This is the third in a series about gender affirming healthcare for trans folks. Kaitlyn is a young trans woman who is a friend of mine. Her story, like the others, made me cry. We really have not got our heads on straight about what it means to be transgender, and how we handle it. You’re also going to want to read Huey’s and Wren’s stories, and please share the series far and wide. These stories are incredibly important, and I’m very privileged to have these folks sharing them with me, and allowing me to publish them!
Discovery of being Trans
Like Wren, I figured out I was a flavour of trans after I had my childhood puberty. Something had felt wrong for my whole life, and I was always told “Oh that’s just what being a teenager feels like” or “Oh it’ll go away after puberty and it’ll all fit back together”. So I waited, waited for the day I’d be able to stand looking at my face in the mirror and feel comfortable in my skin like everyone else did. Growing up in the spot that is, on a technicality, “Metropolitan Melbourne”, even though it took more than an hour to get to the CBD, meant that the society I grew up in didn’t have the best attitude to mental health, but god could we all stamp down on internal feelings, and hard. Go figure that a town with a lot of tradies could bury things well.
It was only when I got to university, and saw how other people expressed themselves that I even realised that being transgender was an option. Where I grew up, “Gay” was a grievous insult, and being remotely associated with being transgender (or more accurately all the slurs surrounding the concept) made people recoil with horror. Cue a good friend (who I have still managed to keep, even with all the mental distress they had to coach me through), explaining to me that being male wasn’t actually a requirement of me, and I could genuinely be who I wanted to be. We also missed all our classes that day and cleared out the university bar, but that was part of the experience.
So I entered the cycle that is probably familiar to people who have revelations about themselves. I picked up every piece of “me” and looked at it, now through a different lens and realised I could change it if I wanted, and this included physical parts of me, not just mental.
Skimming over half a year I had it figured out, or as much as that version of me could. She wanted to have boobs, she wanted smooth skin and no facial hair, she wanted to sound such that she wouldn’t get picked out of a crowd, and eventually she wanted something to be done to make wearing skirts and dresses a lot easier.
Interactions with the healthcare system
As a white, tall, AMAB (Assigned Male at Birth), het presenting adult, the Australian healthcare system has always been a breeze for me to access and to get the physical healthcare I need. Mental healthcare was easy too, once I had found a GP that recommended someone who dealt with a lot of the issues I was dealing with. My first visit to the clinic that I still use today was aided by someone who showed me a great kindness, I knew them from high school and knew they were trans, and they met up with me before my first appointment.
For context on how easy the healthcare system is when you are at an intersectionality of privilege, I saw a doctor and he asked me to get a psych evaluation before they would prescribe me hormones. All I had to do was ask him to refer me to a colleague that did informed consent, allowing me to dodge this requirement if the GP thought I was of sound mind and I got a second booking and walked away from that with a blood test, third visit I had started hormones.
(Informed consent within the topic of HRT/Trans Healthcare is a process where a GP will fully explain what the HRT is and will do, inclusive of all risks, benefits, etc, and with the patient’s consent HRT can begin without the need for psychological evaluation. This allows the patient autonomy and the dignity of not having to “prove” to a psychologist that they are “trans enough” to receive HRT.)
These hormones did, and still do cover a lot of the big things that I wanted out of the medical system. Softer skin, growing breasts (yes, actual breast tissue), and wow did it help my emotional state to actually have the correct hormones flowing through my system. As someone with a lot of anxiety, this at least allowed my body to look the part so as long as I didn’t have to speak, I could move through public spaces and no one would do a double take for me not fitting into my gender box.
The hormones aren’t perfect though, taking estrogen orally can lead to blood clots so there’s a maximum you can have. Also, as I went through my first puberty on testosterone, not estrogen there is a lot of support tissue for breasts that was not grown on me, and the second puberty can’t do a lot to place it in there. Some people worry about their broad shoulders and thicker waist from testosterone, and while looking in the mirror my outline isn’t perfect, I’m putting on enough muscle the way I want to move my body anyway.
