Trans people remain one of New Zealand most discriminated-against groups – and nowhere more so than in the provision of healthcare. Why are people in desperate need continuing to wait decades for potentially life-saving surgery, asks Madeleine Holden.

If 2015 was the year of trans visibility, then the protection of trans rights has became an even more crucial issue in 2016. The election of Donald Trump as US President has left LGBT advocates reeling and trans people and their allies fearful of how they will fare under the new regime.

Despite the visibility of high-profile trans celebrities like Caitlyn Jenner and Laverne Cox in recent years, ordinary trans people in America continue to face discrimination, poor mental health outcomes and lowered quality of life on a daily basis.

That’s America, though – what about New Zealand, our little progressive bastion in the South Pacific? We don’t hear as much about transgender rights in the media here, nor do we have the same lineup of high-profile trans celebrity advocates that America does, but surely we’re more progressive than the land of evangelical Christianity and “pray the gay away” style conversion therapy?

Turns out, however progressive we might be down under, the situation at home is far from ideal. Trans people in New Zealand face similar levels of discrimination to those overseas, and have equally poor mental health outcomes. Transgender youth in New Zealand face frequent bullying (weekly or more) at a rate five times higher than their cis peers.

A 2008 Human Rights Commission report looking into the experience of discrimination faced by trans people in NZ found that they faced discrimination in all areas of their lives, from levels ranging from “constant harassment and vicious assault” through to “daily challenges to find acceptance and do the things other New Zealanders take for granted.” The report concluded that “Trans people have had to triumph over severe, sometimes heart-breaking, adversaries.”

One such adversary is the ongoing battle for access to appropriate healthcare. The inquiry found significant gaps and inconsistencies in the provision of health services, and concluded that most trans people cannot access the gender reassignment services necessary for them to live according to their gender identity:

“There are very significant barriers for trans people at each stage of a medical transition process. For many, genital surgery is a very long-term goal and the more immediate hurdles will be seeking information, counselling or psychotherapy support, trying to access hormone treatment, obtaining electrolysis (for trans women) or chest surgery (for trans men). Without such medical interventions, many trans people struggle to be themselves or to participate fully in their communities.”

For trans people in New Zealand, getting information and guidance on gender reassignment surgery is a minefield. Many trans people who went to their general medical practitioner seeking initial medical information found that their doctors were unlikely to have any prior knowledge about trans health issues.

“You don’t know anything at first. You ask your local GP and they don’t know,” commented one trans woman, who remained anonymous, and a trans man added that he “always [had] to start from the beginning and teach them rather than concentrate on my own wellbeing and have them help me.”

Even after the process for reassignment surgery has been demystified, trans New Zealanders face hurdles every step of the way, especially in terms of access. And, after the retirement of New Zealand’s only specialist reassignment surgeon, the prospects have become even bleaker.

Jennifer Shields, a trans advocate and trans woman, wanted to check in on the waitlist for trans feminine surgeries, which had been previously reported as 30 years long. On 31 August 2016, the Ministry of Health responded to her Official Information Act request, and the results were worse than previously imagined.

The waitlist for trans feminine surgeries is now 71 people long, which, at the present rate, means it clocks in at a staggering 50 years – a wait that, for quite obvious reasons, puts the surgery out of reach for practically all trans New Zealanders depending on the public healthcare system. No other medical procedure in New Zealand has a waitlist approaching even close to 50 years, and for trans New Zealanders contemplating the surgery, the current waitlist stifles all hope.

It’s also worth noting that, even if a trans person is on the list, that fact alone doesn’t automatically render them eligible for surgery. Surgery depends on a number of factors including age, mental health, the availability of psychiatric reports and the length of time the candidate has lived in their chosen gender role. The Ministry has no plans to increase the frequency of surgeries and will stick to their current rate of three surgeries every two years. It’s possible for trans people wishing to undertake gender reassignment surgery to travel overseas and pay privately, but at a cost of around $20,000 NZD, it’s beyond the means of most trans New Zealanders. The OIA response also includes a request from the Association of Plastic Surgeons for the creation of a fellowship so that a local surgeon can be trained in these surgeries to either perform them here or provide post-op care, at a cost of around $100,000 per annum. According to the Ministry there is no funding for this. The failure to invest $100,000 per annum for these surgeries is, not to put too fine a point on it, pretty gutless: it’s a paltry amount in terms of government spending and a necessary investment in light of the current length of the waitlist. A common, unsympathetic response to the waitlist is to roll one’s eyes and explain that gender reassignment surgery is “elective” or “cosmetic”, and therefore not as important as hip replacements and triple bypasses. Shields disagrees, and argues that, for a huge number of trans people, the surgery is literally lifesaving:

“For so many [trans people], just “working on being okay with it” isn’t a possibility; it isn’t something that can just go away at all. Our community already has huge rates of mental illness, substance abuse and suicide, and pretty much every professional out there agrees that these surgeries are lifesaving for those who need it.”

The WPATH Standards of Care for Gender Identity Disorders – first issued in 1979 to articulate the “professional consensus about the psychiatric, psychological, medical and surgical management of GID – clarify that gender reassignment surgery is “unequivocally” medically necessary:

“Sex reassignment plays an undisputed role in contributing toward favorable outcomes… The medical procedures attendant to sex reassignment are not “cosmetic” or “elective” or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition.”

The WPATH Standards also clarify that these surgeries are not experimental – “Decades of both clinical experience and medical research show they are essential to achieving well-being for the transsexual patient” – and that they are cost-effective rather than cost-prohibitive. It beggars belief, then, that New Zealand won’t facilitate more than three of these surgeries every two years.

As the Human Rights Commission report clarifies, trans people aren’t embarking on a “lifestyle choice” – they are working towards the realisation of a core part of their identities: their gender expression. Gender reassignment surgery is, in many cases, a crucial component of this journey. It’s not “elective” or “cosmetic”: it’s medically necessary and, in some cases, literally a matter of life and death for the trans New Zealanders who need it.

New Zealanders are increasingly alive to the importance of improving our mental health outcomes on a societal level. Unless this is little more than lip service – and unless we don’t think trans people deserve the same level of care as the rest of us – the Ministry of Health must do more to decrease the waitlist for gender reassignment surgeries.

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