Soul Mehlhopt talks about the process of surgery and the challenges facing the transgender community.

In New Zealand, transgender people can wait decades before being given the opportunity to undergo life-changing surgery. Georgia Forrester chats to two transgender men about their lives.

For many transgender people, their "lightbulb" moment – a moment of stark realisation – happens at a young age.

Soul Mehlhopt was born in Rongotea, as a girl. But at just 16-years-old, he knew he was really a boy.

David Unwin/Fairfax NZ Soul Mehlhopt talks about being transgender, the process of surgery and the progress needed in the transgender community.

His lightbulb moment sparked while watching cosplay videos – the type where people dress up as their favourite pop culture characters.

The cosplay character in question was binding his chest. Confused, Mehlhopt asked the friend he was watching with what the purpose of the binding was.

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The response: "Oh, he's trans".

"After that I went home and watched all his videos and just researched and researched and things just started clicking.

"It was just a real lightbulb moment. It just developed from there."

Looking back on his childhood, the 22-year-old says there were a lot of pieces that fitted together.

There were the times he refused to wear t-shirts while swimming, because his brothers didn't have to.

He was just "always hanging out with the boys".

And then there were the massive tantrums after being told he would grow up and have to wear a bra.

"They are the kind of tantrums that I guess parents are really embarrassed by when their kids have them in public – flop down on the floor and yell and scream."

Like a jigsaw puzzle, it all clicked in place for Mehlhopt.

"If you looked at them all together you would think, 'oh yeah, this is definitely going to happen'."

Kyle Vaughan realised he was transgender a bit later in life.

"I must have been 22-23. I just kind of had this lightbulb moment when I was thinking about how I would be for the rest of my life... I thought about living life as male. I could see that and I could see that I wouldn't regret that.

"A month later, I had a binder and I just wasn't going back."

Vaughan was born in Wellington and spent the last few years of high school at Awatapu College, Palmerston North.

He didn't want to be photographed, but spoke freely about his experiences.

During his childhood, Vaughan says he assumed everyone felt like him - a girl who felt like a guy.

"I think growing up I just didn't really understand why I wasn't a boy. But then everyone tells you that you are a certain gender so you just try to make the most of that...

"I think I had a different perspective to a lot of people I know.

"I just assumed that every chick wanted or felt like they were a guy, but couldn't be, and somehow found female things interesting. Of course, that's completely not what it's like, but in my head when I was a kid, that's how it was."

At 17, Vaughan came out as a lesbian to his friends, and from there on, he says he mostly had queer friends.

"It was harder for me to come out as gay than as trans. I think it was because of the friends I had then versus the friends I had when I was trans. Sometimes, it's just environment."

While his parents asked a lot of questions about the transition process, he says they eventually came around to the idea.

Few, if any, of Mehlhopt's friends at Freyberg High School, in Palmerston North, knew about his switch in gender. But at 17, he also told his family he was transgender.

His mother was "pretty sweet with it".

"She's a massive fan of Cher, so knew all about her son. We had a conversation and then talked about names and what name I would like to choose, and what she would have called me if I was a guy."

The hardest conversation was with his dad, but Mehlhopt says it was clear he was supported by him in every way, except financially.

The cost. The wait. The surgery

In New Zealand, the cost of gender reassignment surgery – genital reconstruction – from male to female ranges between $35,000 and $40,000, Ministry of Health chief medical officer Dr Andrew Simpson says.

For female to male reassignment surgery, it can be as much as $180,000.

The ministry has a high cost treatment pool, which provides funding to New Zealanders requiring transgender-related plastic surgery.

There is public funding available for three male to female surgeries and one female to male surgery every two years, he says.

However, there are 71 people on a waiting list for male to female surgery and 19 waiting for female to male surgery.

Information obtained from Capital and Coast District Health Board shows gender-reassignment statistics have fluctuated over the years.

