Category: Written by Roxanne

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. 

Nine days ago I attended my most recent GP appointment. Visiting my GP is a fairly regular occurrence for me these days. Transitioning has meant that between general checkups and pop-up medical issues, obtaining referrals to my milieu of medical specialists and subsequent GP followups, I have been seeing him on average a little more than once per month for the past three years. The purpose of my most recent visit was to renew my mental health care plan for 2019 … my fourth such plan since My Epiphany in 2016.  For those that haven’t yet taken advantage of a mental health care plan, I highly recommend them. They allow you to access a series of partially subsidised sessions with a mental health care professional. Being transgender, and then making the call to transition (not that there is actually any choice once you know you are transgender) is enough to destroy most people’s financial health, so every little bit of money you can claw back counts.

Having a mental health care plan in place is, for me, simultaneously about being able to access my psychologist at a cheaper rate, but at a baser level it is also about simply having the plan in place … having a plan helps guide you through the big stuff. In 2016 I visited my psychologist 6 times, firstly to make sure I wasn’t having some sort of breakdown or delusion. Once that was settled in the negative, my next aim was to try and understand why my brain had waited until what should have been the best parts of my life were over before it showed me the real me. I now clearly understand it’s logic and reasoning, but that’s a story for another day. Oh … and also to get a referral to an endocrinologist so I could start my long overdue hormonal transition. In 2017 and 2018 I only went to my psychologist 2 or 3 times both years. My brain had stopped whirling quite so vigorously by then, so I felt there wasn’t quite the pressing need. With the date set for my gender affirmation surgery rushing towards me (at the time of writing it is only 7 months away), I am expecting to use more of my allocated subsidised sessions this year … both before and after the procedure.

The first step in arranging my mental health care plan each time is to complete a DASS (Depression, Anxiety and Stress Scales). The DASS comes in a 42 question version for clinical situations, though my GP prefers the 21 question version … I assume because it only takes 3 minutes to complete, as opposed to 5 to 10 minutes for the longer version … a neater temporal fit for a GP appointment I suppose. The 21 questions seek to tease out any incidence over the previous week of hopelessness, lack of interest, propensity to anger, situational anxiety and the like. The participant answers either Never, Sometimes, Often or Almost Always for each question. This was my fourth attempt at a DASS21, so I well knew the drill. In the past I had usually stopped and pondered on at least a handful of questions … second guessing whether my annoyance was justified in a particular situation, for example. This time I breezed through nearly every question. I loitered ever so briefly on only one question. I was more sure of each answer, and more comfortable answering each question, than ever before. I was aware that my total completion time was much shorter too, but it was only when I had finished the last question and glanced back at my answers did I notice that I had circled ‘Never’ 18 times and ‘Sometimes’ only 3 times. This was a significant improvement on every other time, so I proudly slapped my pen down on the desk, swung the form around and slid it back towards my GP. I may also have ever so slightly puffed out my bosom.

He picked up my sheet of paper and with a satisfied, but slightly surprised, look on his face exclaimed “Well that’s a bit different to before!” I triumphantly beamed “Well I feel a bit different to before!” He tallied up my scores and almost off handedly said “Well … that all seems normal.” My first reaction was serene satisfaction, and was just about to move on when an overwhelming need for perspective kicked in. I realised that I needed to clarify what he, and The School of Psychology at the University of New South Wales, meant by normal. I needed to place this event in context, however painful my intervention may turn out to be. For it had suddenly occurred to me that the way I felt now … by far the best I have ever felt … is how I should have been feeling my whole life, but was disallowed by being forced to assimilate into a dangerously fictitious binary gender system. The enormity of the context struck me hard. The realisation that I have far more years of depression behind me than I will ever have years of joy and happiness in front of me is always painful. In these moments though, I try to remember my guiding rule that the way we live our life should be to never forget the journey that we undertook to get to the present, but to use that journey as a substrate on which to build our future, happier life.

5 or 10 seconds passed before I was finally able to ask “Are you telling me that this is how people normally feel?” In hindsight this must seem an absurd question for anyone that hasn’t either suffered from severe depression themselves, or otherwise aren’t intimate with it’s ravages. The usual guidance surrounding depression is to monitor extended periods of sadness and to seek help if the sadness persists. But no-one ever seems to have the magic solution for the people that have suffered from depression their entire adult life. I suspect a compulsory periodical DASS would help identify the cohort of people that suffer from long term depression but aren’t aware of it for whatever reason, but that is only my unqualified opinion. He said “Yes … I mean you won’t feel like this all the time … that won’t happen … but essentially … yes.” I protectively folded my arms a fraction of a second before my head collapsed heavily onto them, a reaction which thankfully prevented my head from hitting the desk hard. I stayed put, sobbing, with my head resting on my folded arms on the desk until I remembered that I wasn’t his only patient, and I probably should grieve elsewhere at another time for the past that I never had the opportunity to have. I could easily have stayed there and cried and cried and cried. But I had a new life to live.

I walked from my GP’s room a few minutes later, now chuckling at the emotional enormity of the past 15 minutes, clutching my mental health care plan in a white unmarked envelope. The two receptionists smiled at me, as they always do, and one of them asked of me “What’s so funny?” I proudly told them that my GP had finally declared me normal. They joined me in my chuckling. It is so very important to surround yourself with lovely, caring people.