Last year, Cherry* looked up at the moon, the sky awash with pinks and purples. The sun was just coming up, and in the cool morning air she felt calm and at peace.
“Everything was cosmically lighting up to just be perfect. It felt like a sign that everything was gonna be okay. Because, you know, here’s a beautiful, clear blue, pinky, purple sky. It felt otherworldly, like I was in a dream, and then I had the operation, and then I woke up, and it wasn’t a dream, it was real”.
Cherry, a transgender woman, was on her way to hospital, where she was undergoing minimal depth labiaplasty, a gender-affirming procedure that removes the penis and testicles, shortens the urethra and reconstructs the remaining tissue to create a neo-vagina.
She had been preparing for this moment for months, and in the chaos of her final push before the hospital admission, she felt that everything had clicked into place, and she could finally relax.
The term “gender-affirming surgery” is broad and complex. In general, it refers to any surgery a transgender person undergoes to help align their body with their gender identity. The most common types of gender-affirming surgeries are performed on the chest, genitals or face, to help correct primary and secondary sex characteristics that are incongruent with a person’s gender identity. Not all transgender people pursue surgery, and there are a huge range of surgeries that could be considered gender-affirming.
One of the biggest barriers is the high out-of-pocket costs, as gender-affirming surgeries are not covered under Medicare. These costs can add up to tens or hundreds of thousands of dollars. Many choose to get procedures overseas, which carries its own risks around language, the healthcare system and revisions.
In March 2023, the Australian Society of Plastic Surgeons (ASPS), the peak body for plastic surgeons in Australia, lodged Application 1754, asking the government to fund over 30 gender-affirming surgeries under Medicare. Whilst many more surgeries could be considered gender-affirming, the ASPS chose these as they are the most common. This includes the creation of new Medicare Benefits Schedule (MBS) item numbers, as well as editing some existing ones to be more fit-for-purpose.
What surgeries could be covered?
Application 1754 encompasses facial, genital, chest and vocal surgeries.
Facial surgeries are a broad term for feminising or masculinising plastic surgeries, including remodelling of the brow, forehead, jaw, or lips.
Chest surgeries include breast augmentations for feminising the chest as well as the removal of breast tissue and reconstruction of a masculine chest.
Genital surgeries make up the largest category. They include hysterectomy and the removal of the uterus and cervix, as well as the penectomy and bilateral orchidectomy, the removal of the penis and both testicles. Genital surgery also includes reconstruction, which predominately uses donor tissue from other parts of the body – such as taking the outer skin of the penis to create vaginal depth, or skin grafts from the arm, leg or abdomen to create a penis.
The application includes just one voice-related procedure, a tracheal shave for reducing the appearance of the Adam’s apple.
Whilst these are the surgeries included in the official application; there is no guarantee that any will end up being covered.
The road to surgery
For those seeking gender-affirming surgery, the process is not as simple as booking an appointment and putting down a deposit. There are numerous stages, which start at the GP for a referral. If a patient does not have a diagnosis of gender dysphoria already, that referral goes to a psychologist or psychiatrist to begin the process.
To obtain her dysphoria diagnosis, Cherry had to answer over 50 questions about her familial and romantic relationships, sex life, sexual fantasies, adolescent development and attitudes toward the LGBTQIA+ community. This workbook is one component of a gender dysphoria diagnosis, which also includes questionnaires for mental illnesses including autism spectrum disorder, dissociative identity disorder and borderline personality disorder. After these screenings, multiple hour-long consultations with a psychiatrist are needed to satisfy several extra criteria to meet the World Professional Association for Transgender Health (WPATH) standards for a diagnosis of gender dysphoria.
The WPATH standards are notorious among transgender people. This process is exhaustive, with many patients reporting that the questions are particularly invasive, and not always relevant to their gender identity or goals for gender-affirming care.
For Jasmine Best, a transgender woman, the questions oscillated in their relevancy. The instances of gender incongruence that she experienced in her youth and adulthood, how these feelings manifested, and how her assigned gender made her feel, all seemed clear in their purpose.
Then came what she thought of as “bad questions”, which included examining her relationship with her parents, her romantic relationships and friendships.
