A Guide to Transgender Health Care
in Queensland

by Dr Gale Bearman

For those in the early stages of exploring gender identity there is a sea of information on the web but much of it does not relate to Australia, let alone Queensland.

I Think I am transgender What Do I Do Next?

The first step is to seek an assessment. A Psychiatrist or Psychologist provides this. This health professional is not giving you .therapy.. More than likely you have a normal mind (and a normal but mismatched body). The Psychiatrist will be seeking to confirm that you are eligible for hormones. Of course you may have other problems such as depression, which can be helped before you embark on the challenges of transition. If you have other major issues such as severe anxiety, childhood sexual abuse, or a significant relationship, which you do not want to risk losing, you may actually need therapy before transition.

This assessment can be arranged by myself if you make an appointment to see me at the Brisbane Sexual Health Clinic. There is usually a 2-month wait for the Sexual Health Clinic appointment. This service is free. Another route, sometimes quicker, is to ask your GP to refer you to the Psychiatrist. A list of Psychiatrists who are experienced with Transgender issues can be obtained form ATSAQ. Most Psychiatrists do charge a fee above the Medicare rebate.

If you live outside Brisbane a local Psychiatrist in your region will often do this assessment with a referral from your GP. Sometimes the Psychologist at your local regional Sexual Health Service will do your assessment.

If you are frustrated by the waiting time to see a Psychiatrist/Psychologist ask yourself what positive forms of body modification you can undertake for yourself first. You do not need a Psychiatrist to get some electrolysis or laser, get fit, lose weight, stop smoking, learn make-up skills, prepare a career path, plan disclosures. Peer support (ATSAQ, web friends) is valuable at this time.

Hormone therapy is easy to obtain once you have a confirmation from a Psychiatrist. It is not expensive and is often available on PBS. You costs will range from $10 to $30 a month. Hormone therapy is managed either by an Endocrinologist (referral from your GP) or by myself (Gender Clinic on Wednesdays or Brisbane Sexual Health Service on Mondays). If you live outside Brisbane your hormone therapy can be managed by your nearest regional Sexual Health Service e.g. Mackay, Cairns. Routine blood tests are done prior to initiating hormones and periodically while on therapy. A person might have 3 blood tests in the first year and then a test only once or twice a year.

Gender Reassignment Surgery is not expensive in Australia compared to many other countries, but it is best to have private health insurance. Most Queenslanders who seek GRS travel to Monash for this. If you have been living in role for at least 12 months and you have a letter from your Psychiatrist you will usually only need one visit to Monash to assess your eligibility for surgery. Monash is usually happy with the standard of supervision available in Queensland so all your pre-operative care can be done in your home state.

I have worked with gender clients in Queensland for nearly 10 years. This work is at times frustrating, at times rewarding, at times saddening, at times joyful, and always a privilege.

Finally I would like to share a few observations, which may be useful whether you are transgender, or know someone who is transgender, or work in a professional capacity.

Transgender Emergence is a dynamic adaptive process, which takes time.

Starting hormones or getting on a surgical list does not mark the path from a place of denial and self-hatred, to a place of self-respect and a fully congruent identity. It is a process with many different stages, not always linear. It involves developing awareness, seeking information, making disclosures, exploring identity, exploring body modification, undergoing various degrees of modification, adapting relationships and work, negotiation of loss, synthesis and integration of a new identity. No two journeys are exactly alike. Some are proud of a transgender identity and proud of their past struggle. Many prefer to meld into the binary world and bury the past.

Trust yourself. Listen to advice, and then work it out for yourself. Allow others their unique timeline.

If you are a Significant Other, be re-assured that the self-absorbed early stages of transgender emergence are just a re-run of the adolescence your loved one was never allowed to have. All things will move on.

Like all migration there is trepidation, hope, anticipation, a journey in-between, pesky officials at the border wanting your papers, cultural changes, and a new life.