how much is gender reassignment surgery in australia

Healthdirect Free Australian health advice you can count on.

Medical problem? Call 1800 022 222. If you need urgent medical help, call triple zero immediately

healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.

Gender affirming surgery

7-minute read

Share via email

There is a total of 5 error s on this form, details are below.

• Please enter your name
• Please enter your email
• Your email is invalid. Please check and try again
• Please enter recipient's email
• Recipient's email is invalid. Please check and try again
• Agree to Terms required

Error: This is required

Error: Not a valid value

What is gender affirming surgery?

Gender affirming surgery refers to a variety of procedures that some trans or gender diverse people may use to affirm their gender.

Surgery is just one option for gender affirming care. All trans and gender diverse people are unique and will choose to affirm their gender in a way that feels right for them.

Gender affirming care might include:

• Social affirmation, such as changing names, pronouns, hair or clothing.
• Legal affirmation, such as changing legal name or gender.
• Medical affirmation, with hormones or surgery.

Read more about gender incongruence, gender dysphoria , and gender affirming care here.

This article talks more about gender affirming surgery.

What happens during gender affirming surgery?

There are many different gender affirming surgeries and procedures. They may include making changes to your face, chest, genitals, or other body parts.

For people assumed male at birth, feminising surgeries may include:

• Breast augmentation with insertion of breast implants.
• Facial feminisation — changing the shape of any or all facial features.
• Vocal surgery — shortening the vocal cords for a higher, more feminine voice.
• Tracheal shave — reducing the size of the ‘Adam’s apple’.
• Fillers or liposuction, to achieve a more typically feminine shape.
• Orchiectomy, or removal of testicles.
• Bottom surgery or ‘genital reconfiguration surgery’, involving changes to the genitals.

Bottom surgery is called ‘genital reconfiguration surgery’. This was previously known as ‘sex reassignment surgery’ or ‘gender confirmation surgery’. The name change shows that your genitals don’t define your sex or gender.

Feminising bottom surgery may involve a combination of the following procedures:

• Removing the testicles (orchiectomy).
• Removing and reshaping tissue from the penis to make a vulva. This includes external labia or lips, and a clitoris. This is known as vulvoplasty.
• Shortening the urethra (tube that you urinate — wee — from).
• Creation of a vaginal canal (vaginoplasty). This is a complicated step which some people choose to skip. After surgery, vaginal dilators will need to be used to maintain the shape of the vaginal canal.

For people assumed female at birth, masculinising surgeries may include:

• Top surgery, with reduction or removal of breast tissue (mastectomy). This creates a flatter or more neutral chest. There are many different techniques used to achieve this.
• Liposuction to achieve a more typically masculine shape.
• Hysterectomy , or removal of the uterus (womb) and ovaries.
• Bottom surgery or genital reconfiguration surgery. This involves changes to the genitals.

Masculinising bottom surgery may involve a combination of the following procedures:

• Hysterectomy, if not already performed.
• Vaginectomy, or removal of the vagina.
• Creation of a penis, which may include metoidioplasty or phalloplasty.
• Metoidioplasty involves making a penis shape wrapping tissue around the clitoris after it is enlarged by testosterone hormone therapy.
• Phalloplasty involves making a larger penis with tissue from the arm, thigh, back, or abdomen. This involves lengthening the urethra to be able to urinate from the tip of the new penis. An inflatable penile implant may be inserted inside the penis to allow an erection.

Is gender affirming surgery right for me?

Choosing to undergo any surgery is a big decision. Everyone affirms their gender in different ways, and that may or may not include surgery.

Surgery is permanent so you need to make sure it’s the right choice for you. Surgery doesn’t make you more or less trans.

Before being able to access gender affirming surgery, you need to meet the criteria below:

• A history of gender incongruence (for 6 months or more).
• The ability to make a fully informed decision.
• Be over the age of 16 for top surgery, or 18 for bottom surgery. Some surgeons will provide surgery to younger people in very specific situations.
• Ensure that any physical or mental health conditions are well managed.

You will need letters of support from a mental health professional before having gender affirming surgery.

For top surgery, one letter is required. For bottom surgery two letters are required. For bottom surgery, you are also required to have ‘lived as your current gender’ for 12 months, meaning you have socially transitioned. The letter needs to state that surgery is appropriate for you and is likely to help affirm your gender and reduce any gender dysphoria that may be present.

If you are taking gender affirming hormones, or want to take hormones in the future, you should do this for 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

Most people who have surgery are happy with their results and feel more comfortable in their bodies. But some people are disappointed with the results, or find that any gender dysphoria that was present is not fully resolved. Make sure you discuss any difficult feelings with your doctor or psychologist.

What questions should I ask before surgery?

It’s important to talk about the pros and cons of surgery in detail with your doctor. It’s a good idea to ask to see pictures of how other people look after surgery.

Questions to ask your surgeon include:

• What different surgical techniques are there?
• What are the pros and cons of each technique for me?
• What results can I expect?
• What are the possible risks and complications?

For help in having the discussion, visit healthdirect’s Question Builder .

What should I expect after surgery?

Surgical recovery can be long and uncomfortable. Your surgeon will be able to give you more information on what can be expected before, during, and after surgery. This might include spending time in hospital afterwards, any special dressings, surgical garments, or follow up care.

Make sure you do everything your doctor tells you and go to all follow-up appointments. This will help you get the best results from your surgery.

Having surgery is a big deal. Even if you’ve been looking forward to it and are happy with the result, it can still be quite confronting. It might take some time to get used to your new body.

Talk to your doctor if you are feeling any distress following surgery.

How much will gender affirming surgery cost me?

Gender affirming surgery can be very expensive. It can cost between $20,000 to more than $100,000, depending on which procedures you need.

Your surgeon will be able to tell you how much surgery will cost. The cost may include specialist visits before and after surgery, surgeon and anaesthetist fees, hospital and theatre costs, and any other products or services necessary.

Some costs may be covered by Medicare, such as specialist consults if you have a referral from your doctor. Unfortunately, most gender affirming surgery in Australia is done privately, meaning there will be large out-of-pocket costs.

You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online .

Some private health insurance will also help with gender affirming surgery. If you have health insurance, it’s important to check with your health fund first about your level of cover. There is a range of health insurance comparison sites available online, such as privatehealth.gov.au .

Legal matters

Changing your gender on your passport, licence, Medicare card or birth certificate all require separate processes. These vary between states and territories. In some states and territories, you must have undergone specific types of gender affirmation surgery to change the gender marker on your birth certificate.

You can find out more about the specific processes at TransHub .

You are legally protected by the Sex Discrimination Act from discrimination on the grounds of sexual orientation, gender identity or intersex status. Visit the Australian Government Attorney-General’s Department for more details.

Where can I get more information on gender affirming surgery?

• TransHub has information about gender affirming surgery.
• The Gender Centre (NSW) provides resources and support.
• Transgender Victoria has resources and links to other services.
• The Australian Professional Association for Trans Health (AusPATH) lists some providers.

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: June 2022

Search our site for

• Transgender
• Gender Dysphoria

Need more information?

These trusted information partners have more on this topic.

Top results

Understanding Gender Identity | headspace

Gender identity is your sense of whether you are a man, woman, nonbinary, gender fluid or a combination of one or more of these identities. Learn more about gender identity and how you can get help from headspace.

Read more on headspace website

Everything you need to know about gender identity | Gender Identity

If you’ve ever wondered ‘what does gender mean?’, you’re not alone. Gender and identity exists on a diverse spectrum. Learn more about gender in this guide.

Read more on ReachOut.com website

Understanding gender identity and young people | headspace

It's important to understand the ways your young person can express their gender identity. Visit headspace to learn about gender identity in young people.

Gender Identity Examples, Meaning & Definition | Kids Helpline

Gender identity is more than being male or female. Kids Helpline can help you understand what it is and how you can understand your own identity.

Read more on Kids Helpline website

Gender dysphoria & identity: kids & teens | Raising Children Network

Gender identity is feeling male, female, both or neither. Gender dysphoria is when your child is distressed by feeling different from their birth gender.

Read more on raisingchildren.net.au website

Gender dysphoria & diversity: support | Raising Children Network

If your child is gender diverse or experiencing gender dysphoria, support means embracing their gender identity. Your support boosts your child’s wellbeing.

How Emma learnt to accept herself and her gender identity | ReachOut Australia

Emma, a young transgender woman, shares how reaching out for support helped her to accept her gender identity.

Supporting a transgender teenager - ReachOut Parents

Learn how best to support your teen as they embrace their gender identity, with ReachOut Australia and Ross Jacobs from QLife.

Your child’s gender diversity: your family | Raising Children Network

If your child is gender diverse, it’s OK if you and your child’s siblings have mixed feelings about your child’s gender identity. It’s good to seek support.

Gender diversity - a QLife guide for health professionals

Many people assume that gender is binary; that all people are women or men. However, gender can more accurately be thought of as a colour palette, with many possible shades of identity and subtle expressions of gender far beyond only woman or man.

Read more on QLife website

RACGP - LGBTIQA+ Family abuse and violence

Reproduced with permission from The Royal Australian College of General Practitioners

Read more on RACGP - The Royal Australian College of General Practitioners website

RACGP - Care of older LGBTI people

Reproduced with permission from The Royal Australian College of General Practitioners. The historical pathologising of older lesbian, gay, bisexual, transgender and intersex (LGBTI) people’s bodies and relationships continue to adversely affect their health and wellbeing

Bisexuality - a QLife guide for health professionals

Bisexual people are attracted to people of multiple genders and these attractions may be fluid over time.

Young people - QLife guide tip sheet

Social conditions for the acceptance of LGBTI (lesbian, gay, bisexual, transgender and intersex) people have improved dramatically in Australia in recent years.

Coming out, inviting in and disclosure

‘Coming out’ typically refers to acknowledging one’s sexuality or samegender attractions to oneself and disclosing this to others.

Antidepressants in adolescence - Australian Prescriber

Antidepressant drugs are not the first-line treatment for adolescents with mild symptoms of depression.

Read more on Australian Prescriber website

Clinical guidelines – Intersex Human Rights Australia

Are clinical guidelines enough to eliminate human rights violations against intersex people in medical settings? Reviewing the evidence, we believe they are inadequate, and their prerequisites do not exist.

Read more on Intersex Human Rights Australia website

For Health Professionals | Cancer in Aboriginal and Torres Strait Islander People - Our mob and cancer

Culturally appropriate, optimal cancer care for Aboriginal and Torres Strait Islander people Cancer is the third leading cause of burden of disease for Aboriginal and Torres Strait Islander people

Read more on Cancer Australia - Our Mob and Cancer website

The Health and Care of First Nations Australians | Ausmed

First Nations Australians are diverse peoples with a variety of histories, cultures, languages and experiences. In order to deliver appropriate and culturally competent care, it is essential to understand the care needs and health of First Nations peoples.

Read more on Ausmed Education website

Healthdirect Australia is not responsible for the content and advertising on the external website you are now entering.

Healthdirect 24hr 7 days a week hotline

24 hour health advice you can count on

1800 022 222

Government Accredited with over 140 information partners

We are a government-funded service, providing quality, approved health information and advice

Healthdirect Australia acknowledges the Traditional Owners of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to the Traditional Owners and to Elders both past and present.