Best, who was seeking the diagnosis to pursue gender-affirming vaginoplasty – the creation of a neo-vagina with depth – believed that this line of questioning about her relationships, home life, and childhood was exhaustive and irrelevant to her diagnosis.
“It obfuscates the fact that there is a core of questions that are very relevant and very clear in terms of how they relate to being trans,” she said.
Some of her motivation to undergo a vaginoplasty was “purely functional”, she said.
“Some of it was just like, I would like to have a functional sex life, and I currently can’t do that, and that seems to be because of the dysphoria. So, if I got bottom surgery that would help with that.”
With the political climate changing to favour right-wing policies and parties, and many organisations rolling back diversity equity and inclusion (DEI) policies, many transgender people feel that they only have a matter of time before their rights are taken away.
“I don’t want to ever be able to be forcibly detransitioned,” Best said, “You can’t put it back on, so what are you gonna do?”
Best has her surgery booked for November. The process has taken years. She has been on hormone replacement therapy (HRT) for almost three years, which involves taking hormones, such as oestrogen and progesterone, to feminise her appearance.
For Cherry, it was 12 months after her referral that she even talked to the surgeon. She was told that her referral would sit on a waitlist on the surgeon’s desk for six months before she heard anything; it took another six months to get an appointment.
“To suggest that [surgery] something that is just done, I’m gonna say the worst word – willy nilly – to suggest that it’s something that’s done on the fly, is an absurdity”, she said.
At the surgeon’s office, Best was talked through the risks: infection, nerve injury, wound breakdown, scarring and potential need for revision surgery, as well as more serious risks such as bladder perforation, spermatic cord neuroma, lack of clitoral sensation, urinary or faecal incontinence, or a rectovaginal fistula formation – a rare complication involving a wound breakdown that creates a tunnel between the vaginal wall and the rectum.
She was also quoted over $30,000 for the surgeon’s and anaesthetist’s fees, a figure that does not include private health cover, hospital stay or any other auxiliary costs.
But the process, and the expenses, were far from over.
After the first consultation, Best started working through the preparation for the surgery, which included health insurance battles, hair loss procedures, weight loss, and fundraising. Each has to be completed before she can go under the knife.
Insurance
Best did not expect insurance to be a roadblock. To undergo genital reconstruction surgery, some private health insurers require an element of psychiatric care to be covered – she was told that her surgery required an unrestricted level of psychiatric care. That pushed her policy up to a gold level, adding $7,200 to the sum she was already paying.
Her surgeon recommended that she hold this level of health insurance for at least 12 months before surgery, to clear any waitlist times, and for at least 12 months after, in case of complications. Best negotiated her insurance at a lower level but is still fearful that this will come back to bite her before her surgery later this year.
“We know that [the health insurer] could decide that this isn’t approved on the day”, she said. “Some insurers will arbitrarily decide that you do require that higher level of care for the recovery period”.
Hair removal
Best has also been undergoing electrolysis, a hair removal technique that permanently destroys the hair follicle. This is so that when the surgeon creates the vaginal cavity, there is no chance of hair growing inside – something that would complicate healing greatly and would require surgical removal.
Best says she’s paying $130 an hour for what will end up being 10 to 15 hours of electrolysis. She’s doing each session an hour at a time, due to the pain.
“I would say it’s worse than getting a tattoo, kind of like getting a needle, like a blood test, where the nurse isn’t very good – you get that feeling. You then get the feeling of you are touching a hot iron. You then get someone plucking a hair out.” She said.
Weight loss
Body mass index is another key requirement of surgery. Best’s surgery information pack states – in bold and underlined – that the practice does not operate on patients with a BMI over 28. This is in part due to an increased risk of complications, such as deep vein thrombosis and pneumonia, and because additional fat in the area increases the technical difficulty of the surgery. However, it is not empirically based as an appropriate barrier for gender-affirming surgery.
“That’s been something that has upset me a lot, mostly because I’ve reached a point where I am happy with my body, and to then be kind of forced to alter it in a way that I don’t particularly care about, sucks” she said.
Fundraising
Best had saved about $35,000 for her surgery, which will cover most but not all the costs. She recently moved into a ground floor apartment – a more expensive rental – so she would not have to climb any stairs during her recovery. Adding surgerical fees, pre-surgery consultation fees, preparation costs, and other peripherals such as her home, Best is looking at costs over $43,000 for a single procedure.
