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That’s cruel. There are more doctors that are qualified and willing to perform these procedures and I would argue that it’s the ethical responsibility of the public health system to do whatever it takes to utilize these doctors.
Tbh I'm always amazed by how trans care is so... whacky.
Like, the US is becoming more and more hostile towards trans people (especially trans women), and US healthcare means gender affirming care can be very expensive (especially surgery-related stuff). On the other hand, adults in the US can typically start HRT within a week of seeing a doctor because the US allows for informed consent; you see a doctor, request hrt, they inform you of the risks and effects, and if you consent, you can begin HRT. Then, if you have the money or really good insurance, you could be """finished""" transitioning (be on hrt and have gender-affirming surguries done) within a year or two. You probably still won't pass because I've been told it can take years for HRT to fully feminize/masculinize you, but at that point the only thing left is waiting for your body to do its thing.
Then you have Canada and European countries, where, based on what I've seen, they tend to be more accepting of trans people and trans care tends to be covered by the government (or so I've heard). However, they have all kinds of waiting periods, from being forced to wait several years to ensure you're "truly trans", waiting again to see if your surgery is approved, waiting again for an opening, waiting again because the doctor decided to take the week of your surgery off to go on vacation, etc.
Then you have Australia and New Zealand where you're forced to wait and there's no guarantee the government will cover the medical costs of transitioning.
Why is this so hard?
Why can't people get their shit together so it doesn't take a decade or more for someone to finish transitioning?
Considering the symptoms and side effects of gender dysphoria, it's unlikely someone suffering from gender dysphoria will be functioning at maximum efficiency. As such, while it might appear more expensive on paper, it seems like the impact of prioritizing gender affirming care (similar to how I assume people with cancer and disabilities are prioritized) would be cheaper long-term. The faster you get them care, the sooner they can start working at their maximum potential; and the sooner they start working at their maximum potential, the larger the benefit they can provide to society.
You've also got to remember the US health system is user pays, but most of the NZ health system is free.
The US system is faster because patients are customers... well insurance is but you get the idea. Ours if free, but prioritised by the needs of the whole. If you go private in NZ you have similar or better wait times.
10-12 years is a long wait time, even for triage.
Medical gatekeeping is also very much a problem. I started petitioning for bottom surgery 6 years before I was actually able to get it. Not because of any wait list or qualifications or anything like that. Purely because my doctor and my counselor thought I wasn't ready. Getting a new doctor here (Eastern Canada) takes close to a decade. So I had to wait till they decided I was ready. I was repeatedly told that my poor mental health made it so I couldn't get surgery. My mental health never magically got better. They just eventually changed their minds and gave me referrals. Having bottom surgery saved my life and dramatically improved my mental health. I spent 6 years in abject misery when I could've gotten the surgery to begin with and spent that much more time happy and moving forward with my life.
I'm very happy to have had it and I for once in my life see a future for myself and a life that is worth living. But there is definitely a bitterness about the way that multiple health professionals all seemingly misunderstood that my anatomy was a significant contributor to my poor mental health.
That's the real issue isn't it. In an informed consent system if your GP is a transphobe or clueless or ill trained then they can deny you care based on moon logic. Theres similar issues with sterilization on all fronts. It's rarer for vasectomies but still happens depending on where you are for the most part. You have to beg for sterilization because anything under the age of 40 is like " you're too young - you might regret it. So I, a person who doesn't even know you personally will tell you what is best for your situation and you're going to have to live with it because I hold the power over your bodily autonomy in my hands."
Like dude, I'll sign a waiver. It's not your lookout whether I'll regret it or whatever - just stay in your lane and do your bloody job. Made me angry enough I could have bent rebar between my teeth with how hard my jaw was clenched.
Like those are the practical arguments for informed consent, but I just keep coming back to a different reason: because it’s my body and that makes it my choice and my consequences.
A thing that is really frustrating about a lot of health care providers is they insist on using outdated "best practice" blood levels for trans fem HRT which puts our estradiol levels significantly lower than cis women.
Im lucky that I have a dr in cali who is good and insists on me having proper estradiol levels but in the past they were significantly lower with other doctors. And I can absolutely tell the difference I feel so much better with my current levels and physically the effects are noticable as well.
To clarify, in Australia, you're forced to wait for surgery, and the government won't cover it. But HRT is more accessible, and covered under our public healthcare system, so once you've got your prescription, it's cheap to access.
Just to add, although the US allows informed consent for adults, some of us are still required to do a certain number of months in therapy and/or provide letters from mental health professionals before we can access hrt or surgery, because that's what some health insurance companies require. Even then, ofc, the option does exist to do informed consent and pay out of pocket.
Yeah, 12 months lived in experience, 2 therapist letters (one had to have a PhD), and one primary letter to get me bottom surgery. Also they wouldn't even do the consultation before I get all that done so it was almost another year after that.
Oof, that's harsh. I'm glad you managed to trudge through it. It's not unlike how difficult, if not impossible (and expensive) it is in some states (mine included :/) to get a legal name and/or gender marker changed.
They just gotta make it as hard as they can, don't they.. 🙃
the cruelty is usually the point. It's not like there's an excuse, certainly not one that can be taken seriously.
Yeah. Trans people and most of the major medical organizations have been presenting mountains of research and scientific fact to the ignorant and intolerant for decades, and we still have millions of people and most governments who willfully ignore it and oppose it because they have closed off their minds and fear and hate that which is different from them.