© 2024 Healthdirect Australia Limited

Support for this browser is being discontinued

Support for this browser is being discontinued for this site

• Internet Explorer 11 and lower

We currently support Microsoft Edge, Chrome, Firefox and Safari. For more information, please visit the links below:

• Chrome by Google
• Firefox by Mozilla
• Microsoft Edge
• Safari by Apple

You are welcome to continue browsing this site with this browser. Some features, tools or interaction may not work correctly.

• Call Monash Health
• See all locations
• Emergency departments
• Our hospitals and locations

Frequently asked questions

Read through monash health gender clinic’s frequently asked questions for more information about the clinic and general gender information., important information.

Updated 04/08/2023

The Gender Clinic currently has a long wait list: in July 2023, we were booking appointments for clients whose referrals were received in February 2022. Additional clinical staff have been employed and we are seeing a gradual reduction in waiting times.

Whilst on the Gender Clinic wait list, you can be referred to a Monash Health Laser hair removal clinic (approximately eight months wait time) and a Latrobe University Voice clinic (24 months wait time). After consultations with Gender Clinic clinicians, you can be referred for gender affirming hormones at the Monash Health Endocrinology clinic (six to eight months wait time).

We offer telehealth or in person appointments at the Pride Centre.  Please advise the admin team if you would like to enter the building via a private side entrance, rather than the main front entrance.

Surgeons providing gender affirming surgeries have very long wait lists for new clients​. Please contact them directly if you need further information. The Gender Clinic can provide financial assistance to clients who we have referred for surgery.

If you urgently need support, please see our resources lists: TGDNB Peer Support ;  Clinical Support . In particular Switchboard Victoria run two phone contact lines open every day: Rainbow Door 10am-5pm ( https://www.rainbowdoor.org.au/ 1800 729 367); and QLife ( QLife.org.au 1800 184 527) 3pm-midnight. Lifeline ( Lifeline Australia 13 11 14) provide all Australians experiencing a personal crisis with access to 24 hour crisis support and suicide prevention services.

Please note: we no longer accept referrals by fax, email or post . All referrals must now be forwarded through this link: Secure eReferral by HealthLink .

Find up-to-date information about how to send a referral to Monash Health Specialist Consulting Clinics at this link:  eReferrals page.

On this page

Referrals into the gender clinic.

• Gender Clinic Services
• Assessments

Starting at the Gender Clinic

General Information about the Gender Clinic

What is the Gender Clinic?

The Gender Clinic is part of the Monash Health network in Melbourne, Victoria, Australia. It also has links with the Monash University Department of Psychological Medicine. The largest government-funded clinic of its kind in Australia, we provide services for trans, gender diverse and non-binary people.

These include:

• assisting with exploring gender identity, informing about diverse way that gender is identified and expressed;
• assessing if a person is experiencing gender dysphoria;
• exploring how a person’s gender dysphoria may be lessened, through various medical and social interventions;
• assessing if hormonal and surgical treatments are suitable;
• providing psychological support with issues that relate to transition.

For more information, please visit our About the Monash Health Gender Clinic page.

Who can access the Gender Clinic?

We provide services to residents of the Victoria or Tasmania, who are

• trans, gender diverse and non-binary people of 16 years of age or older,
• their family members, and
• their partners.

We are also a resource for health care providers and community and advocacy groups.

Clients are referred for many reasons:

• they may want to just explore and achieve a better sense of their gender identity
• others who identify with a gender other than their birth-assigned gender may seek assistance to make their body as congruent as possible with their affirmed gender.

If attending the clinic in person, there are on-street parking options on Jackson St and other nearby streets. Please check parking signs for restrictions, time limits and fees. The most convenient public transport access are the 16 and 96 trams.

The main entrance and lifts are suitable for people using wheelchairs. Please advise about your needs when you confirm your appointment.

Clients may also be eligible for transport assistance. For further information, please see the  Victorian Patient Transport Assistance Scheme (VPTAS)  website.

Clients can have sessions conducted via teleconference, using HealthDirect. This is the preferred option since the start of the COVID-19 pandemic.

Back to top

How do I arrange an appointment to be seen at the clinic?

You will need to get a referral from a medical practitioner, such as a GP or medical specialist. They can submit this through eReferral by HealthLink, which is now our required method of referral; we no longer accept referrals by fax, email or post. Find up-to-date information about how to send a referral to Monash Health Specialist Consulting Clinics  on the eReferrals page on our website.  You can provide your health care provider with this information: information for health care professionals

If you are worried that your GP will not refer you, ask for a second opinion from another GP – click here for a list of GPs experienced with trans gender diverse and non-binary clients.

Gender Incongruence and Gender Dysphoria are internationally recognised medical conditions, for which patients are entitled to seek treatment. Please be aware that your GP may not have had experience of the trans and gender diverse community and may not be aware of procedures, but they can find guidance from HealthPathways.

A month before your first appointment, please provide the following:

• A report or psychiatric assessment from any previous or current mental health clinician (if applicable)
• A brief (1-2 pages) autobiographical statement explaining how gender dysphoria or gender variance has developed in your life, including information regarding schooling, friends, family and occupation.

This can give us an understanding of your background before we meet with you and provides an opportunity for you to consider your thoughts and feelings in your own written words.

Is there a waiting time for an initial appointment?

Waiting times vary throughout the year, check with our administrative staff when you submit your General Information Form and referral letter, or later via email to [email protected] with: surname, date of birth and Medicare number.

There are a range of private practitioners who provide similar services. Please feel free to discuss options with our Administrative staff.

If you have a referral for endocrinology at Monash health, you will not require additional assessment at the Gender Clinic.

Are there private practitioners who provide similar services?

Specialist gender-related mental health assessments are also provided by psychiatrists and clinical psychologists who work in the private sector. A list of these private providers are found (links below) in

• the  service providers section of the Australian Professional Association for Trans Health main page.

Please note: you can remain on the Gender Clinic waiting list whilst seeing private providers.

These assessments are best done by specialist providers. If you are already seeing a counsellor, psychologist or psychiatrist; we suggest you still make sure that your assessment is done by mental health professional who specialises in gender dysphoria.

Clinicians working in the private system usually have significantly shorter waiting lists than the Gender Clinic. However, there are costs to see a private clinician, even after a Medicare rebate has been claimed. These extra costs can range from $20 to $120 per session. For up-to-date information regarding waiting times and consultation fees, please contact the clinicians directly. Contact details are provided in the attached list of private clinicians. You will also need to contact them directly to organize an appointment.

Please note: if you have a gender-related mental health assessment done by a private provider, this will not shorten your waiting time on the Gender Clinic waiting list. You will still see a Gender Clinic mental health clinician, with the usual waiting times involved. If you have a mental assessment previously done by a private clinician, your assessment with one of our clinicians is likely to be much briefer.

Informed consent primary care options

We encourage clients who  only wish to commence hormone therapy  to be referred to a clinic that provides care under the informed consent protocol. An exception is when a client has complex needs or is seeking more comprehensive mental health assessment and support, particularly if this is beyond a GP’s usual scope.

For more information about our intake criteria and a list of relevant clinics, see our Information for health professionals page.

Australian Professional Association for Trans Health – List of Victorian Providers

External website

What can I do while I wait for an appointment?

Everybody’s situation is different and personal to them. The best advice we can give you is to keep yourself fit and well, both physically and mentally. We also encourage clients to engage with local peer support groups.

You may wish to also consider the following while on the waiting list:

• Taking some steps to change your identity documents.
• Seeing a speech therapist.
• Seeking private counselling.
• Commencing hair removal treatment such as laser therapy or electrolysis. This is available at Monash health while you are awaiting assessment.

About the services at the Gender Clinic

What services are available for trans, gender diverse and non-binary people and their loved ones through the Gender Clinic?

The Gender Clinic itself provides mental health assessment and treatment, related to gender transition, for:

• gender identity, gender expression and/or gender transition related concerns
• social work and psychological support.

Gender Clinic clients can be referred to other departments in Monash Health for:

• Endocrinology for hormone assessment and prescription.
• Surgeries including hysterectomy (removal of womb), oophorectomy (removal of ovaries), tubal ligation (surgical contraception), and initial assessment for fertility preservation at Obstetrics and Gynaecology.
• Orchidectomy (removal of testicles) at Andrology
• Laser hair removal

Our clients can be referred to private service providers outside of Monash Health for:

• Most surgeries: breast reduction or enhancement and genital surgeries (vaginoplasty)
• Peer support
• Advice on presentation (make-up, etc)
• Fertility preservation
• Speech therapy

What services can I use while on the waiting list for assessment?

A range of needs can be helped while our clients are on our waiting list:

• Private mental health professionals or experienced GPs can conduct an assessment.
• Speech therapy (voice and communication training) at La Trobe Communication Clinic can begin. They accept referrals from health professionals, social workers, the Gender Clinic; or a self-referral.
• A referral can be arranged for laser hair removal at Monash Health.

Some mental health conditions can complicate the results of a mental health assessment (eg, psychosis or dissociative identity disorder). It is a good idea to seek treatment for these while on the waiting list.

Intake Call/Peer workers  About 6-8 weeks after we receive your referral, our intake team will reach out to you for an initial phone assessment. This is to introduce you to our clinic’s services and help the clinic understand your gender affirmation objectives. The intake call should take no more than 30 minutes, during which we’ll explore your goals for attending the clinic and to ensure that the gender clinic is the most appropriate service for you. We may suggest alternative services that you can consider.

The clinic provides peer support by peer workers with lived experience. They can provide mutual support, information and practical assistance to Gender Clinic clients and carers/family as appropriate. They can also provide referral and liaison support to assist clients in accessing other LGBTIQ+ services. Individual and group peer support is available to clients referred to the clinic, including those on the waitlist.

Who is able to access the laser service? 

Free laser treatment is available for current Gender Clinic patients. This includes those on our waiting list. Referrals are accepted from your treating clinician or our intake worker.

What areas can be treated?

The Monash Health laser service is approved to treat any areas that a medical officer indicates has excess hair. That is not the same as all unwanted hair. For Gender patients, it means laser treatment is available to those areas of your body that are relevant to having your gender affirmed. The Gender Clinic will write these areas on the referral. This means the laser service may not be able to treat all of the body areas you wish.

The Monash Health laser service performs this service one referral at a time. If a client has new areas of excess hair, the first referral must be completed first. Then a new referral may be written for the new area. Please note: the maximum number of treatments offered per area is between 8 to 12 sessions. The exact number is determined by the dermal therapist, at their discretion.

How can I access Speech Therapy?

For many people, it is felt that the gender they were assigned at birth is reflected in their voice and the way they communicate. A gender transition can include modifying the voice.

People who wish to modify their voice or communication style as part of their gender transition can be referred to the La Trobe University’s Voice Clinic. Clients will usually see a speech therapy student who is in their final year of training. If so, that student will be supervised by a qualified speech therapist.

Speech therapy can be arranged at any time during your transition process. The service can range from:

• one or two sessions for voice analysis and advice, to
• regular weekly sessions for focused voice modification.

The needs of every speech therapy client is different. This therapy targets a person’s individual needs. It is not possible to say how many sessions are required to meet those needs.