But male to female surgeries have increased from one surgery in 2011, to four in 2015.

These surgeries were all performed overseas at the patients' cost.

In the past 10 years, there have been three female to male surgeries – one in 2007 and two in 2014.

Two of these reassignment surgeries were funded by the ministry's high cost treatment pool. No record of funding for the third surgery could be found.

Neither Mehlhopt or Vaughan have had gender reassignment surgery.

Mehlhopt says there are a lot of factors to take into account with bottom surgery, including time, quality and cost.

While it was not currently on the cards, he says that could change in a couple of years, depending on his financial status.

However, both Mehlhopt and Vaughan had top surgeries or chest reconstructions, to remove as much of the breast tissue as possible.

Luckily for Mehlhopt, his top surgery was publicly funded in July 2015.

He was on hormones for a couple of years and had multiple medical appointments with an endocrinologist at MidCentral DHB.

Within a year of having serious discussions about top surgery with his endocrinologist, Mehlhopt was called up for surgery due to a cancellation.

Because it was a general surgeon who performed the surgery, he had it at Palmerston North Hospital, rather than being transferred to Hutt Hospital for plastic surgery.

"I have a few friends who are on [the] high cost treatment pool and they're waiting ages for that. But they are on it to boost the numbers on it as well.

"So if they have to wait for surgery anyway, then why not chuck their name on a list and make a point to the Government. This is like something that is needed for our wellbeing, so we can function in communities and in society."

Vaughan, on the other hand, privately funded his keyhole top surgery, which cost him $14,000.

He had bound his chest for a year and a half and had been on hormones for about 10 months before having surgery.

He says he had looked to get the surgery done overseas, as it's often a quicker process.

However, luckily, he chose to have the operation in New Zealand, because he developed a haematoma following his surgery and ACC ended up covering the costs of the post-surgery side effects.

Post surgery

Mehlhopt says his surgery offered him a greater quality of life.

Before the op, he avoided swimming.

"You avoid it because you have to wear a bathing suit or you have to wear a t-shirt, or some people wear a binder swimming.

"It's not worth it, so you just stick your feet in the pool and that's about it."

But now, he says, he is no longer held back by anything.

Vaughan says surgeries "save lives" and offer people the opportunity to look and feel the way they want to.

"One of our friends is 20-something. She's on the waiting list and she'll probably be 60-65 before she gets it. That does something to a person – that lack of hope."

Simpson says there is no-one in New Zealand with the specific expertise and training to carry out the male to female gender reassignment surgery.

Female to male surgery is a highly specialised surgery and has always been carried out overseas.

Since the retirement of the plastic surgeon on the gender reassignment surgery team in 2014, the ministry has been working with the referring specialists and referring people for treatment overseas, he says.

Currently, all publicly funded male to female surgeries are provided overseas, until a surgical team is able to carry out the procedure in New Zealand, he says.

Moving forward

Vaughan says the influx of transgender people in our modern world is more about visibility and an openness to coming out.

But Mehlhopt says when it comes to navigating the health system and knowing what options are available, there is frustration and confusion felt by many people within transgender diverse communities.

"Most of the frustration comes from confusion and a massive lack of knowledge. So getting referrals turned down creates a lot of frustration, especially if you don't know of anywhere else to go and the only other option is privately funded stuff, which a lot of young people can't afford."

While the current wait for surgery could last decades for some trans people, on the flip side of things, Mehlhopt says having time to process life changing decisions, and meet with medical professionals, is extremely important.

Vaughan says despite the length of time, having a publicly funded waiting list gave people some form of hope.

"A lot of the time it's just hope that they need. Even if there's a two or three year waiting list for something, it's better than never having a waiting list to begin with."

Mehlhopt says there needs to be more conversation between trans people and medical professionals, psychologists and counsellors, so everyone can work together with the same goals in mind.

"What needs to be done is just having those conversations and working together and listening to the people who are using your services to try and make things better overall."