Sam Dengate has had to pay thousands of dollars during his gender-affirming journey, but he is hopeful the hefty costs could one day be a thing of the past.
He feels that change could perhaps be on the horizon after almost 150,000 people backed the parliamentary petition - the fifth most-signed in the system's five-year history.
Federal Greens MP Adam Bandt is set to table the petition in the House of Representatives on Tuesday.
Sam said the reality of gender-affirming surgery being covered by Medicare is something that he has "had to put to the side for such a long time, and almost not allow [himself] to think about".
"Because in my lifetime I didn't think it would ever be possible. It's almost borderline overwhelming to think that one day that would actually be possible," he said.
Not all trans people seek out surgical intervention, and the steps they take to affirm their gender are unique and personal decisions. But surgery can bring significant psychosocial benefits for those who want and are able to access it by alleviating gender dysphoria.
In Australia, it is a costly exercise.
While some gender-affirming surgeries have Medicare Benefits Schedule (MBS) item numbers that allow for a rebate, procedures are undertaken by private surgeons who set their own fees. This means that there is often a significant gap that needs to be paid out of pocket.
Private health insurance can help close this gap, but it's not something everyone can afford. And even with a health fund's assistance, costs can still be prohibitive.
A recent evidence brief by LGBTIQ+ health service ACON noted that a fully-insured individual seeking a vaginoplasty could still have to pay up to $20,000.
It also said that those seeking surgeries at multiple sites — for example, top and bottom surgeries — may face costs anywhere from $20,000 to $100,000.
Sam has felt the weight of the extreme financial burden first-hand.
Hormones, two surgeries, aftercare, and medical appointments and checkups have cost Sam Dengate about $70,000 over almost 14 years. Source: Supplied/Sam Dengate
Hormones, two surgeries, aftercare, and medical appointments and checkups have cost him about $70,000 over almost 14 years.
"I haven't quite classed my medical transitional journey as finished and that's already what I've had to spend to date," he said.
He said he had to work three jobs to pay for his surgeries because crowdfunding "and community support wasn't there the way it is now".
He said "at certain points" the exorbitant costs meant "you're choosing between quality of life and a roof over your head".
"You're choosing between safety and security, and affirmation and aligning with one's self and living authentically. And that's a choice you shouldn't have to make."
'An incredible sense of relief'
Bayley Turner transitioned about 18 months ago.
Bayley said everyone approaches their transition differently. But for her, it occurred the moment she "connected with womanhood".
"I'm now making other decisions about life, my body and my relationships and my connection to the people around me, and that is informed by that transition," she said.
She said the cost of surgery for those who seek it can be "incredibly alarming", and it comes "on top of every other means by which you need to go through your transition socially."
"The reality is that if you're someone who chooses to make a reconstruction of their genitals as a trans woman, you're looking at around a $30,000 out-of-pocket expense, and that's on top of health insurance," she said.
Bayley said while not all trans people choose to pursue gender-affirming surgery, the costs for those who do can be "incredibly alarming." Source: Supplied/Bayley Turner
And that's just for genital reconstruction. Other surgeries, particularly those that trans women might explore such as Adam's apple reduction, facial reconstruction in order to appear more feminine, hairline replacement surgery, and breast augmentation all come with additional costs, Bayley said.
She said it was "a shame society makes these surgeries imperative".
"Because without them our ability to hold down jobs, our ability to get stable housing, our ability to find a fulfilling relationship can be compromised," she said.
Her "genital construction has very little to do with [her] transition", and at this point, she is not seeking "such extreme steps forward."
But she said if Medicare was to help cover gender-affirming surgeries, it would be game-changing.
"What it would mean to me is an incredible sense of relief that I know that when I am ready, I can move forward without the inhibition of having to stop other important elements of my life in order to raise enough money to align my mental and physical wellbeing," she said.
She added: "It is health care that makes my body healthy. It's as simple as that.
"The issue that we have is that these surgeries are looked upon as cosmetic, and they are not cosmetic, they are lifesaving."
She hoped such a move "could open up more discussions among people to understand a more diverse range of trans experiences."
She said it would mean "trans people across all aged can live more comfortably, live more openly, and life more joyfully."
"And I think that will represent an incredible change in society where we're not seeing trans-ness as a form of illness or a form of difficulty or challenge or a form of sorrow. We're seeing it as a great flourishing of life and celebration and euphoria of self, and that can only have a positive impact on society," she said.
'It is lifesaving'
ACON's acting director of community health, Teddy Cook, said while some surgical procedures do have MBS item numbers, "the barriers trans people face when seeking such surgeries make access a key issue to the health and wellbeing of the community across Australia."
"For instance, facial surgery has been found to be one of the most critically important interventions for many trans women, and yet access is so poor locally that most women are forced to travel overseas to Spain, at their own great expense," Mr Cook said.
Mr Cook said "the term gender-affirming surgery comprises hundreds of specific surgical procedures", and they, as well as all other steps a trans person may take to affirm their gender, should be funded through Medicare.
While this step would be an important one to take, it's not the only issue that needs addressing.
"There are a number of state-based policy settings that effectively ban access to all gender-affirming surgical intervention taking place in public hospitals across Australia," Mr Cook said.
ACON's acting director of community health, Teddy Cook. Source: Supplied
"This means all surgery is performed privately or overseas, and the costs are prohibitive for most. Additionally, publicly funded access to surgery would also increase the number of trained and competent surgeons operating in Australia. Right now, we could almost count the number of surgeons available on one hand."
Senior research fellow in endocrinology at the University of Melbourne and lead of the trans health research group, Ada Cheung, agreed that expanding Medicare coverage of gender-affirming surgeries would help address the qualified surgeon shortfall.
Dr Cheung said hospitals would also likely need to set up units that focussed specifically on people undergoing gender-affirming procedures.
"You need a certain amount of infrastructure to support the surgical service," Dr Cheung said. "So if there's an emergency and the patient after a procedure comes to the emergency department, who are they going to call? They would usually call the unit that performed the surgery. So it's not just a single person, it's a team of people."
Dr Cheung and Mr Cook both said that making gender-affirming surgery more accessible was vital.
"The literature affirms that access to surgical intervention is a key driver to preventing trans suicidality and suicide," Mr Cook said.
"For a population that shoulders one of the heaviest burdens on mental health, access to surgery for those who seek it is lifesaving and must be enabled through our world-class public health systems."
A spokesperson from the Department of Health while there are "no specific or overarching MBS items for gender-affirming surgery", a range of individual surgical procedures and consultation services are listed.
"These items and rebates are available to patients for services deemed clinically relevant for their treatment by the patient’s doctor," the spokesperson said.
"The MBS items for specialist consultations with plastic and reconstructive surgeons and psychiatrists may also be relevant for some patients. There are a range of Medicare rebates for these services."
The spokesperson said the government is responsible for setting Medicare rebates, but it has no authority to determine what fees private medical practitioners charge.
"As a general principle, medical treatment provided in the private sector can also be provided in a public hospital, including gender affirmation surgery," the spokesperson said.
"However, decisions about which procedures are provided in public hospitals and waiting times are matters for each state government and its hospital network."
LGBTIQ+ Australians seeking support with mental health can contact QLife on 1800 184 527 or visit . also has a list of support services.