You may wish to see a a private speech therapist. If so, you can discuss how to get a referral with your clinician.

How much do appointments at Monash Health cost?

There are currently no costs for attending appointments at Monash Health.

How much do gender affirming hormones cost?

Hormones are available on the PBS, and so usually cost between $6 and $40 per month. This depends on the hormone prescribed and if you have a health care card.

What does gender affirming surgery cost?

There are significant costs associated with surgery.

Costs of Reproductive organ surgery

Some surgeries are provided to trans masculine people by Monash Health at no cost to the client and no need for private insurance, including:

• removal of internal reproductive organs (hysterectomy and oophorectomy)
• tubal ligation for contraception.

For private hysterectomy and oophorectomy, out of pocket costs will vary between surgeons and hospitals.

Costs of Genital surgery (vaginoplasty)

To perform vaginoplasty, Monash Health requires that their clients take out private health insurance. Medicare only covers a small proportion of the procedures involved. The clinic is unable to assist with the cost of private health insurance.

The out-of-pocket cost of vaginoplasty, with top level private health insurance, is around $18-30,000. Please contact the surgeon directly for an up-to-date estimate of costs.

Costs of Chest reconstruction surgery

Medicare only covers a small proportion of the procedures involved in chest reconstruction surgery. For chest reconstruction surgery, the out-of-pocket cost is $6,000 to $18,000, depending on whether you have private health insurance. Please contact the surgeon directly for an up-to-date estimate of costs.

Limited financial support for Gender Clinic surgery patients

The Gender Clinic provides some financial support to a limited number of clients each year. This assists with out-of-pocket costs of vaginoplasty, vulvoplasty and chest reconstruction (mastectomy). This support is intended for those who cannot afford to pay for private surgery.

We do not reimburse costs for surgery that a client has already paid for. The surgeons charge us directly, and our clients wait in turn for the available funding. Please speak to your clinician for further information.

Private health insurance is recommended for surgery

For most gender transition surgeries, we strongly recommend private health with the highest level of hospital cover. This is needed to cover some of the costs of the surgery.

Please note: even with the highest level of private health insurance cover, there are still significant out of pocket fees. All health insurance companies have waiting periods (usually 12 months) before a claim can be made.

PrivateHealth.gov.au  is an unbiased way to find private health insurance options  How much cost the private health insurance will cover depends on the type of insurance you have and the cost of the surgery. You can speak to your private health fund to ask them about the amount you will get back.

About Mental Health Assessments

What are the WPATH Standards of Care and does the Gender Clinic follow these guidelines?

Standards of Care is a document published to communicate worldwide professional opinions about the treatment and management of gender dysphoria. Gender Clinic staff follow these guidelines when providing gender transition-related care.

WPATH is the shortened name for the World Professional Association for Transgender Health. WPATH is a non-profit, interdisciplinary, professional and educational organization devoted to transgender health. Its mission is to promote evidence-based health care, education, research, advocacy, public policy and respect in transgender health.

These guidelines can sometimes appear restrictive. However, it is important the Gender Clinic and its clients are cautious in how we deliver gender affirming care. Together, we must be sure it is highly unlikely that a client will regret having that treatment. However, the clinic applies the guidelines in a way that recognizes a person’s unique anatomical, social or psychological situation. This flexible approach aims to achieve positive outcomes for clients in a safe manner.

The Standards of Care are available at  www.wpath.org . The Standards of Care were updated from version 7 to 8 in September 2022.

Why do you require a mental health assessment?

Having a gender identity that differs from the gender assigned at birth is not considered a psychiatric disorder. However, some mental health conditions that are not related to gender identity can present with gender variance. It is very important to rule out those conditions before we provide gender-affirming care. As a result, the clinic takes great care to ensure a comprehensive assessment is conducted first.

Also, these assessment identify any supports that may help with affirming gender before any medical treatments are commenced. We can then refer clients to appropriate services; such as assistance with housing, employment and social isolation.

Please note: clients who have a mental health condition such as schizophrenia, depression, Borderline Personality Disorder or Autism Spectrum Disorder are still eligible to receive support from our clinic. However, their assessment may be extended, to ensure that adequate supports are in place prior to any gender-related treatments.

A comprehensive mental health assessment is a very important part of the clinic’s work with clients. During the assessment your clinician will gather information about:

• Your experiences of gender at various stages of your life,
• Any gender-related distress,
• Your mental health history and current supports,
• Other relevant life experiences.

The purpose of this is to identify your strengths and what supports are needed as you embark on strategies to reduce your distress.

The assessment process is strictly private and confidential. We will not speak to your family unless there is an immediate risk to your safety or we have you clear consent to do so. We do however encourage meeting with families to provide education and discuss any concerns they may have, in order to help them support you during your transition.

What other mental health assistance is needed during transition?

Gender transition and the “Real Life Experience” of living in the affirmed gender can present a number of social and psychological challenges along the way. This can be helped through ongoing monitoring or counselling. Importantly, this is done with a mental health clinician that the client can form a trusting relationship with, so they can explore their gender identity with confidence. As everyone is unique, there is no standard number of the sessions needed or recommended.

Meeting regularly with a mental health clinician helps clients who are transitioning to achieve stability and satisfaction in their lives. by:

• Helping to find the best set of medical and social options
• Working through difficulties where they arise
• Addressing any expectations of the outcomes of transgender treatments and gender transition.
• Being a source of general support during transition.

What are “gender dysphoria” and “gender incongruence”?

“Gender Dysphoria” is the discomfort and unhappiness a person might experience as a result of the tension between the gender assigned to them at birth and the gender with which they identify (including non-binary gender identities). Not everybody who experiences gender diversity feels this distress.

The term ‘Gender Dysphoria’ is also used for a specific psychiatric diagnosis, found in the American Psychiatric Association’s Diagnostic and Statistical manual (DSM-5). However, the Gender Clinic team strongly reject pathologising gender diversity. We believe that psychiatrically diagnosing aspects of gender identity is damaging for our clients.

The Gender Clinic strongly supports efforts to depathologise gender diversity. This includes adopting the advice of the World Health Organisation’s International Classification of Diseases version 11 (ICD-11). It instead recommends using the term “Gender Incongruence”. When a diagnosis is required, that is the term we will use.

Staff at the clinic seek to work with our clients to individually select the best medical and social options for them. The WPATH Standards of Care notes:

“While many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options and some need neither. …

Health professionals can assist gender dysphoric individuals with affirming their gender identity, exploring different options for expression of that identity, and making decisions about medical treatment options for alleviating gender dysphoria (p9).”

If I have mental health issues or if I am neurodivergent will this impact my assessment?

Receiving care and treatment for mental health issues or neurodiversity issues will not prevent you from accessing our clinic or getting treatment with us. It’s not uncommon for trans and gender diverse people to have or to have had mental health issues or to be neurodivergent.

The Standards of Care do state that mental health conditions must be “reasonably well controlled … these concerns need to be managed prior to or [at the same time as] treatment of gender dysphoria.” Therefore having treatment for mental health conditions may assist in gaining approval for hormonal or surgical treatments.

Many of the clients we support have, or have had, mental health issues or are neurodivergent. Sometimes, their mental health assessment may take longer. This is only to ensure that the right supports can be provided, in preparation for any gender-related treatments.

The Gender Clinic is not a crisis/emergency service. As such, we must be sure that our clients have access to any needed support and treatments for mental health conditions, before we can approve hormonal or surgical treatments.

Our clinic welcomes neurodivergent clients, including autistic people and people with ADHD. Neurodivergence is not a barrier to accessing hormones or surgery, but may mean the assessment will take more time. This is only to ensure that the right supports can be provided, in preparation for any gender-related treatments.

Government assistance with travel costs

Assistance with travel costs can be provided to people with demonstrated needs. You can contact the Clinic [email protected] to access a document for guidance on Government provided schemes, or talk to the social worker to discuss options.

Telehealth or face to face available

Both face to face and teleconference appointments are available. When booking your appointments the administrative assistant will discuss the use of teleconference. The gender clinic uses HealthDirect software (it’s is similar to Skype or Facetime but offers greater security). Gender Clinic staff are working both offsite and onsite. If you have an upcoming appointment, please contact our admin team to advise them if you would prefer a face to face appointment otherwise we will assume that the appointment is to be held via telehealth. Also advise the admin team if you would like to enter the building via a private side entrance, rather than the main front entrance.

What can I expect when I come to the Gender Clinic?

Gender Clinic clients often feel nervous before their first appointment. The clinic is a safe space for you to explore some very personal issues. Being honest and open with your clinician helps to form a comprehensive understanding of your experiences and needs.

There is no requirement about how you present your appearance at the clinic. We encourage you to dress in a whichever way makes you comfortable.

As a new client, you will be offered appointments at the clinic with a mental health professional. These are for:

• conducting an initial series of interviews for a mental health assessment, under the WPATH Standards of Care guidelines;
• with your consent, a detailed psychological assessment and/or a family assessment;
• discussing the treatment options that are best for you.

The mental health assessment sessions are:

• so that your clinician can gather information about your gender related experiences at various stages of your life and any associated distress;
• identify your strengths;
• assess what supports are needed as you embark on strategies to reduce your distress.

Some aspects of the assessment may be conducted by another member of the team. All assessments are discussed at regular staff meetings.

If clients are approved for gender affirmation therapies and wish to proceed, they can be referred to other clinicians for:

• Hormonal treatment to masculinise the body (partially irreversible) or feminise the body (which is largely reversible); and
• If appropriate and when additional criteria are met, surgical procedures (which are largely irreversible).

About Hormones

What are the processes for starting on hormone therapy.

Endocrinologists and General practitioners can prescribe hormones. If your referring GP has indicated a willingness to do so, they will initiate the hormone treatment.

If your GP prefers, we can refer you to a Monash Health Endocrinologist for hormone therapy. The endocrinologist may require you to undergo a full physical examination to ensure that you are physically well enough to be able to have hormone treatments. They will then write to your GP to advise on the type and dosage of hormone treatments and what monitoring will be needed throughout your treatment. If your GP or another service provider begins hormone treatment before or while you are on the waiting list, this will not affect your position on the waiting list.

Anyone assessed as not being appropriate for gender affirmation therapy will be offered support to find non-medical ways of living with their Gender Dysphoria/gender variance. If a client has non-medical interventions, they may then be offered the option of a future re-assessment.

If you consult the Clinic about hormone treatment, we will follow the criteria specified in the WPATH Standards of Care. The criteria to commence hormone therapy as specified in the Standards of Care must be satisfied prior to referral to the hormone prescriber.

If you and your allocated clinician agree that hormones may be helpful, you are referred to an endocrinologist or your GP. Assessment times vary, depending on your individual circumstances. Your clinician will review your progress after the initial set of 3-6 sessions.

Starting hormones could be delayed, If there are significant social or mental health issues that need to be addressed first.

After commencing hormones, individuals are invited to attend follow up sessions for support or other identified needs.

What are the impacts of hormonal treatments?

Hormone treatment plays an important role in the physical and psychological transition process for many clients who attend the clinic.

There can be medical, psychological and social side effects for all people receiving hormonal treatment and it is important to familiarise yourself with these prior to commencing hormones.