Importantly, Best has paid sick leave for 30 days after surgery, which equates to about six weeks. For casual or insecure workers, lost income can add significantly to the cost incurred.
She will receive some money back from Medicare, the surgeon has quoted a $2,500 rebate.
The MBS items used in these estimates cover several components of the surgery, including penectomy, orchidectomy, urethroplasty, vaginoplasty and several for skin grafts and restoration of sensation.
Many of these numbers, while accurate to this surgery, are not truly fit for purpose. A penectomy is often used for the removal of the penis in the case of penile cancer – drastically different application to the creation of a new vagina, which often uses tissue from the penis to create the vaginal depth.
The cost also does not take hormone replacement therapy (HRT) into consideration. Surgeons generally recommend at least six months of HRT before undergoing surgery, so that hormone levels can be at a roughly cisgender female reference range. HRT can cost between $7 and $40 a month, depending on the type of drug.
The proposed rebate from new MBS items is just a small dent in a looming $40,000 total cost, but could help immensely in budgeting.
Best said a larger rebate “would make a difference, because it would give me a bit more surety, because I would have a bit more of a backup plan if something else goes wrong”.
“What if I have to go care for a family member? You know, I’m wiping out most of my sick leave. I’m spending most of my savings… Do I wait another year and save up another five, ten, grand? And you can keep catastrophising yourself into delaying it year after year”.
For Cherry, even a small rebate from Medicare would mean she could have saved more before her surgery, a cheaper minimal depth vaginoplasty that creates the outward appearance of a vagina without the vaginal canal, creating a “vaginal dimple”. Instead, she had to do a community fundraiser to help raise money for her surgery, and post online for a year to crowd-fund the procedure.
“It just would have made everything just that little bit more affordable” she said.
When her surgery date was confirmed, about eight months after her initial consult, Cherry said there was “no way” she could fund the surgery on such a quick turnaround. To help pay for the procedure, she turned to GoFundMe, publicly appealing to people to donate on social media and taking part in a community fundraiser, which raised about $3,000.
“How much am I happy to trade my own privacy for money?” she said, “If I had the money to do this, I wouldn’t have to do the public call out for donations. I wouldn’t have to be the recipient of the fundraiser. I wouldn’t have to do any of the public begging, ‘please give me money’, and I would just be able to go away and do it privately. And no one would know that I had even had the surgery, unless I chose to tell them. So, the penalty is, if you’re poor, you have to beg, and everyone has to know your inner workings”.
As Cherry underwent her procedure in Canberra with Dr Kieran Hart, the fundraiser helped cover her travel and accomadation.
“For some people, [public fundraising] will just be too embarrassing, too much shame around it. Can’t do that. Can’t put myself out there, which just means that then it becomes more and more unlikely that they will get the surgery that they need” she said.
“There’s also an immense amount of privilege of being able to hit the target”.
In many cases, Cherry and Best are the lucky ones. Many transgender people cannot access surgical procedures. AusPATH, the Australian Professional Association for Trans Health, currently lists 18 surgeons across Australia who perform any kind of gender-affirming surgery. 10 of the surgeons listed are in Victoria, leading to poor regional availability for much of the country. Complex surgeries, such as masculinising genital surgeries, also have high recovery times and high complication rates.
The Australian Landscape
Recent studies suggest that in funding gender-affirming care, the government could save millions of dollars in mental health care. The authors published two studies looking into how subsidising gender-affirming care can affect government funding – one on hormone replacement therapy and one on gender-affirming surgery.
Clue Coman, one of the authors of the hormone therapy study, described the sample as “an order of magnitude” larger than comparable studies, which typically only look at a period of months to years, rather than over a decade.
Based on earlier findings that gender-affirming care improves quality of life, psychological distress and suicidal thoughts, the study looked at how access to hormones and surgery changed transgender people’s reliance on mental healthcare services.
Over 12 years, 3,698 adults underwent gender-affirming surgery – either chest or genital – just over 300 surgeries a year. Coman says the small number of people accessing surgery should not dissuade action.
