Transgender 18-year-old Attempts Surgery On Himself At Home Due To Lack Of Access

Murphy,
Digital Journalist

A transgender young person’s
attempt to perform top surgery on himself is a clear result
of historical underfunding and inequitable access to gender
affirming healthcare, an expert says.

The 18-year-old
turned up at an emergency department after attempting to
perform a bi-lateral mastectomy, also known as top surgery,
at home. He was several hours through the procedure when he
became concerned he would cause nerve damage.

The case
was published in the New Zealand Medical Journal on
Friday and was described as an “act of
desperation”.

The young person was facing long wait
times for a surgery referral in the public health system and
was unable to afford to go private – which can cost up to
$35,000.

“This is a clear result of the historical
underfunding and inequitable access to gender affirming care
around the country,” said Jennifer Shields, president of the
Professional Association for Transgender Health Aotearoa
(PATHA).

“Research shows that gender affirming
hormones and surgeries are essential for the wellbeing of
many trans people,” she said.

Not all trans and gender
diverse people experience gender dysphoria or seek medical
affirmation such as surgeries or hormones.

But in
2019, almost half of all trans and non-binary people who
wanted top surgery said they
had an unmet need.

The Counting Ourselves survey
found cost, alongside not knowing where to go and waitlist
times, were the biggest barriers they
faced.

Preliminary data from the 2022 Counting
Ourselves survey, due to be published later this year, shows
little movement in these levels of unmet need.

Lack
of access ‘unacceptable’

The Medical Journal
paper said having experienced gender dysphoria, this young
person was suffering from “significant psychological stress”
because of his chest ahead of an upcoming pool
party.

The teen was found by an acute mental health
team to have “no active mood disorder, psychosis or
suicidality” and could consent to surgery, which was
subsequently undertaken.

He healed well after the
surgery and “reported improvement in self-esteem and
self-confidence and his ability to complete school
work”.

“Young people are being forced to choose
between other essential costs and fundraising to pay for
medically necessary healthcare. This means forgoing or
delaying education or staying in unsafe housing because it’s
all they can afford,” Shields said.

Access to gender
affirming healthcare, including surgeries, varies from
region to region. In some areas of the country there is no
public pathway at all to access gender affirming top
surgery.

Shields said this was
unacceptable.

“When trans people don’t get referred
for medically necessary gender affirming healthcare because
there is no service available, their health needs are
ignored, and go uncounted, leading to further inequities and
under-resourcing.”

‘Extremely
concerning’

Wellington clinician and PATHA executive
member Dr Rona Carroll said it was “extremely concerning” to
hear that inadequate access to medically necessary care
through the health system led to the significant distress
this young person experienced.

Carroll regularly sees
trans people at her clinic who have been unable to access
top surgery.

They describe “struggling to leave the
house, being constantly misgendered and feeling deeply
uncomfortable in their body and not able to feel or be seen
as their true self”, she said.

PATHA “absolutely does
not recommend attempts at self-surgery, which can be
life-threatening”, Shields said.

“Trans people deserve
nothing less than safe, timely, access to medically
necessary healthcare.”

In a briefing to the incoming
Minister of Health Dr Shane Reti in December, PATHA called
for investment in a targeted national approach to improve
trans health.

Of its priorities for action given to
the minister was that there be “adequate provision of
gender-affirming surgeries and wrap-around support,
including for the national genital surgery service” and a
nationally-coordinated approach that addressed unacceptable
levels of unmet need.

Reti has been approached for
comment.

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