Birth-assigned males treated with feminising hormones can expect this treatment to result in:

• breast growth,
• some redistribution of fat,
• decreased body hair,
• slowing or stopping of male pattern balding,
• decreased testicular size,
• reduced fertility and less frequent,
• less firm erections,
• possible loss of libido.

Birth-assigned females treated with masculinising hormones can expect this treatment to result in:

• permanent deepening of the voice,
• permanent clitoral enlargement,
• mild breast shrinkage,
• reduced fertility,
• increased upper body strength,
• weight gain,
• facial and body hair growth,
• increased libido,
• decreased fat on the hips,
• possible male pattern baldness.

What if I have been taking hormones without a doctor’s prescription?

The clinic will see patients who have been begun hormonal treatments without medical supervision. However, reflecting a harm minimisation approach, we will refer you to an endocrinologist or experienced GP to assess the impacts and begin prescribing, so that hormones are taken in a controlled manner.

Obtaining hormones without a prescription is strongly discouraged by the clinic. Our advice is that for your health and safety, you should never take medication sourced through the internet or on the ‘street’. Starting hormonal treatments that are not medically supervised can be dangerous to your long-term health.

The clinic understands the enormous pressures that some people will feel about the need to begin a physical transformation. Despite this, the clinic will always advise that you wait until you have been assessed. The timing of hormone treatments is very specific to the individual and is dependent on a whole series of considerations that need to be made by you and your doctors.

About Surgery

Why is surgery important for some clients, and what does it involve.

For some people, surgery is an important step in affirming their gender. This involves generally irreversible surgical procedures. It aims to provide a body that is consistent with their gender.

Types of gender affirming surgery For clients assigned male at birth, surgery can include:

• removal of the testicles and penis,
• creation of a vagina,
• breast enlargement,
• rhinoplasty,
• laryngoplasty (shaving of the “Adam’s apple”),
• vocal cord surgery,
• facial feminisation surgery.

For clients assigned female at birth, surgery can include:

• chest masculinisation,
• removal of the uterus, fallopian tubes and ovaries.

Surgery to create a penis (phalloplasty) or metoidioplasty (clitoral release) is associated with a number of complications that led to the discontinuation of these procedures in Victoria. However, these procedures are still performed elsewhere.

Before surgery, the surgeon will detail to the client the nature of the surgical procedure, its risks and possible complications and the cost.

Providers of gender affirming surgery At present the only surgical procedures available through Monash Health are:

• removal of the uterus and/or ovaries (hysterectomy and/or oophorectomy);
• removal of testicles (orchidectomy); and
• vocal feminisation.

Other procedures are performed by private surgeons, and your clinician will be able to assist in making referrals as appropriate.

The Gender Clinic itself does not offer other surgical treatments at this stage. However, we are able to provide letters of support to appropriate private surgeons. They can advise you of their fees when you make your appointment with them.

Financial support for surgery

The Gender Clinic is able to provide some financial support to a limited number of clients each year to assist with private surgical costs for:

• chest masculinization for clients assigned female at birth
• genital surgery for clients assigned male at birth.

To qualify for this financial assistance, a client must have been referred to the surgeons after consultations with Monash Gender Clinic clinicians. Please speak to your clinician for further information.

Obtaining gender affirming surgery from overseas providers

Surgery is available in Australia. However, some people may choose to pursue surgery overseas. Please note; the Gender Clinic does not have any official links or affiliations with any overseas surgeons.

Reputable overseas surgeons follow the same Standards of Care as our clinic. Therefore, they often ask our Clinic confirm in writing that we consider those same requirements for gender affirmation surgery have been met.

Complications can arise after gender affirmation surgery. Please note: if this occurs, Australian surgeons are reluctant to perform revision surgeries on work that was done by other surgeons.

When can I have surgery?

If you feel ready for chest masculinization or genital surgery, you will be referred to a surgeon for a medical assessment following your initial assessment. Once you have met with the surgeon you may then book a provisional date for surgery.

Within three months prior to your surgery date your mental health professional need to meet with you and supply a letter of support for surgery, in line with the WPATH Standards of Care. Once this is done, you can contact the surgeon to confirm your surgery date.

The recent Standards of Care guidelines (version 8) requires one opinion/referral for all gender affirming surgeries. However, some surgeons require two opinions for genital surgeries. If a second opinion from a different mental health professional within the team is required, this is usually completed in 2-4 sessions. Please check with your surgeon for their requirements and expectations.

Requirements for surgery set out in the WPATH Standards of Care are as follows:

• Gender incongruence is marked and sustained;
• Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention;
• Demonstrates capacity to consent;
• Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options;
• Other possible causes of apparent gender incongruence have been identified and excluded;
• Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed;
• Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated). [Suggested criteria]

Do I need to be living full-time in my affirmed gender before I have surgery?

There is no requirement in the WPATH Standards of Care 8 for people to live in a role congruent to their gender identity prior to genital surgery. However, it notes that such “social transition can be extremely beneficial to many TGD people.”

Social transition allows the person to develop stability in their affirmed gender, and to build confidence in their ability to live in the affirmed gender role. Gender transition has been known to contribute to employment discrimination, marital problems, divorce, and the restriction or loss of contact with children. Social transition helps raise awareness of these personal and social consequences.

On the other hand, the WPATH Standards of Care 8 also notes: “not all TGD people are able to socially transition or wish to socially transition. Consequently, some TGD people seek gender-affirming interventions after social transition, some before, some during, and some in the absence of social transition. Social transition and gender identity disclosure can improve the mental health of a TGD person seeking gender-affirming interventions. In addition, chest and facial surgeries prior to hormone therapy can facilitate social transition.”

What issues can delay or rule out surgery?

Treatment can be deferred for many different reasons. Your treating clinician will discuss your individual circumstances with you and will explore with you ways in which you can progress.

Having a high body weight increases risk in surgical operations. The surgeons who perform these operations have Body Mass Index (BMI) score requirements for patients who wish to undergo surgery. This BMI score requirement varies between procedures and surgeons. Excess body mass can create problems with breathing under a general anaesthetic, blood loss and causing difficulty with accessing the parts of the body where surgery will be performed. Generally, it is preferred to achieve a weight of under 100kg and BMI less than 30. You need to discuss these requirements with your surgeon.

Your BMI is calculated by dividing your weight in kilograms (kg) by your height in metres (m), then dividing the answer by your height again to get your BMI score. This is a commonly used method by doctors and nurses to approximate whether a person is under or overweight. You calculate your BMI using the  BMI calculator . The calculator will also indicate how much over or under your ‘ideal’ weight you are.

Smoking also increases risk in surgical operations. There are already numerous health reasons for quitting smoking. This becomes even more important prior to hormonal treatments and/or surgery. All the hormone and hormone-blocking medicines prescribed to aid with gender affirmation raise the risk of an occurrence of Australia’s biggest killers: heart disease, cancer and cerebrovascular accidents (strokes). The surgeons may not offer treatments until you are able to quit smoking for a period prior to surgery.

What support is available?

• The Gender Clinic can provide support/explanation for partners, parents and children.
• We can help with support with recovery from surgery.

How do I change my name and gender marker on personal documents?

Changing gender markers on ID varies between each State and the Commonwealth Government. A useful summary is can be found at Parents for Gender Diverse Children .

Victoria Drivers’ Licence 

https://www.vicroads.vic.gov.au/licences/renew-replace-or-update/update-your-details/change-of-gender

https://www.humanservices.gov.au/individuals/enablers/update-your-personal-details-medicare-card

Centrelink, ATO, other Commonwealth government bodies

https://www.humanservices.gov.au/customer/enablers/updating-your-gender-details-us

https://www.passports.gov.au/passportsexplained/theapplicationprocess/eligibilityoverview/Pages/changeofsexdoborpob.aspx

Birth Certificate

Birth certificates vary by state, and can depend on a number of factors. Contacting your state Births Deaths and Marriages or equivalent is necessary to obtain the most up to date information.

• New South Wales
• Western Australia
• South Australia
• Northern Territory
• Australian Capital Territory

Monash Health Records Monash Health client records will follow the details on your Medicare card. Please advise if your Medicare card name and gender marker change. In the meantime, a preferred name can be registered on the Monash health system. You can also inform Monash Health staff of your preferred title and pronouns. The Gender Clinic will make every effort to respect your choices.

The Keypass ID is an ID without a gender marker on it. It is available through Australia Post

Relationship Status

If someone change genders, they are still considered to have been in a defacto relationship.

Since the Federal same-sex marriage laws were passed, married people who transition can change identity documents including birth certificates, with nno need to divorce.

Federal government considers adding gender-affirming surgery to Medicare rebate list

When Max Jahufer became a dad, his plans of undergoing gender-affirming surgery took a back seat. 

Key points:

• Only a handful of Australian surgeons offer certain gender-affirming procedures
• The ASPS wants the government to add gender-affirming surgery to Medicare
• The federal Department of Health and Aged Care is considering adding 21 items to the benefit system

Max and his partner Paris welcomed little Windsor into the world on a chilly winter's day in July. 

From that moment, his young family became his number one priority. 

However, being his authentic self for them is something Mr Jahufer, a transgender man, is still coming to terms with. 

It is something that is particularly pertinent when he thinks of his newborn son. 

"I do have moments in time where I think, 'Am I going to be adding confusion to his life if my body doesn't represent who I'm living my life as?'," Mr Jahufer said.

Having chest masculinising surgery, known in the community as "top surgery", is something that Mr Jahufer has long desired.

But the costs associated are prohibitive.

Mr Jahufer has been quoted upwards of $20,000 through a private surgeon, something that is hard to swallow when balanced with the increasing costs associated with his growing family.

He said news that the federal government  was considering adding gender-affirming surgery to the Medicare rebate program  was like "a light at the end of the tunnel".

"I think it would change so many people's lives in ways that I don't think a lot of people can understand," Mr Jahufer told the  ABC's Victorian Statewide Mornings .

"It's something that I've been needing and wanting to do for a very, very long time.

"And to be honest, if it's something that's going to come into play relatively soon, say within the next 12 months, I would consider waiting [for it] because it is a huge financial burden."

Not just about looks

The federal government will consider an application by the Australian Society of Plastic Surgeons (ASPS) to add 21 Medicare items for gender-affirming surgeries, such as chest surgery and genital reconfiguration. 

Such surgery is often performed on people experiencing gender incongruence or gender dysphoria, where individuals experience an incongruence between their experienced gender and assigned sex. 

The ASPS's application estimated that in 2023, more than 125,000 people would eligible for such surgeries — more than 47,000 of which would utilise the surgery in its first year under the scheme.

Doctors in the field and trans people say there are only five Australian surgeons regularly performing some of these procedures.

"The objective of these amendments and additions to the Medicare Benefit Scheme is to facilitate a multidisciplinary best model of care framework for patients pursuing medical interventions for gender affirmation that extends before and after any surgery," the ASPS application stated. 

The federal government's Population, Intervention, Comparator and Outcome (PICO) Advisory Sub-committee, a subcommittee of the independent Medical Services Advisory Committee, is scheduled to discuss the ASPS application on Thursday, December 7.

A Department of Health and Aged Care spokesperson said the government was committed to supporting all Australians' access through Medicare. 