“We should still care about these people and their well-being. Even if only one person needs a particular kind of healthcare, if they have a human right to access that, then it is the responsibility of the Australian government to make it accessible” they said.
“People are fired up about a minority of the population accessing healthcare that is essential to their well-being. But the reasons they’re fired up about that has very rarely got anything to do with government spending and waste, and a lot more to do with their own personal feelings about that particular group.”
The findings show that after a transgender person gets chest surgery, the government spent $1,769 less on their mental health care over the following five years. For genital surgery, the savings were $3,416 per person.
Factoring those savings into consideration, if the proposed Medicare rebates are approved, the government can expect to receive a return on investment within 4-5 years.
Coman said the difference was “stark”.
“Once you treat gender dysphoria using hormone therapy, people no longer need a band-aid solution of constant mental health care. You’re actually treating the problem, rather than just throwing funding at treating it like a mental illness” they said.
An important caveat of the research is that the number of transgender people who accessed surgery is taken from data from private providers. Anyone using MBS items that are not fully encompassing of the surgery they have received, or who has travelled overseas, is not been captured in this data.
“A lot of the issues we’re facing has a lot more to do with the fact that we have an aggressively bioessentialist and binary healthcare system that refuses to see trans people or refuses to acknowledge their existence in ways that make them easier to study and understand” Clue says.
“My general feeling is trans people having such high rates of self-harm and suicide, that almost all of those are going to be preventable deaths, you know? And we, as a society, have a responsibility to prevent those deaths… I have a lot of trouble justifying why such a small cost would be a barrier to not just quality of life, but continuation of life”.
Coman says that the science shows a strong consensus that gender-affirming surgeries and hormone treatments are safe and effective and that there’s “pretty much no debate left to be had about that”.
They said that “if people are saying the research isn’t there, it means that they’re not doing research.”
“The logical stretches that need to be done, the poor representations of data that needs to happen to try and disprove what has been consistently proven for decades… it’s a waste of everyone’s time and resources”.
What’s Happening Now?
Application 1754 is still being considered by the Medical Services Advisory Committee (MSAC), an independent government health advisory group. It is still in the first of two stages – with the next discussion planned for November 2026.
The first stage considers clinical evidence for the proposed health intervention. The ASPS compiled an evidence brief covering a detailed description of the current research landscape, current processes for transgender people undergoing surgery, and detailed descriptions of the proposed surgeries to be added to Medicare.
After consideration of the application, MSAC returned a detailed document with several feedback points to consider before the next stage can progress. It criticised the literature review as not robust enough in historical research on gender incongruence, information about regret and detransition rates, long term outcomes of surgery and the current care pathways in Australia. MSAC has since released the results of two of their own literature reviews, focussing on and clarifying these points.
MSAC has nonetheless acknowledged an unmet need for gender-affirming surgeries and advised the Department of Health, Disability and Ageing to progress the application, recommending additional consultation with consumer, medical and allied health disciplines to provide more certainty about the provision of gender-affirming care.
In consultation with the Urological Society of Australia and New Zealand (USANZ), MSAC have also recommended adding 31 extra genital reconfiguration surgeries, as the original application did not sufficiently cover the range of techniques that are possible, including revisions.
In December 2025, the ASPS confirmed MSAC had begun community engagement with consumer organisations.
“ASPS and our partners in the Australian Collaborative on Access to Gender Affirming Medical Services (ACA-GAMS) will continue to work constructively with MSAC and the Department of Health towards improving access to care for trans Australians”, the society said in a statement.
As the application in ongoing, the ASPS declined an interview. In a statement it said, “The weight of published medical literature now clearly shows that there is strong evidence to support provision of gender-affirming surgery services…Representatives of our specialty are currently participating in an application to the Government and medical authorities, alongside other relevant medical specialties, to allow for more streamlined and accessible care in this area”.
Multiple surgeons also declined to be interviewed due to the ongoing nature of the application.
Behind the Application
Michelle McNamara is a board member and former Treasurer of Transgender Victoria (TGV), Victoria’s leading body for transgender and gender diverse people. She lead TGV’s submissions to MSAC as part of this application.
“I’m a nerd, you know, I’ve read an enormous amount of about the transgender community and about the literature around their health and well-being and so on,” they said.
