The Roxy Epoch

Transitioning gender is an uncharted heady mix of recasting your relationships with yourself, your family, colleagues, friends & strangers, for most, beginning a course of cross sex hormones to induce a second, more appropriate puberty, and for some, but not all, consulting one or more surgeons to determine what surgeries may be beneficial to your transition.

Earlier this year, I was invited by Plastic Surgery Hub to write a series of blog posts for their website. Plastic Surgery Hub are an award winning patient and practitioner website dedicated to connecting Australian patients with fully qualified and suitably experienced Australian Specialist Plastic Surgeons and practitioners. They have an extremely large presence on Social Media with over 23,000 unique members on their Instagram and Closed Facebook Groups and over 10,000 visitors to their website every week. 

It was an exciting, yet daunting, opportunity to put my words, and my life, in front of so many new readers. Here is my first instalment:

For as long as I can remember, I have been aware of the existence of cosmetic and plastic surgery, and what they meant to their partakers. I didn’t personally know anyone that had partaken, to the best of my knowledge, but I fully supported people doing what they thought best for their own bodies. I had no problem with others availing themselves, though I always knew that it wasn’t for me. But that was back when I thought I was a cisgender* man. Nearly three years ago, in a landslide of emotions and unearthed memories I realised that I was in fact a transgender** woman.  Now I’m on track to pay around $75,000 in surgery and associated costs over the next couple of years.

Nearly two years after first introducing into my body two delicious female sex hormones, and another to block my testosterone (the hormonal transition) and 8 months after I began presenting full time as female (the social transition), it is nearly time to commence my surgical transition. Three years ago I knew nothing about the types of transitional surgeries available, but now, finances notwithstanding, after years of extensive reading, watching and listening, I have a short list (in order of likelihood that each will actually happen) of gender affirmation surgery, breast augmentation, facial affirmation surgery and vocal affirmation surgery. 

Gender affirmation surgery, for me as I’m transitioning male to female, essentially means a vaginoplasty (removing my gonads and refashioning my genitals into a neo-vagina and labia. It involves quite a lot of rest and healing time: 6 to 8 weeks off work, 2 months of only gentle exercise and 3 months of avoiding everything energetic. This surgery I consider will be life saving.

Breasts continue to grow for years after commencing hormonal transition, so it is a good idea to wait until they stop growing before considering breast augmentation. Mine are still growing, so I have parked this decision for now.

Facial affirmation surgery would mean using certain specialised surgical techniques to bring my entire face to within normal female range. Most people haven’t considered this, but there are very few definitively gender based facial characteristics apart from male facial hair. Facial characteristics tend to exist in a spectrum and most people have a combination of both male and female characteristics that our brains use to sort faces into male, non-binary or female. My face, although generally male in appearance, is substantially naturally within normal female range, so any surgery would probably only require forehead feminisation, hair transplants, a lip lift and a rhinoplasty. 

Vocal affirmation surgery would mean using several tiny sutures to join only a few millimetres of my vocal cords together. This would increase the pitch of my voice to within normal female range. As I am currently undertaking specialist voice training that sounds like it will successfully bring my voice to within normal female range, I probably won’t end up proceeding with the vocal affirmation surgery.

To transition fully will cost me around $100,000 all up, and for someone that doesn’t have much in the way of savings (this is common for transgender folk as severe depression has often interfered with our ability to work what others would consider a normal work load), the financial impact is much more worrying to me than the surgical impact. One step at a time though. First off, I’m soon to have my first appointment with my gender affirmation surgeon. Waiting lists for this type of surgery are often around 7 to 9 months, so it isn’t something that is just around the corner for me, but I do have plenty to do in the meantime, so the time should pass quickly enough. Some of the waiting time is to force you to carefully consider that this is what you should be doing with your body … the implications of making the wrong decision are fairly dire. The rest of the waiting time is because although there are many cosmetic and plastic surgeons in Australia, only 1 or 2 surgeons are able to perform gender affirmation surgery for those transitioning from male to female. 2019 should be a very challenging year for me.

*Cisgender:  where a person’s gender identity matches the sex that they were assigned at birth.
**Transgender:  where a person’s gender identity doesn’t match the sex that they were assigned at birth.

Trigger warning: concept of suicide mentioned

I am 49. I was lucky enough to be born with white skin. I was lucky enough to be assigned male at birth. I am well educated. I have an accounting degree. I have variously worked as an accountant or bookkeeper for most of my working life. I am reasonably fit and healthy, and getting more so. I currently score towards the lower end of the normal range for depression, anxiety and stress. I am happier now than I ever remember being in the past. I live in a wonderful regional community. I have a fabulous group of friends and acquaintances. I have steady work that pays reasonably well. I have a sturdy roof over my head. I do not fear for my life. I generally do not fear for my safety.