"There are several MBS [Medicare Benefit Scheme] items for surgical procedures, which may be performed during a patient’s gender affirmation process, if the treating practitioner deems these procedures to be clinically relevant to a patient’s care," the spokesperson said.

"There is also a range of GP and specialist consultation items, which may be relevant to patients undergoing a gender-affirming process."

The best is yet to come

For Mr Jahufer and Paris, their journey as a family has only just begun.

They have  shared their family journey on Instagram  as part of their advocacy work in the IVF and transgender awareness spaces.

Mr Jahufer said the surgery would allow him to finally look the way he felt, and not feel a sense of shame when he looked in the mirror.

"I think being able to have the surgery is really going to take me one step closer to that authenticity, and really looking in the mirror and not having to look away," he said.  

"It'll help my happiness and in turn he [Windsor] will see that, and it'll normalise it even more." 

If you're unable to load the form, you can access it here . 

• X (formerly Twitter)

Related Stories

Trans australians waiting years for gender-affirming surgery, as medicare bid looms.

Victoria makes it possible for people to change their legal gender without having to undergo surgery

Miss Universe changes rules to allow transgender women

Russian parliament takes step toward banning gender reassignment surgery

• Gender Discrimination
• Health Policy

What subsidised gender affirmation surgery would mean to trans Australians

A 150,000 signature-strong petition calling for medicare to cover gender affirmation surgery is set to be tabled in federal parliament this week. here, trans men and women and their advocates tell sbs news why such a move would be "lifesaving"..

Bayley Turner said gender-affirming surgeries are "lifesaving". Source: Supplied/Bayley Turner

More than 111,000 people sign petition for gender affirmation to be covered by Medicare

'An incredible sense of relief'

Doctors call for end to LGBTIQ+ health discrimination, gay 'conversion' practices

'It is lifesaving'

How the trans community is using crowdfunding to raise money for surgery

Petition calls for better recognition and protection of transgender inmates in Tasmanian prisons

Share this with family and friends

Recommended for you

Who was Joel Cauchi, the Queensland man who carried out the Bondi mass stabbing?

This Australian tourist destination is banning cash, and travellers aren't happy

A 'wonderful human' and a Trump fan: Who is the stabbed Sydney church leader?

Terrorist attacks

Australia Post will make a big delivery change next week. Here's how it will affect you

Postal service

Refugee who died defending others among six victims of Bondi stabbing attack

Nariman was forced to give up her career dream because of this 'discriminatory' requirement

Student finances

Wages on the rise: How does your income compare to others?

Personal income

Boomtown: Australia's 'rising star' suburbs and towns where prices could surge

Housing Affordability

Get SBS News daily and direct to your Inbox

Sign up now for the latest news from australia and around the world direct to your inbox..

Morning (Mon–Fri)

Afternoon (Mon–Fri)

By subscribing, you agree to SBS’s terms of service and privacy policy including receiving email updates from SBS.

SBS World News

• Why Choose Dr David Caminer?
• CURRICULUM VITAE
• ROOMS & CONSULTATION
• OPERATING FACILITIES
• David’s Passion For Art
• Interviews & Media
• Breast Implant Surgery Sydney
• Breast Lift
• Breast Reduction
• Calf Implants
• Ear Surgery
• Eyelid Surgery
• Facelifting
• Fat Grafting
• Female Genital Surgery
• General Reconstructions
• Gummy Smile
• Hand Surgery
• Head & Neck
• Inverted Nipples
• Liposuction
• Male Breast Surgery
• Male Genital Surgery
• Male Penis Enlargement
• Medial Thigh Lift
• Mole & Skin Lesions
• Nose Surgery
• Tattoo Removal

Transgender Surgery

• Trauma, Accidents & Emergencies
• Anti-Wrinkle Injections
• Dermal Fillers
• Fat Reduction
• Lip Enhancement
• Coolsculpting Sydney
• Skin Tightening
• Hair Removal
• Vein Therapy
• Pigmentation
• Pearl & Laser Resurfacing
• Caminer Original Skin ™
• Hydrafacial ®
• Tailored Skin Treatments
• Contact Information

Transgender is a term used to describe people whose gender identity does not match the sex they were assigned at birth. Gender identity is a person’s personal sense of being a man or a woman. In other words, for transgender people, the sex that they were born with and their internal gender identity are mismatched.

The term transgender, transsexual or gender diverse, are all synonymous terms used to describe these types of individuals.

History of treatment for transgender individuals

The modern history of transgender people goes back to a time when they were considered to have a serious psychological disorder. As such, treatment was firmly in the domain of the psychiatrists, who were notably unsuccessful in their attempts to heal transgender individuals.

As the years progressed, it became clear that transgender individuals are a diverse group of people with varying personalities, the only exception being that they do not feel they belong to the sex they were assigned at birth.

Modern treatment of transgender individuals

Fortunately, thanks to an environment with increased acceptance, and the advantages of modern medicine and surgery, treatment of transgender individuals has changed. Today, we can assist transgender people with both supplemental hormones and with surgery.

With surgery, we can physically alter the sexual appearance of your upper body, as well as your sexual genetalia, aligning your genital appearance with your gender identity.

There are specific upper body features that characterise a male person and others that characterise a female. These include: forehead shape, brow shape, brow position, nasal shape, nasal size, upper lip length, cheekbone height, chin prominence, Adams apple or thyroid cartilage prominence, as well as voice pitch. There are also the obvious differences of the chest and breasts, as well as with the male and female genitalia.

A lot of these characteristics can be altered with hormonal therapy, but certain characteristics cannot be altered with this type of treatment. For example, facial hair, thyroid cartilage or Adams apple prominence, voice pitch, and the size of your hands cannot be altered with hormone therapy.

Issues arise however, once puberty finishes and some of these characteristics become irreversible. Therefore, if a young person knows that they have a gender identity crisis or feels that they belong to the opposite sex, it is best to initiate this change before puberty, so that these non-reversible changes do not become established.

Under these circumstances, you can transition to full puberty and if you wish, you can undergo gender reassignment surgery after the age of 18.

What is gender transitioning?

Transitioning is the process of changing one’s gender presentation and/or sex characteristics to accord with one’s internal sense of gender identity – the idea of what it means to be a man or a woman.

Transitioning may involve various forms of medical treatment involving hormonal therapy and psychological counselling. It can also include behavioural therapy to help align your physical characteristics with your gender identity. Affirmed gender is the term used for the gender of the transitioned individual.

What is gender dysphoria?

The medical diagnosis of someone who feels that they do not belong to their assigned birth gender is known as gender dysphoria. This is defined as the experiencing of discomfort or distress, due to a mismatch between your biological sex and your gender identity.

Many transgender individuals who wish to transition or become aligned to their correct gender are prescribed hormones by their doctor or endocrinologist, which will change the physical appearance of their body. Some transgender individuals who transition with hormones will eventually undergo surgery to complete their transition.

Not all transgender people can or will take these steps and it is important to know that transitioning need not involve any form of medical intervention.

Requirements for transgender surgery

There are strict guidelines from the WPATH Society governing what needs to happen before gender reassignment surgery can take place. These requirements are that you must have a constant and consistent desire and have lived as male or female for at least 2 years, and must undergo psychiatric assessment for at least 2 years.

You must also demonstrate that you have lived as male/female for 1 year and dressed according to your desired gender, before considering male to female or female to male gender reassignment surgery (XRS). This type of surgery is also known as gender confirmation surgery.

How is the transgender surgery performed?

Gender affirming surgeries can either be male to female surgery (M2F) or female to male surgery (F2M). Surgery to the top half of your body, which encompasses your facial appearance and the chest/breast area, can be performed before or after genital surgery, however it is more common to do this type of surgery first.

The top half surgery, in both instances, can be done in one stage or numerous stages depending on your wishes. The bottom half surgery in a male to female surgery is usually performed in one stage, but there can be numerous touch ups later, if required.

Female to male surgery is usually performed in a few stages, mainly due to the issue of lengthening of the urethra and insertion of an implant to stiffen the neo-phallus. There are usually three stages involved in female to male surgery.

Male to female (M2F) surgery

Male to female (M2F) surgery is easier to achieve than the female to male (F2M) surgery. The goals of the male to female affirming surgery are most commonly a functioning vagina and a typical female external genitalia that is cosmetically acceptable.

At the time of this operation, the testes are removed (orchiectomy), the penis is excised with preservation of the skin envelope, and a new vagina is reconstructed utilising all of the penile skin. The scrotum is used to reconstruct the labia minora and majora and a clitoroplasty is usually performed, by using a neurovascular island flap and some of the glands of the penis.

Male to female gender affirming surgery takes approximately 3 to 4 hours and requires a general anaesthetic. For the first 2 post-operative days you will need to remain on bed rest and you will have a urinary catheter and some drains as well, which will need to remain in place for up to a week.

Post-operatively, you will be prescribed analgesia (pain medications) and intravenous antibiotics, which will be changed to oral antibiotics a few days after your surgery.

You will remain in the hospital for 8 – 10 days, before being discharged.

It is important to understand that M2F gender affirming surgery will not allow a woman to have any pregnancies or be child bearing. Male to female surgery once performed is totally irreversible.

Female to male (F2M) surgery

Female to male (F2M) surgery is performed in three different stages, with the first stage being the longest. All of the three stages of F2M surgery require general anaesthesia and bladder catheterization.

First stage of F2M surgery

The first stage involves the following operations: an oophorectomy (removal or ovaries), hysterectomy (removal of the uterus) and a vaginectomy (removal of the vagina). The latter operation, a vaginectomy, can be performed at any stage, as it’s not considered to be part of gender affirming surgery.

In addition, a new phallus needs to be fashioned from tissue, which can be harvested from numerous parts of the body. However, microsurgery is often necessary when one transfers tissue from either the forearm or the arm, to the pubic region. For the new phallus, an inner and outer tube need to be fashioned with the inner tube forming the new urethra and the outer tube forming the penis or phallus. This is the first stage of the surgery and might take 4 – 6 hours.

The new urethra must be completely healed and watertight, prior to commencing the second stage of gender reassignment surgery.

Second stage of F2M surgery

In the second stage, the existing urethra (prior to surgery) is joined to the new urethra and the glands are fashioned on the penis.

Third stage of F2M surgery

The last stage of your F2M surgery is the insertion of a prosthesis to keep the phallus’ rigidity. The scrotum are fashioned from the labia and the testes are made by inserting silicone oval shaped implants.

Risks involved in transgender surgery

There are always risks involved with any type of surgery, and M2F and F2M gender reassignment surgeries are no exception.

These risks include: infection, bleeding, delayed healing, skin loss, flap loss, and hypertrophic or keloid scarring. In M2F surgery, injury to the bowel or urethra are also possible and in F2M surgery, injuries to the urethra structures are possible, as are one or more fistulas.

In addition, there is also the possibility of revision operations.

I hope this has given you some insight into transgender surgery or gender confirmation surgery.

If I can be of any more help or if you wish to schedule a consultation with me, please feel welcome to contact my office.

Your consultation can be at any stage of your transition.

 Thank you .

