her first financial hurdle — to cover her first round of surgery in June.

"I exhausted pretty much every avenue I had at my disposal to get this first amount of money," Ms Workman said.

Beyond that, she's not sure how she'll cover costs.

"I was really lucky to have a lot of supportive fans who were able to contribute, who I'm eternally indebted to. But that's not something that I'd be able to do again," she said.

Ms Workman hopes to be able to afford facial feminisation surgery in 2019 as well as other cosmetic changes, but is bracing for a long process.

Ms Workman pays for taxis home at night because of the elevated risk of assault for trans women. ( Facebook: Cassie Workman )

Surgery is the most expensive part of her transitioning process, but she said the little things add up too.

"The most immediate one … is riding in an Uber or a taxi, because it's dangerous to be out at night," Ms Workman said.

"And hormone replacement therapy is an ongoing cost for the rest of your life … so you've always got to have something coming in."

Critical shortage of surgical specialists

As well as the high price tag, specialist care for trans people is in extremely short supply.

The Signal spoke to Dr Andrew Ives, a Melbourne-based surgeon who performs breast surgery, as well as male-to-female genital reconstructive surgery.

"From the genital surgical perspective, there's myself and another surgeon who I know of practising up in Sydney, but he doesn't do many [surgeries] any more," Dr Ives said.

"So essentially at the present moment, I'm doing most of the surgery I believe."

Stand-up comedy has been Ms Workman's main income for the past seven or eight years. ( Facebook: Cassie Workman )

According to Dr Ives, the shortage is essentially self-perpetuating.

"Because there's no formal centre for treating patients … there's nowhere really for any formal training of registrars who are coming through those specialities [like urology or plastic surgery] who might have an interest in it," he said.

It's not just a shortage of surgeons either.

Ms Workman said in Sydney she's only aware of two endocrinologists — the doctors responsible for hormonal treatment — who specialise in treating trans people.

"You cannot get in to see these people," she said. "If you miss an appointment, that's it. It's really crazy."

Lifesaving surgery

Ms Workman describes coming out as a lifesaving measure.

"I knew that I couldn't do it for another 35 years. I knew that there was no way," she said.

"That's why I drank and smoked and did a bunch of drugs and stuff, because I'd sort of hoped it would kill me before I ran out of energy. But it didn't, and I'm glad."

As well as the high price tag, specialist care for trans people is in extremely short supply. ( Facebook: Cassie Workman )

Although not everyone who transitions opts for surgery, or at least the same kinds of surgery, Ms Workman sees it as essential in her case.

Surgeon Dr Ives agrees that gender affirmation surgery for many is a matter of life and death.

"I mean the suicide rate for the trans community is significantly higher than the general population," Dr Ives said.

He argues it should be fully covered by Medicare, even though it doesn't fit the traditional definition of a lifesaving procedure.

"It's not like, [they] had an accident [and they] need to have the surgery or they die — those patients go to hospital they all get treated, full stop.

"This is sort of like if the patient wasn't able to access this surgery somehow, then they might consider trying to end their life."

In a statement, a spokesperson for the Department of Health said there are rebates for some surgical procedures and partial rebates for appointments with specialists.

The statement goes on to say the only way that support would change is on the recommendation of an expert advisory committee.