Then we get to my voice. I come from a line of Australians who live on farms and work with their hands, and I went through puberty and then sounded the part. When a kid goes through a testosterone-based puberty their vocal chords will typically lengthen, and mine did with great enthusiasm. This is not reversible from taking HRT however, it’s like asking an arm bone you grew to get smaller. Due to this, there are 3 common options:
- Not to care about your voice, it’s yours and you don’t need to change it.
- Do vocal feminisation therapy, it’s basically training you to speak in a higher resonance and pitch, and eventually has you speaking the part.
- Get surgery to reverse the lengthening.
Option 1 is for people who are not me. Much like there is no correct way to be a human, there is no correct way to be transfemme. A voice is a voice and it should be respected as it belongs to a person. However I really don’t like my voice (I hated every recording I was in since I was a child, I wonder why?) so I want something to change.
Option 2 is great and I have been exploring that for the better part of 2 years. While voice therapists are rather fully booked (much like most specialists), I eventually found a wonderful person who is doing their very best to help me. However after doing therapy for 2 years, I don’t sound much different, so this leads to…
Option 3, surgery. Fuck surgery is scary, and for some people it’s necessary. After not having much results from therapy I went to get my throat checked and it turns out that some people just have their vocal cords lengthen too much, or they have naturally too much stress from speaking and they may never achieve their goals without surgery. Guess what camp I recently found out I was in.
Next up, is facial hair. “Just get laser”, yeah I know I’ll book it at some point when I can look at my calendar and see free time. Shaving every day is a pain and is a big insecurity, but I do have to say that I look at my face in a mirror with bright lights at a distance of about 10cm. If anyone else is that close, it’s my fiancé so I really don’t have to worry.
Finally, bottom surgery. This is a part of the system I have not yet brushed up against. From talking to doctors, there are maybe a handful of surgeons per state that do bottom feminisation surgery, a handful of surgeons in the country that do bottom masculinisation surgery, and a number approaching none that do nullification surgery. Doctors that I have seen when I bring up the topic do generally say “While I can’t recommend you just go to Thailand to get it done, I don’t really see many other options.”.
Review of the healthcare system
So everything I have said so far sounds pretty good, right? Well…
Look, whenever there is a societal health issue, disease, contraceptive, medical condition, cancer, there are a few steps that are taken to ensure that the maximum amount of people possible can not only access the healthcare, but not get the condition the care solves in the first place. First, a healthcare system will ensure it has a cure for a condition. Whether that cure is a drug, antibacterial, surgery, or medication to remove the worst of the effects there will be an effort to ensure that anyone who has the condition will live their best life.
Second, a healthcare system will work on prevention. Sunscreen, pre-screening recommendations, testing the sewerage supply for viral markers. All of these things help prevent outbreaks in a community or an individual from acquiring the condition in an immediate sense.
Third, a healthcare system will work on awareness. Messaging about the dangers of sun damage, posters about how to wash your hands to ensure they are perfectly clean, booklets about dangerous diseases that could crop up and their symptoms, pamphlets of signs that someone is under acute stress or could be suffering a mental illness. All of these things allow a community to check in and make sure everyone is safe and has the information on how to report if they are displaying symptoms.
The failure of the system for me was not the hormones, or the therapies, or my need for surgery. Healthcare has failed me as at no point in my childhood was it pointed out that I didn’t need to be a boy, no one told me that I didn’t have to go through a testosterone-based puberty, that I could have switched puberties or taken some puberty blockers while I considered how it would impact my life. And now I get to pay for it in the scars on my body that a testosterone based puberty wreaked on me. Scars that I did not want and was not told that I could have avoided.
When I see a voice therapist, my voice therapy sessions aren’t booked to Medicare under “affirmative gender care” or anything to say that someone like me should have to see a voice therapist, my sessions are booked under “Chronic Disease Management”, and like a lot of Chronic diseases, I wouldn’t have to be there if I got the information and treatment when I needed it, when it would have been the most effective.