She said there is a “substantial body of evidence that surgery helps the people that need it. Absolutely does. And the thought that we aren’t funding it under Medicare is just abhorrent to me, you know. It’s offensive”.
McNamara, who had gender-affirming genital surgery in 2021, said it was very surprising how big of an impact it had on her.
“I had the feeling that it shouldn’t, but it did. It had a huge impact,” they said. She needed follow up appointments with a pain specialist and a physiotherapist afterwards, but said those costs were worth “living a fuller, freer existence in who I am”.
The first stage of the application “seems to be sitting nowhere with MSAC at the moment,” she said and that having the Department of Health, Disability and Ageing look into the application and do its own community consultations “could mean anything”, not providing any clarity around if and when the application would be considered to advance to the next stage.
Despite this, she has “a good feel” and is “not worried about [MSAC’s] commitment” to reviewing the application.
If approved in the November 2026 meeting, the application moves to the second stage, which will consider the financial and economic impacts of funding the MBS items.
If the application went ahead, what would that look like?
Approval would not completely cover every surgery for every transgender person. It would provide a small rebate to the otherwise still large cost of surgery. The creation of new MBS items also does not mean that gender-affirming surgeries will be available or conducted in public hospitals.
The ASPS application proposes a number of costs and rebates for the surgeries listed. The proposed rebate is 75 per cent, averaging just over $1,000 per item.
Importantly, not every proposed MBS number has a proposed cost and rebate: 15 procedures have rebates subject to confirmation at the second stage. MSAC also can recommend that more or less surgeries to be covered under Medicare.
How much would the government have to pay?
The second stage of the application will look at exactly this. However, publicly available data on the cost to the government is limited.
The surgery study estimates a $34 million cost to subsidise gender-affirming surgery, calculated from a rebate of $1,328 for each person accessing chest surgery and $1,195 for genital surgery.
McNamara says that having multiple surgeries all submitted in the same application “might be described as brave”, given the broad nature of the types of surgeries, variable benefits and variable costs. Most MSAC applications seek funding for one or two items, compared to the 30 in this application. McNamara says having this many items makes the application “a complex one”.
“It seems pretty out there for ASPS to bundle them all together and even more amazing for MSAC to accept it… To me, that seems there’s an acceptance that these are important things that shouldn’t have been left out of Medicare,” she said.
McNamara expects MSAC may remove some surgeries to “make it more palatable”. She points to breast augmentation, which could be removed on the basis that it is popularly considered to be cosmetic, or phalloplasty, which could be removed for the high cost and difficulty of the procedure.
According to MSAC guidelines, the economic evaluation looks at the cost of the procedures to the government as well as the cost over time, impact on the patient and how they interact with the healthcare system.
The economic analysis also considers total health care resource uses and costs, which can include the health technology itself (in this case, the surgical procedure) as well as hospital services, medicines (including the PBS), diagnostic tests and medical services such as specialist or GP visits.
McNamara is optimistic. If MSAC pass the first stage, she said, there should be good progress on the second.
If this happens, she said, “it’s probably time to try and beat a path to the door of [Mark] Butler, and say, look, what about committing to funding this, at least when you get a preliminary analysis from MSAC? Because there’s evidence that it’s going to save you money to fund these surgeries”.
“The numbers, though, [that] are being talked about are relatively very small in terms of the healthcare budget”.
Is the government willing to pay?
If application 1754 clears both the stages, MSAC provides the data to the federal health minister, currently Mark Butler, as a recommendation. Once the recommendation is sent off to the Department of Health, Disability and Ageing, there is no guarantee that it will be implemented at all.
Funding new MBS items usually requires a new policy proposal to secure funding through the federal budget. This process is beholden on both the budget cycle and the priorities of the government in power.
The Australian Greens are the only political party that have a defined policy position on funding gender-affirming surgeries. Their platform states that transgender people should have access to all forms of gender-affirming care, including hormones, products, services and surgical procedures, “all to be provided at no out of pocket costs”.
The party explicitly that they wish to implement the recommendations from Application 1754, however, with “universal funding via the MBS for patient consultation, medical interventions, and surgical procedures for gender affirmation in people with gender incongruence”. In their proposal to the Parliamentary Budget Office, they estimated this would cost the government $114 million between 2025 and 2029.