• Dr David Caminer
• Laser & Skin Care

MED0001151603 – This website contains imagery which is only suitable for audiences 18+. All surgery contains risks, Read more here

We have moved to Woollahra View Map + Address NEW AHPRA Regulations for Cosmetic Surgery from 1st July – See Blog

How much is Top Surgery in Sydney? Gender Affirmation Surgery Prices Sydney NSW

Top surgery is a gender affirmation procedure that alters the shape, size and overall appearance of the chest. Patients for top surgery are trans men and women, as well as non-binary patients. The surgery is typically performed by a plastic surgeon who is trained to perform gender affirmation procedures. If you are interested in undergoing gender affirmation surgery, then you might want to know more about top surgery prices in Sydney.

The Top Surgery procedure can be performed on transgender women to make their breasts look more feminine or transgender men to help them achieve a more masculine chest.

As a result, there is both FTM Top Surgery (female-to-male) and MTF Top Surgery (male-to-female).

• FTM Top Surgery involves the removal of breast tissue and chest contouring to achieve a flat, masculine-looking chest. The procedure is ideal for transgender men who want to overcome their gender dysphoria and wish to achieve a more masculine look.
• MTF Top Surgery typically uses saline or silicone implants to increase the breast size and alter their shape in order to achieve more feminine-looking breasts. The procedure is ideal for all transgender women who want to overcome their gender dysphoria.

Dr Jeremy Hunt is a Specialist Plastic Surgeon with cosmetic clinics in Sydney and Wollongong NSW . He has performed hundreds of breast procedures in over 20 years of practice. Dr Maryam Seyedabadi has recently joined the practice in Edgecliff and is available now for consultations on a range of plastic surgery for transgender men and women.

How do I get top surgery in Australia?

The criteria for getting top surgery in Australia is:

• Persistent, well-documented gender dysphoria
• Capacity to make a fully informed decision and to consent for treatment
• Reached the Age of 18 (if younger, follow the SOC for children and adolescents)
• If significant medical or mental health concerns are present, they must be reasonably well controlled

Top Surgery Prices Sydney

What’s included in top surgery:.

The cost of top surgery depends on a range of factors including the experience and expertise of the surgeon, your hospital and how much coverage you will be able to get from Medicate or insurance. In general, the cost of top surgery will include:

1. Surgeon’s Fee

The first and most important thing that will make a major part of the overall quote will be the surgeon’s fee. Obviously, this will be the biggest chunk of the entire cost and is highly dependent on the experience and expertise of the surgeon. The more experienced a surgeon is, the higher are the chances that he or she will charge more than a surgeon with little to no experience in the field.

2. Hospital or Surgical Facility Costs

The next thing that is of critical importance is the surgical facility or the hospital where the surgeon is going to perform the surgery. Make sure you visit the facility beforehand and ensure they are able to cater to all kinds of emergency situations.

3. Anaesthetist Fees

Your quote also involves the fees of an anaesthetic surgeon. Again, this varies from hospital to hospital and surgeon to surgeon. Make sure to know the cost beforehand.

4. Medication

During and post the surgery, you will be administered medications, primarily comprising of antibiotics and pain killers. The overall cost given to you will include the cost of the medications used during the process and during the post-surgical phase.

5. Post-Surgery Garments

You will be asked to wear post-surgery garments to minimise the swelling and help with recovery. These garments boost up the healing process and help you feel more comfortable during the recovery period .

6. Medical Tests and X-rays

You will be asked to undergo a series of medical tests and x-rays for the top surgery. A series of tests and x rays will be performed to ensure you are a suitable candidate for the procedure and there are no contraindications.

How much is Top surgery in Australia? – Gender Affirmation Top Surgery Prices in Sydney

Prices vary and the cost is based on the experience and expertise of the surgeon, the factors listed above and how much (if any) assistance you will be able to get from Medicare & Health Insurance.

The price ranges are:

• Male to Female MTF Top Surgery prices can range from around $7,000 to $17,000 in Sydney NSW.
• Female to Male FTM Top Surgery prices can range from around $10,000 to $20,000 in Sydney NSW

Please Contact us or Phone the clinic for a more accurate estimate.

How to Find the Right Surgeon in Sydney – Choosing a Surgeon

Choosing the right surgeon for your gender affirmation surgery can be a difficult task. Here are a few tips that will help you:

1. Ask for Referrals

One of the best and easiest things you can do in order to find a surgeon is to ask for referrals from your local GP. Generally, they will be able to make great recommendations.

2. Check your Surgeon’s Credentials

Another thing you can do is do your own research with the help of the internet. Make sure to pay close attention to their credentials and ensure they are credible and experienced to perform the top surgery.

3. Choose a Surgeon with Experience

Make sure to select a highly experienced surgeon who has performed top surgeries on plenty of patients. The more experienced the surgeon is, the higher are the chances of getting the results you desire.

4. Your Hospital Choice Matters

The medical facility where the surgery is performed is important too. Have a close look at the surgical facility/ hospital, your surgeon is planning to perform the surgery at.

5. Pay Attention to Communication Skills

You need to feel comfortable with the surgeon. Make sure the surgeon is able to answer all your questions and queries regarding the surgery. By the end of your consultation, you will have a fairly clear idea of whether the surgeon is right for you or not.

FAQS about Top Surgery – MTF Surgery – FTM Surgery

Here is a list of frequently asked questions we get regarding top surgery in Australia:

Is top surgery covered by Medicare Australia? – Does Medicare cover top surgery prices?

• Medicare may pay for some of the individual treatments associated with gender confirmation surgery including surgeries, medications, tests and consultations.
• Medicare may only partially cover the cost of Top surgery. New Medicare codes for Gender Affirmation surgery may be available in late 2022.

Can you get top surgery in Australia?

• Yes, you can get top surgery in Australia. Make sure to choose your surgeon wisely and find a Gender Surgery expert , ask for referrals, research the facility/ hospital, and then make a final decision.

What do I need to have top surgery?

• The standard criteria for getting top surgery is that you have persistent, well-documented gender dysphoria .
• Most surgeons require you to be 18 years old or above to get the surgery.
• You should be able to make a fully informed decision and consent to the treatment.

What is gender dysphoria?

• As per NHS, Gender dysphoria is a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.

How long does it take to get diagnosed with gender dysphoria?

• The DSM-5 defines gender dysphoria in children as a marked incongruence between one’s experienced/ expressed gender and assigned gender, lasting at least 6 months. In adults, gender dysphoria is diagnosed if you have had two symptoms or more for at least 6 months.

Can you get top surgery if you are overweight?

• It is recommended you have a BMI of less than 30 for top surgery. A BMI of 30 to 35 may be possible but if you are overweight or obese, the surgeon might advise you to lose weight prior to getting the top surgery.

Do you need to be on T to get top surgery?

• No, WPATH Standards of Care do not require hormone therapy to be eligible for Top Surgery.

How long do you need to be on T to get top surgery?

• You are not required to take testosterone before getting top surgery. However, if you are taking testosterone or are on any other medications, the surgeon will ask you to stop the use for at least 2 to 4 weeks before the top surgery. In case of necessary medications, you may be offered an alternative.

Can breasts grow back after top surgery?

• No, it is one of the most common myths associated with top surgery. Even if you gain weight or stop taking testosterone, your breasts will not grow back once they have been surgically removed.

Is Top surgery reversible?

• No, the results of top surgery are regarded as permanent and not reversible. Hence, it is important to ensure that you are ready for the surgery and won’t regret it later on.

Is Top surgery painful?

• You won’t feel anything during the procedure as it is performed under general anaesthesia. During the first week post-surgery, it is normal to feel some slight pain and discomfort that are easily alleviated with medication.

Can you get top surgery without scars?

• No, you cannot get the top surgery without scars. The surgeon will try his/ her best to conceal them and make them less visible. Moreover, you can also opt for scar minimisation procedures once you are fully healed.

What should I wear after top surgery?

• Make sure to wear a loose, comfortable and breathable button-up shirt or hoodie because you will have a limited range of motion post-surgery.

Do you have to stay in the hospital after top surgery?

• In most cases, you will be asked to stay a day in the hospital after top surgery. In some cases, you might be allowed to go home on the same day, once your condition has stabilised.

Do you need physical therapy after top surgery?

• It depends. In most cases, surgeons recommend getting some physical therapy to speed up the recovery after the surgery.

When can you sleep on your side after top surgery?

• It is best to avoid sleeping on your side for at least the first six weeks after getting top surgery.

Further Reading about Gender Affirmation Surgery & Top Surgery Prices:

• Read Dr Hunt’s Gender Affirmation Surgery page
• Read Dr Hunt’s MTF Top Surgery page
• Read Dr Hunt’s FTM Top Surgery page
• Read Dr Hunt’s pricing page

Medical References about Top Surgery

• Top surgery for transgender men and nonbinary people
• What Is a Top Surgery for Transgender People?
• Transgender surgery can improve life for most, study confirms

About Dr Jeremy Hunt – Specialist Plastic Surgeon

Dr Jeremy Hunt is a specialist plastic surgeon performing breast , body , face and nose surgery in Australia. He is a member of FRACS & ASPS and has over 20 years of experience providing plastic surgery in Sydney.

Careful, considerate and honest, Dr Jeremy Hunt works with you to find a solution that is suitable for your body and your lifestyle. Every patient is unique and requires a personalised approach to reach their goals.

Dr Hunt has provided his one-on-one service and attention to detail to thousands of women and men from the Sydney & Wollongong NSW area and across Australia.

Dr Hunt’s qualifications and education

Dr Jeremy A. Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of ASPS – the Australian Society of Plastic Surgeons . He completed a Fellowship at the University of Texas in the United States, where he learnt from well-established and experienced plastic surgeons.

Next Step – Make an Enquiry or Request a consultation with Dr Hunt

Want more information before scheduling your consultation?

• Find out more about pricing, medical payment plans and paying for your surgery
• Request more information about the procedure – call on 1300 157 200 or contact us

If breast reduction (mammoplasty) is something you’re considering, Dr Hunt can thoroughly explain all the options to you in a one-on-one consultation.

• Make an Enquiry or Request a consultation with Dr Hunt

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health professional.

About The Author

Dr jeremy hunt fracs - specialist plastic surgeon.

Schedule your consultation with Dr. Hunt

Book A Consultation

Or send us a quick enquiry by completing the form below and one of our staff will respond to your enquiry as soon as possible.