By rights, given all of the above, I should be reasonably financially secure at this stage of my life. I should be well on my way to owning a home. I should be enjoying (at least occasional) overseas holidays. I should be indulging in enjoyable weekend leisure activities. Yet none of these things are true. I have very little in the way of savings, and most of what I do have is in the form of locked up superannuation. I am renting a room in a house owned by a friend of mine. I haven’t been overseas for about eighteen years, in fact my last proper holiday was well over 10 years ago. Large chunks of my weekends are spent resting at home, exhausted from hectic weeks. I don’t expect much of this to change.

You may wonder how this could possibly be true, given my background. Simples: I had the rather unfortunate luck to be born transgender into a family and community where that wasn’t welcome, or tolerated, sending me off in a spiral of chronic depression that lasted 3.5 decades. My depression and anxiety have only just faded away, after several years of bumpy transition. While now gone, they did both leave an indelible mark on my financial circumstances, having only allowed me to work part time for much of the past 15 years. 

Although I would have much preferred to have been born as a cisgender woman, living as a transgender woman isn’t so bad in my community. It’s certainly much better than having to pretend to be a cisgender man, anyway. My most significant problems are not social, they are financial.

I require three cross hormones daily to maintain, and progress, my transition:

• Spironolactone, my testosterone blocker, thankfully only costs me $8.25 per month
• Prometrium (progesterone) costs me $41.00 per month
• Estradiol (oestrogen) costs me $32.50 per month in patch form

As I understand it, once my gonads are eventually removed, I will no longer require Spironolactone, but that I will continue to take Prometrium & Estradiol for the rest of my life.

Removing hair from a body that was once male is ridiculously expensive:

• I have so far undergone about 104 hours of facial electrolysis (and yes, it is extremely painful), costing me nearly $7,000 directly, not including the 5 hours I need to take off work for each 2 hour session as there are no suitable electrologists within an hours drive. I probably have another 20 or so hours of electrolysis to go.
• I have spent over a thousand dollars on full body waxing in the past 2.5 years. Thankfully my body hair is finally starting to grow more slowly and more sparsely.

But these items are all small bikkies, really, compared to my planned surgical transition. I have recently received my initial quotes for my gender affirmation surgery scheduled for later this year. All going well, the direct costs for my surgeon, anaesthetist and pre and post procedure accomodation will cost about $24,000. Having no savings to speak of, I will be applying to the Australian Taxation Office to have $30,000 (super gets taxed upon release) of my “retirement” superannuation released to me on the basis that this procedure is life saving. Which it most definitely is. A life long fan of universal health care, I reluctantly signed up for the highest possible private health insurance coverage a year ago, for my surgeon will not operate unless this level of coverage is in place. At least this means that my 6 or 7 days in a private hospital should only cost me the amount of my excess. I will need approximately 2 months to recover from the procedure. This means I need to somehow save up enough money to get me through 8 weeks of no income while I am convalescing. I am hoping to get some small amounts back from IPTAAS, from my private health insurance and from Medicare, though the procedure and the amounts remain mysterious at this stage.

I had previously accepted that as universal health care in Australia had largely put trans folk in the too-hard basket, this was to be my problem to deal with, and the problem of every other trans person that needed to transition hormonally or surgically. This made it especially upsetting over recent days as my senses were constantly assaulted by budget announcements and commentary on “other peoples” health and welfare. Sure, many of the issues definitely deserve to be covered and dissected. The initial decision to omit Newstart recipients from the $75 energy supplement, the proposed flattening of the PAYGW tax scales and the decision to not increase Newstart in real terms are all appalling and deserve to be called out. New drugs are to be subsidised under the PBS at a cost of many hundreds of thousands of dollars per patient. For the patients concerned, this is great news.

I am not arguing that solutions to other peoples health and welfare issues are without merit. I am arguing that a contribution towards gender transition as low as $50,000 per person could save many lives and significantly reduce the incidence of mental illness in trans folk. I’m not sure of the percentage of trans folk that either take too many years to save up for their surgical transition, or are never able to afford to transition surgically, but I imagine it is quite high.  Transitioning genders has been estimated at costing individuals about $100,000.  

I imagine too, that many trans folk sadly don’t make it through this period. The psychological strain during transition is immense. I would like to start hearing more calls for gender confirmation surgeries to be made available in the public system. I would like to start hearing more calls for all cross hormones to be made available under the PBS.  I have heard many politicians recently wax lyrical about how they will strive to reduce the incidence of mental illness in the community through budget measures. The massive personally borne cost of transitioning, and sometimes massive delays in being able to commence transitioning, are a direct cause of significant mental health issues amongst trans folk.

Personally, the thought of having to use substantially all of my life savings to transition and then financially begin anew at 50 is quite distressing to me, if I let myself think about it, which I usually don’t. I find it distressing to think that this wouldn’t happen if I was born with a faulty heart or lungs. They would be fixed for me. I was unlucky enough to be born with the wrong genitals, so bad luck, it’s all up to me to rectify. I do consider myself lucky though, that at least I do have some super so I am able to buy myself another 20 or 30 years of life with it. This just means that I will need to work until I can’t work any longer, and then, who knows. Oh well. Lucky I like my work.

Warning: if I hear one more comment about whether or not someone will or won’t receive a $550 tax refund, be warned I will probably scream.