Senator for Tasmania and Australian Greens LGBTIQA+ Spokesperson Nick McKim declined to be interviewed but has supported the party’s position on gender-affirming care, saying: “Gender-affirming care saves lives. It allows trans folks to live with dignity, and it allows them to actually be who they are”.
McKim has been vocal about his experience with his transgender child, Jasper. “I fought for him and with him and for and with every other trans kid in this country, all the way through, and I will continue to do that”.
Labor, the current majority government, released a National Action Plan for the Health and Wellbeing of LGBTIQA+ People in December 2024, however, it does not contain any mention of gender-affirming surgeries, let alone a plan to fund them. Labor has also been subject to misinformation online, claiming that they are spending $10 million “bulk-billing gender reassignment surgery for children as young as 8 years old”.
Unless Application 1754 passes MSAC consideration whilst there is a Greens majority government, there is no guarantee that it will be legislated. The Department of Health, Disability and Ageing did not respond to a request for comment.
The Australian environment
In 1985, Judge Robyn Layton was commissioned to lead a review into Medicare and MBS items, where the report recommended that “gender reassignment surgery should only be performed on patients who attend special gender reassignment units. It believes the best way to encourage this is to exclude the payment of Medicare benefits for such surgery and to provide funding for such units through Health Program Grants”
Three publicly funded gender clinics operated in Australia, two in Melbourne and one in Adelaide, until 1988, when only one remained, the Monash Gender Dysphoria Clinic (now named the Monash Health Gender Clinic).
This position has persisted for 40 years. “There is a whole history there of transgender health being something that doctors go, oh, no, no, we don’t want to deal with them,” McNamara said.
“Fast forward to today, and the demand is such that not having it as a general MBS item is actually inhibiting surgeons taking on training to become the specialists [in gender-affirming surgeries]” they said.
“If you had the MBS numbers, it’s not so much the amount of money that comes from them, but it’s the effect of the private healthcare insurers that then start to have to fund those numbers” McNamara said. “There was a whole negative view of doing anything for transgender health. And that’s kind of still out there… it’s gained a lot of respectability, but it’s been quite a long journey.”
Michelle said a lot of attitudes toward the provision of gender-affirming care, dates to the 1970s and 80s, when patients would have to “prove” they were transgender by living in their affirmed gender for a certain amount of time, behaving in ways that were stereotypical of said gender.
McNamara also said that in parts of the US, transgender people were advised to move away from their homes after transitioning so they could start again “without people having knowledge of your past history”, which she says, “today seems so many different ways wrong”.
The Public Debate
Transgender people are increasingly becoming the subject of media and political debate in Australia.
Much of it frames biological sex as innate, and that when transgender people enter single-sex spaces, they are infringing on this right.
This can be seen in the recent Tickle v Giggle case over, in which a female-only social media app had unlawfully discriminated against transgender women and the Lesbian Action Group’s appeal circumvented the Sex Discrimination Act to hold events exclusively for cisgender lesbians.
In 2013, the Sex Discrimination Act was amended to broaden the definition of gender, sex and intersex status, to achieve “maximum protection” for transgender and gender diverse people. Since then, the Federal Court of Australia had not heard a case on the Act until the Tickle v Giggle case.
A recent push in media attention on the concept of biological sex has reached federal politics. Opposition Leader Angus Taylor has said under his leadership, the Sex Discrimination Act would be amended to include definitions of man and woman to protect biological sex.
Nationals MP Alison Penfold has introduced a Private Member’s Bill to do just that, arguing it will seek to “reinstate the legal definition of a woman” in order to protect women and girls.
Equality Australia Legal Director Heather Corkhill said this bill “risks weakening protections for all women” and that “sex discrimination has never been about biology alone… it is about gendered stereotypes, assumptions, and the unequal treatment of women and how they ‘should’ act and live”.
McNamara said the transgender and gender diverse community are trying to “tread a line between making [the application] very public and not getting it over the line”.
“There’s a certain amount of [public] support for the idea that needs to be fostered, but you don’t want it at such a level that someone like Angus Taylor can hang on to it as he did with the Tickle v Giggle case and say, we’re going to stop this if we’re elected”.