• How To Make A Complaint
• Melbourne Specialist Surgeons
• Dr Craig Rubinstein – Plastic Surgeon
• Dr Broughton Snell – Plastic Surgeon
• Dr Stephen Kleid – Ear Nose Throat Specialist
• Dr Gary Kode – Plastic Surgeon
• Skin Clinic Team
• Careers at Coco Ruby
• Reviews and Testimonials
• Breast Augmentation
• Breast Implants by Cup Size
• Breast Reduction
• Breast Lift (Mastopexy)
• Breast Lift (Mastopexy) with Implants
• Fat Transfer to Breast
• Breast Tuberous
• Remove Replace Implant
• Gynaecomastia
• Abdominoplasty
• Arm Lift (Brachioplasty)
• Face Lift (Rhytidectomy)
• Rhinoplasty
• Eye Lid Lift (Blepharoplasty)
• Gender Top Surgery
• Ear Pinning
• Skin Treatments
• Breast Lift (Augmentation)
• Breast Implant Removal
• Breast Implant Revision
• Breast Asymmetry Surgery
• Tuberous Breasts
• Nipple & Areola Surgery
• Male Breast Reduction – Gyno
• Breast Implant Checks & Reviews
• Liposuction
• Body Lift after Weight Loss
• Belt Lipectomy – 360 Abdo
• Extended Tummy Tuck
• Fleur De Lis Abdo
• Thigh Lift (Thighplasty)
• Bra Line Back Lift
• Labiaplasty
• Male Excess Skin Removal
• Male Breast Reduction
• Facelift (Rhytidectomy)
• Neck Lift (Platysmaplasty)
• Blepharoplasty
• Male Eyelid Lift
• Upper Lip Lift
• S-Lift – Facelift (Rhytidectomy)
• Chin Augmentation
• Chin Implants (Genioplasty)
• SMAS Facelift (Rhytidectomy)
• Fat Transfer To Face
• Ear Pinning – Otoplasty
• Tip Rhinoplasty
• Septo-Rhinoplasty
• Rhinoplasty Revision
• Male Rhinoplasty
• Asian Rhinoplasty
• Sinus Surgery
• Sleep Apnea Surgery
• Female to Male Top Surgery
• Male to Female Top Surgery
• Adam’s Apple Reduction
• Male Rhinoplasty – Nose Job
• Male Chin Augmentation
• Male Eyelid Surgery
• Male Tummy Tuck – Abdo
• Male Excess Skin Reduction After Weight Loss
• Labiaplasty – Labia Reduction
• Skin Treatment Menu
• Anti Wrinkle Injections
• Dermal Fillers
• Lip Fillers
• Hyperpigmentation
• Acne Treatments
• Chemical Skin Peels
• Fraxel Laser
• Cutera Excel V+
• Healite LED
• Vaginal Lasers
• Cosmetic Surgery Prices
• Will Medicare cover me?
• Payment Methods
• Cheap Surgery Deals
• Guides For Plastic Surgery
• Procedure Checklists
• Recovery Guide
• Post-Operative Guide
• Nose Consultation – Dr Kleid
• GP Referrals
• Getting an MRI test
• Hospitals We use
• Risks of Surgery
• Surgery Recovery Tips
• Interstate Patients
• Careers & Recruitment
• Hawthorn East – Melbourne

Changes to AHPRA Cosmetic Surgery Regulations, as of July 1 2023, Learn More

Does medicare cover gender affirmation surgery, can i claim my gender affirmation surgery or gender confirmation surgery on medicare & my health fund.

An increasing number of people are seeking Gender Affirmation or Confirmation Surgery. As the popularity of this surgery grows, many patients often have inquiries regarding the financing of such an operation. As with other surgical procedures, certain specific rules must be met in order for you to be eligible for cover.

Will Private Health Insurance (PHI) cover Gender Affirmation or Gender Confirmation surgery?

In order to request cover for gender surgery from your private health insurance, you must first be eligible for a Medicare item number.

We recommend you consult with your health fund in order to get the correct information regarding;

• The conditions under which you can apply for cover
• The level and extent of your health fund cover required

Gender Dysphoria

Gender dysphoria refers to the condition of feeling that your psychological and emotional identity does not match with your birth gender. Whilst, it can cause serious distress and anxiety , gender dysphoria is not a mental illness.

In 2007 Australian Research Centre in Sex, Health & Society published ‘Tranznation: A report on the health and well being of sex and gender diverse (Trans) gender people in Australia and New Zealand’ the publication shared the following statistics;

• A large majority of trans people (87.4 %) had experienced at least one form of stigma or discrimination
• Over half (53.4%) reported verbal abuse
• One third (33.6%) had received threats of violence or intimidation
• Nearly one in five (18.6%) had experienced a physical attack or other kinds of violence

Transgender people are also likely to experience bullying in schools, workplaces and other social situations.

Reasons for wanting to have Gender Affirmation/Confirmation surgery

Whilst Transgender people do not need medical intervention to have valid identities many choose to transition. This can involve Social and/or Medical transitioning.

• Social transitioning : refers to going by different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender
• Medical Transitioning involves taking hormones and/or surgically removing or modifying genitals and reproductive organs. This is what we refer to when talking about Gender Affirmation or confirmation surgery.

Medicare Item Numbers for Gender Surgery

MBS Item Numbers :

• 31519 – Breast, total mastectomy
• 45451 –  Free Grafting (full thickness)
• 41879 – Tracheoplasty

There is NO Medicare rebate for purely Cosmetic Breast Surgery – like Chest Augmentation with Implants or Breast Augmentation.

Will Medicare Cover Gender Affirmation/Confirmation surgery for medical reasons?

Medicare and Private Health Insurance function on the basic principle that all procedures of an aesthetic nature are not eligible for cover. However, if your condition affects your normal daily functioning, then there is a possibility that your insurance provider will, to some extent, help finance your procedure. The procedure must be medically justified and compliant with Medicare criteria. In every other case, neither Medicare nor private health insurance will not cover the costs.

There are many types of gender affirmation surgeries – often split into “top surgeries” and “bottom surgeries,” depending on the area of the body.

BOTTOM surgeries.

• For MTF or MTN, vaginoplasty and penile inversion techniques are used to construct a sensate vagina.
• For FTM or FTN, phalloplasty and metoidioplasty are surgeries used to construct a neopenis. Scrotoplasty and testicular implants may also be used to construct a scrotum.

TOP surgeries.

• For Female to Male (FTM) or Female to Non-Binary (FTN), top surgery involves removing breast tissue and flattening the chest.
• While, Male to Female (MTF) or Male to Non-Binary (MTN), involves using breast implants (Breast Augmentation) to increase the size and volume of the breasts.

Medicare may also cover; Hormone therapy and counselling. While, additional procedures, such as laser hair removal, tracheal shave surgery, and facial feminization surgery, may also be performed as part of your gender affirmation, these surgeries are generally considered cosmetic in nature, are normally not covered by Medicare.

Research to find out if Medicare and the MBS Covers Your Gender Affirmation/Confirmation Surgery Procedure

• You can download a complete MBS benefits scheme to find out more about the categorization, codes, and conditions for each procedure.
• If you are looking for a specific procedure, you can use a built-in search function to browse through the categorization faster.
• If the desired procedure is not listed in the MBS categorization, Medicare is not offering reimbursement for that specific surgery.

Why is Medicare for  Gender Affirmation/Confirmation Surgery confusing a lot of patients seeking Plastic or Cosmetic Surgery?

Each plastic surgery is strictly individualized and modified for each patient. Gender affirmation/confirmation is more of a process because the gender affirmation process encompasses a whole range of procedures that will vary from patient to patient.

Medicare Rebates are subject to change and review

MBS Item codes can change or be eliminated from the Medicare rebate schedule. If your surgery is currently eligible for a Medicare rebate, it may be best to perform your procedure sooner rather than later.

Tips For Claiming Your Gender Affirmation/Confirmation Surgery

• Gender affirmation surgery is not for everyone. Some patients choose to live with gender dysphoria or just undergo hormone therapy without ever choosing to undergo gender affirmation surgery.
• Ask your doctor to show you photos of patients before and after surgery. This will give you an idea of what to expect from surgery.
• A comprehensive psychological analysis, to diagnose Gender Dysphoria.
• Then, you will need to undergo a minimum of one year of hormone therapy.
• After which you will be able to undergo a series of gender affirmation surgery.

When phoning Medicare and Health funds

• Know your stuff
• Visit the Medicare website
• And, make as many phone calls as you need to ensure you have all the information you need to apply.
• We recommend that you communicate with agents electronically so that you have a written record of each information exchange. However, if it is easier for you to communicate by telephone or do not use email, request written confirmation from the agent for each conversation.
• Organisation is key. Keep your papers in order, preferably in chronological order. This includes; findings, conversations, requests, and official correspondence.
• Unfortunately, Coco Ruby doesn’t provide assistance with Medicare or Health Fund processing. This is solely the patient’s responsibility. However, we do list the Medicare code(s) on your Quote and on your Invoice(s). So, if you are eligible for a Medicare rebate code or health fund rebate, this can help you when it comes to submitting your paperwork.

Our Gender Affirmation Surgeon

More information about your procedure.

• See the Gender Affirmation Surgery GALLERY of Patient Photos
• Read the Gender Affirmation Surgery – PROCEDURE PAGE
• For more information about pricing and payment methods, please visit our page on Surgery Payment options.
• You can also talk to our Patient Care Team from 8 am – 6 pm Monday – Friday on  (03) 8849 1400
• Phone  1300 264  811  or send us an enquiry form, below.

Medical References – Sources;

• https://www.healthline.com/health/medicare/does-medicare-cover-gender-affirmation#does-medicare-cover-it
• https://www.healthdirect.gov.au/gender-confirmation-surgery
• https://www.healthdirect.gov.au/lgbti-mental-health

The content available on our website is meant solely for educational and informational purposes. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or qualified healthcare provider with any medical inquiries or concerns you may have. Never disregard professional medical advice or delay seeking it based on information obtained from this website. The author and publisher of this content do not provide any warranty regarding the accuracy, applicability, or completeness of the information presented herein. Any actions taken based on the information in this article are solely at your own risk. Disclaimer Page .

Specialist Plastic Surgeons and ENT (Ear, Nose and Throat) Surgeon

With a wealth of experience and training, our Specialist Plastic and ENT (Ear, Nose and Throat) Surgeons are dedicated to best-practice patient care and education, customising Surgery for each and every patient to best meet their needs and desired surgical outcomes.

Specialist Plastic Surgeon MED0001124843

Dr Craig Rubinstein

Dr Craig Rubinstein is a Specialist Plastic Surgeon based in Hawthorn East, Melbourne. With over 20 years of surgical experience especially in all areas of Cosmetic and Plastic Surgery, but particularly in breast surgery. These include Breast Augmentation and Breast Reduction as well as Breast Surgery Revision.

Furthermore, he believes that surgical customisation, precision planning and technical expertise help him to provide optimal surgical outcomes for his patients.

Specialist Plastic Surgeon MED0001190266

Dr Broughton Snell

Dr Broughton Snell is a Specialist Plastic and Reconstructive Surgeon based in Melbourne, Victoria, Australia. His training in Plastic Surgery took place in Australia and the United States of America (USA).

Dr Snell is a fully qualified specialist plastic surgeon having completed his Fellowship with the Royal Australasian College of Surgeons in plastic and reconstructive surgery.

ENT (Ear, Nose and Throat) Surgeon MED0001052799

Dr Stephen Kleid

Dr Stephen Kleid is an experienced Ear, Nose and Throat (ENT) Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty, as well as, a strong interest in Rhinoplasty Revision.

Dr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincents. He worked as a surgeon at the University of Florida Medical school for further experience.

Specialist Plastic Surgeon MED0001405964

Dr Gary Kode

Dr Gary Kode is a Specialist Plastic Surgeon, with experience in Aesthetic and Reconstructive Surgery, as well as non-surgical treatments.

Dr Kode is a member of several organisations, including the Australian Society of Aesthetic Plastic Surgeons (ASAPS), The International Confederation for Plastic and Reconstructive and Aesthetic Surgery, and he holds a Fellowship with the Royal Australasian College of Surgeons.

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday - Friday.

Disclaimer : Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.

Start your journey

Book a Consultation

(03) 8849 1400

[email protected]

Our Practice

Hawthorn East

759 Burwood Road, Hawthorn East, VIC, 3123

Get Directions

Get in touch

Ask us a question

Reach out to us to secure your appointment.

• Looking for before and after photos?
• Want to know more about recovery times?
• Wanting to find out costs?

• International edition
• Australia edition
• Europe edition

‘They just go to Thailand’: the long and costly wait for gender-affirming surgery in Australia

Transgender Australians seeking lower body procedures can go to just a handful of local surgeons. It means long waits, huge costs and difficult decisions

• Get our morning and afternoon news emails , free app or daily news podcast

T wo years ago, Kavitha Sivasamy, an articulate, elegant Canberra lawyer, began to face her fears about undergoing gender-affirming surgery. “It’s really scary to go through something so invasive,” she says.

Gender dysphoria had been causing “a lot of distress” in Sivasamy’s day-to-day life. “It can prevent you getting out the door, having and keeping a job, sustaining healthy relationships,” the 27-year-old says. “The list goes on.”

She embarked on a course of hormone replacement therapy, and she liked the physical changes she was seeing, but this meant her “genital dysphoria became more salient”. There was a disconnect between her aspirations for her body and how it looked in the moment.

But Australia is facing a shortfall in surgeons who perform lower body gender-affirming procedures. So , in a route that experts say more Australian trans people are taking, Sivasamy will travel to Thailand for surgery under a medical tourism company’s “one-month care package”. Like some others, she will access her superannuation to pay for the $30,000 procedure.

Sivasamy made her choice after spending many months researching the experiences that others had of surgery. She decided a peritoneal pull-through, adapted from a procedure pioneered in India on cisgender women born without a vagina, was the type of vaginoplasty with the most positive benefits for her.

The standard vaginoplasty has long been a penile inversion, where penis skin is refashioned as the lining of a new vagina. The newer method, using tissue from the patient’s peritoneum membrane in the abdominal cavity, is said to offer greater vaginal depth. However, there is a lack of data on post-surgical quality of life for trans patients.

Sivasamy had been referred to Dr Kieran Hart , a Canberra-based urologist who performs this procedure, but she soon learned that she might have to wait a year and a half to have the surgery here. The idea of delay only compounded her distress.

“Having overcome family, workplace and social barriers, why put the critical years of your 20s and 30s on hold because of the wait in Australia?” she says. She will fly to Bangkok in May.

One surgeon, 120 patients waiting

Only a handful of Australian surgeons offer lower body gender-affirming surgery such as vaginoplasty for trans women, with even fewer offering phalloplasty (penis creation) for trans men. No surgical college offers formal training guidelines, forcing doctors to learn overseas.

Trans health advocates say Medicare is “woeful” and failing to offer any item numbers for medical procedures specifically for gender incongruence, causing confusion about what, if any, aspects of gender-affirming surgeries are eligible for government subsidy.

Private health insurance coverage for gender-affirming surgery is often prohibitively expensive. Even a fully insured person is left out of pocket by up to $20,000 for a vaginoplasty performed in Australia.

An evidence brief prepared in 2021 by the New South Wales community health organisation ACON found that most states and territories have elective surgery policies that “explicitly restrict access to surgical interventions for trans people through public health systems”, forcing trans people into local private care or surgery abroad.

Dr Clara Tuck Meng Soo , a GP and the president of the Australian Professional Association for Trans Health (Auspath), says a lot of her patients “now don’t even bother to go on the waitlist; they just choose to go to Thailand”.

“We have very high rates of mental health harm , and this care and affirmation and support is critical to reducing that harm,” says Soo, who is a trans woman. “But shouldn’t we also be able to access care that we feel we need as a human right?”

Hart says he has 120 trans patients booked and waiting for gender-affirming surgeries, with another 70 scheduled for consultations, and estimates “probably 10 times more” trans people are waiting for surgery across Australia.

Hart has closed his bookings and will reopen them in the second half of this year for consultations to be held in 2024 – with potential surgeries months later.

However, he says he will expedite a surgery if a psychiatrist or family is worried a patient might not survive an 18-month wait. Transgender people have vastly higher self-harm rates than the general population – a 2021 study found 43% of trans Australians surveyed had attempted suicide .

Like others performing lower body gender-affirming surgeries in Australia, Hart came by training in the area by chance: he was taught by the late Phil Thomas at London’s Charing Cross hospital. Hart had only travelled there to train in prostate and bladder cancer surgery.

Based on follow-ups of how patients fared physically and mentally after the procedures, Hart is “convinced” that surgery “must drop the suicide rate”.

Over the past year, Hart’s workload increased in part because of the waves of referrals he was getting from two surgeons winding down their vaginoplasty procedures, including Melbourne plastic surgeon Andrew Ives . Until recently Ives a high profile in the field, but, as his office confirmed in an email, he ceased performing vaginoplasty and labiaplasty procedures at the end of 2022.

In February, Melbourne’s Monash Gender Clinic told patients that it was only then booking appointments for patients referred in August 2021, and that Melbourne plastic surgeon Cheng Lo , trained in vaginoplasty and labiaplasty by Ives, has “very long wait lists”. Cheng did not respond to interview requests.

Hart says: “Andy Ives and I were looking at doing a formalised training program [for gender-affirming surgery], and as he stepped back I’ve looked at doing it myself, but it’s a daunting task. The [Royal Australasian] College of Surgeons has been a bit slow on the uptake for it, like every facet of the transgender sphere.”

In May, the college will hold a scientific congress titled Equity in Surgery in Adelaide, including for the first time talks on transgender healthcare. The college’s president, Sally Langley, admits in the program that the college’s surgeons “have not fully represented the gender … composition of our community”, but declined an interview request.

The many kinds of risk

Sivasamy acknowledges there are “risks” in having surgery in Thailand, but says the country “pioneered a lot of these procedures”.

Travelling abroad for these surgeries, even to a country that has pioneered them, comes with warnings of caution. Soo mentions reports of trans women suffering vagina narrowing or urethra complications after surgery, both in Australia and overseas. The question is: once the patient is back in Australia, who corrects the error?

Hart says surgeons are reluctant to fix another surgeon’s mistakes: “It’s impractical coming from Perth to Canberra to have it fixed up, but it’s far more practical than getting to Bangkok. As a developed nation there’s no reason people should be going overseas.”

Soo says there is also a shortfall of GPs, psychologists and other practitioners in trans health, but evidence “shows if you provide gender-affirming care, be it hormone treatment, surgery and/or social affirmation, [trans] people have very good mental health virtually indistinguishable from cisgender peers”.

Associate Prof Nicola Dean, the president of the Australian Society of Plastic Surgeons, says the federal government must create a dedicated suite of Medicare rebate item numbers for procedures for people with gender incongruence. This would encourage more surgeons into the field, Dean says, giving the surgeries a “stamp of legitimacy”.

For instance, the Medicare item number for a mastectomy was created on the assumption the procedure would be for a cisgender woman with breast cancer. “So using it for a trans man having surgery [to affirm his identity] leaves the doctor feeling vulnerable about whether they’re allowed to use those item numbers,” Dean says.

“It leaves the patient vulnerable because they’re often not sure of the financial implications.”

Associate Prof Peter Haertsch , a Sydney-based plastic surgeon, says he continues to perform about six vaginoplasty procedures a year. At his peak he was performing 30 gender-affirming procedures a year in Australia, beginning in the late 1980s after training in London.

Heartsch says some Australian surgeons have recently exited the field, but he doesn’t know why. “I have tried and am still trying to get some form of help in the way of government funding,” he says.

Another Sydney plastic surgeon, Dr David Caminer, says he performed his first vaginoplasty on a trans person in 2015, after which he toured the US and Europe to watch surgical units perform gender-affirming surgeries.

Up to the end of 2022 he had performed only a few vaginoplasties on trans patients, mainly with the penile inversion technique. But Caminer says so far in 2023 he has performed seven vaginoplasties due to the growing demand. “It was really since Andy Ives stopped doing it that I’ve been inundated with requests,” he says.

The Brisbane-based Dr Hans Goossen , who did not respond to interview requests, performs nearly all the phalloplasty procedures on trans men in Australia, according to the various trans health advocates Guardian Australia spoke to. Another surgeon, the Melbourne-based Dr Gideon Blecher , “has trained in phalloplasty and he is still trying to establish the program in Melbourne”, a spokesperson for Blecher said.

Fiona Bisshop, a Brisbane-based GP and former president of Auspath, says phalloplasty is particularly difficult for trans men to access in Australia, costing more than twice as much as a vaginoplasty. Bishop says almost all phalloplasty procedures have some complication, but three of her trans male patients who went overseas had particularly “terrible outcomes”.

“You can have some very bad experiences over in Thailand,” she says. “There are communication difficulties: the surgeons and hospital staff don’t speak very much English.”

Bisshop says many of her trans patients have “given up on gender-affirmation surgeries, because it is completely out of financial reach”, and she calls the “lack of respectability” afforded to gender-affirming surgery a “vicious circle”, because it is not offered in Australian teaching hospitals where physicians would normally train.

Gender-affirming care

Sydney-based Teddy Cook , ACON’s director of community health, says gender-affirming care means many types of “health interventions of critical need”, and such needs must be “depathologised” and trans people given autonomy.

The lack of comprehensive gender-affirming healthcare in Australia may be because this care is misunderstood as simply cosmetic or solely related to genital surgery, and because trans people are “seen through a lens of being mentally ill, as opposed to just being a natural part of human diversity”, Cook says.

Cook, who is a trans man, says not all trans people seek surgical intervention: “It’s up to the individual what sort of steps they take medically, but cruel legal gender recognition laws in NSW and other states still force surgical sterilisation to update a birth certificate.”

Cook says no reliable figures exist on how many trans people there are in Australia to better plan health services. When unveiling a 10-year national action plan for LGBTQ+ health in March, the assistant health minister, Ged Kearney, said attorney general Mark Dreyfus “might have things to say” about counting LGBTQ+ people in the census, but no announcement has been forthcoming.

As Sivasamy readies for her flight to Thailand, she knows she is one of the lucky ones, not least because she has enough money at a young age to finance the trip.

“The majority of people my age don’t have the superannuation funds to get this done,” she says.

She then opens her palms and waves her hands away, as if to banish doubts about a lack of contingency plan after the procedure. “Definitely, if there’s a readmission surgery necessary, I don’t have the money for that, you know?”

She laughs. “I have no idea what would happen. We’ll just have to cross that route if we come to it.”

• Transgender
• LGBTQ+ rights

Most viewed

State health plans must cover gender-affirming surgery, US appeals court rules

• Medium Text

Sign up here.

Reporting By Brendan Pierson in New York, Editing by Alexia Garamfalvi and Bill Berkrot

Our Standards: The Thomson Reuters Trust Principles. New Tab , opens new tab

Thomson Reuters

Brendan Pierson reports on product liability litigation and on all areas of health care law. He can be reached at [email protected].

Read Next / Editor's Picks

Industry Insight Chevron

Mike Scarcella, David Thomas

Karen Sloan

Henry Engler

Diana Novak Jones