Coman said the addition of new MBS items can complicate healthcare for transgender people, arguing that the added visibility “does just mean those Medicare numbers are very easy to scrap in one or two change of governments time”.
“There is always a fear that shining a spotlight on something that urgently needs to change will result in us losing rather than gaining ground” they said.
Coman says the way that transgender issues have been framed “not just in the media, social media, and the way that politicians talk about these issues, tends to just not be aligned with the scale of what’s happening”.
Community response
Application 1754 is currently in its second community consultation phase leading up to the November 2026 discussion.
In the first, organisations representing health professionals, consumers and carers were inviteded to contribute a written submission, as were individuals and other stakeholders. Most submissions were from people with lived experience of gender incongruence, contributing heavily to the 92% support rate for the proposal. MSAC specifically noted that there was a high level of community submissions, with roughly half of medical and consumer groups indicating support for public funding.
Documents released under Freedom of Information reveal five submissions by community organisations. Of the five responses, two indicated support for funding and two were in opposition.
The fifth submission was from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), whose stance is less clear. RANZCOG state that while it treats and supports patients of all genders, including specialty care for transgender people with specific concerns, such as complications from HRT and previous gender-affirming surgeries, they do not support the creation of new MBS items for gender-affirming procedures.
Instead, they argue that “in many cases the surgical requirement for this cohort is no more complex than those surrounding cis women. Whilst RANZCOG do not support the creation of specialised MBS items, they do support the extension of current MBS items to compensate for the “complexities” and counselling involved in genealogical consultations and surgery. RANZCOG advocate for this code must be available for use with all complex presentations not just those involving gender incongruence”.
RANZCOG did not respond to a request for comment.
Who does not support this application?
The 8 per cent who disagreed with the application did so for a range of reasons, including personal, religious or cultural reasons, disbelief in the concept of gender incongruence, ethical concerns of performing surgery on physiologically healthy tissue, and government spending concerns.
One group that petitioned against the application was Parents of Adolescents with Gender Distress (PAGD), a Victorian-based parent support group that describes itself as “a collective of families with children and young people affected by gender distress.” Formed primarily as a social support group for parents, it is also involved in political advocacy against medical treatment for gender dysphoria.
In its submission to MSAC, PAGD advocated for a “comprehensive psychological evaluation and exploratory therapy by independent practitioners” before any gender-affirming care. It argued the application does not consider “appropriate psychological interventions”, and that surgical procedures that rely on “patient choice” are “clearly elective and not clinically necessary”. The submission also offers five rebuttals to claims that the ASPS made in the original application, querying the quality of the research presented and citing studies in opposition.
Their submission cited five references, including the University of Birmingham’s aggressive research intelligence facility (ARIF), despite their website homepage stating that ARIF was disbanded 2011, and that its reports are “highly likely to no longer be current given the likelihood of more research being undertaken”. The report is no longer publicly available for that reason. Multiple references cited were published before 2010, including papers that are well-known to be misrepresented.
Emma Baillie, a PAGD member, got involved with the group after her middle child told her that they didn’t feel like a girl, and wanted to use he/him pronouns, later preferring he/they.
“So, we had a big discussion about this whole feeling like a girl. I’m like, ‘well, what is feeling like a girl? …Because, you know, I don’t feel like a woman either. I just feel like a me’” she said.
“Our child is saying, ‘I really, really want to do this. It would help my mental health’. There was a lot of unanswered questions in that conversation. And in particular, there was the: ‘what does it mean to you to feel like a boy?’ was unanswered. It was all very much, ‘I don’t know what’s going on, I don’t understand it. I just have this craving in me’”.
Baillie started researching gender dysphoria to try and understand her child, first encountering official information and pro-gender-affirming treatment narratives, before turning to the gender critical movement, such as Genspect, finding its arguments made more sense.
“The other side was a whole mass of emotion about how [gender critics] were terrible people, and a lot of telling you not to look for information, which is a thing that I notice also in the wider discourse in general, and which I hate… it’s promoting fear of information” she said.
A former programmer, Baillie is now completing her PhD on human-computer interactions, focusing on polarisation and social media. Her background and education empower her to “have confidence in my ability to sort out sensible from less sensible.”
PAGD is still organising itself, building a leadership team and defining roles, and Baillie will become a formal committee member. The group is active on social media, particularly X, and attended the Melbourne General Practice Conference in 2024 to promote a non-medical approach to transgender healthcare.
Despite having views on gender and gender-affirming procedures that align with right-wing rhetoric, the group states that they are not the “right-wing religious zealots the current narrative would like to think we are”.
Baillie, who describes herself as “extremely TERF-y”, said the group has a “reasonably high leftward tilt, because we’re Melbourne people and that’s what Melbourne is like”, but noted similar groups tend to skew more to the right.
“People who didn’t really think about politics at all, naturally start gravitating to whoever is talking about the issue and saying stuff that they want to hear” she said. “We see the political polarisation, and we don’t think that that should be a thing when you’re talking about a medical procedure. Everyone should want the medical procedures that you’re doing to be effective ones that actually do what they say they do”.
Many anti-transgender campaigning focuses on the medicalisation of children, arguing they are too young to consent to treatment or grasp the consequences of HRT and surgery. For this application, the ASPS is clear that their proposed surgical outcomes are for patients aged above 18 years old, and do not apply to children.
PAGD align with anti-medicalisation views, with their concerns less for the identification of their children as transgender, and more concern for the desire to affirm these feelings through hormone replacement therapy or surgery.
“If there wasn’t this sort of medical machinery out there going, you know, ‘this is great medicine’ when I don’t think it is, then there would be nothing really much to worry about, it would just be another subculture” she said. PAGD also explicitly state that they are not broadly anti-LGB, because “being gay doesn’t need medical treatment, so there’s nothing there that we would have to care about”.
Where is Australia going from here?
Baillie believes the gender-critical movement is only beginning. “My personal prediction for the way that things are going in gender land is that the ultimate place that we’re going to get to is the place where none of this is accepted for children,” she said.
Baillie says she is “not necessarily” against banning surgery for competent adults “if I thought the industry was acting responsibly” she said, “but I think we’re going to get to the place where people don’t believe in gender medicine, ultimately”.
“We’re going to continue to have a big crisis about it until it’s resolved. I personally believe that the resolution is everyone disbelieving in it, because I disbelieve in it, and I think I have good reasons”.
Conversely, McNamara, while cautious about the backlash, is optimistic about the application, saying that approval would give transgender surgical care the “rubber stamp of legitimacy”.
“There’s already rumours of one particular public hospital, [that] said, if this happens, we will have a unit”.
For Coman, the research environment is changing rapidly. Cessation of funding from the USA for DEI projects means that Australian researchers are watching funding for their projects disappear, including for research into transgender issues.
“We are doing it kind of like they’re bombing the road behind us” they said. “I think there is a real sense of urgency and responsibility in the research community to be doing this work while we have the chance”.
“I think there has been this shift from feeling like we were just a little subset of health research, to suddenly being thrust into the spotlight and now everyone’s much more cautious… Now there’s a lot more discussions around the ethics of what we are willing to expose ourselves and each other to as researchers”.
For now, Best is counting down to November. “I’m trying to not get excited yet”, she said, but is “looking forward to sort of feeling like I’m done with my transition”.
“There hasn’t been a moment where I’ve been like, oh, maybe I don’t want this.
Like ever since I made the initial decision of wanting to inquire about it. I’ve just gotten more and more certain”.
Cherry’s surgery may be over, but her life is just beginning to open up in front of her. She describes her life before surgery as trying to run through water, and now that she’s healed, “all of that resistance is just lifted”.
When asked whether there was anything she planned on doing that she couldn’t before, Cherry said she wanted to learn how to swim.
“I had a go as a kid, and you know maybe it was just being a bit unco, and maybe it was not really connecting with my body, but I never really felt good in the water” she said.
“Going to the pool as a trans woman who hasn’t had surgery, especially around people at the pool who just assume that you’re a pervert, that’s a terrifying thought” she said, “but now that I feel comfortable in my body. I do wanna go and learn to swim so that I can then go and move around more and feel healthier and feel better about my body”.
* Name has been changed for safety.
