Gender-affirming surgery not a 'nice to have' but 'absolutely essential'

STUFF
Shiloh Henderson and Felix Swanepoel are frustrated by the challenges of accessing gender affirming surgery in the public health system.

In January, Shiloh Henderson looked at himself in the bathroom mirror and cried.

Distress overwhelmed him as he faced his reflection, looking at a body he did not feel connected with.

It is the best way the 20-year-old can explain what gender dysphoria feels like.

He is one of hundreds of people in New Zealand seeking access to gender affirming surgery, such as reshaping the face and chest.

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However, publicly-funded surgery is limited and many, like Henderson, are fundraising for private surgery.

Henderson’s assigned gender at birth is female but since he was about 13, something “didn’t feel quite right”.

He didn’t like looking at photos of himself and would look at male characters like Troy Bolton from High School Musical or Tobias Eaton from Divergent and think “I want to be him”.

It was only when he was 16 that he understood being transgender – an umbrella term for people whose assigned gender differs from their gender identity – was something people experienced, and it was only this year that he realised he identified with the term.

“It’s still quite new for me. I remember being really intrigued by it [transgender] ... Probably more than the average cis person (people who identify with their gender assigned at birth) I would say.”

Shiloh Henderson has turned to fundraising for privately funded top surgery, after years of experiencing dysphoria.
ALDEN WILLIAMS/Stuff
Shiloh Henderson has turned to fundraising for privately funded top surgery, after years of experiencing dysphoria.

Looking back, he wondered why he didn’t “figure it out” earlier but said education was lacking.

Although he felt more confident since understanding his gender identity better, dysphoria – a clinical term used to describe the dissonance between one’s assigned gender and sense of self – was something that affected his everyday life.

“I think a lot of people don’t realise that trans people experience that (dysphoria). I think that they think we just want to be a different gender but that’s not it at all.”

Currently, gender reassignment surgery – genital reconstruction – is managed and funded by the Ministry of Health, while other surgeries such as top surgery for trans women and trans men, hysterectomy, and facial feminisation are funded by district health boards.

Henderson was now looking to start gender-affirming hormone replacement therapy and then hoped to have top surgery.

Jessie Mickell has started a Givealittle page for Felix Swanepoel to help pay for the surgery he needs.
BRADEN FASTIER / STUFF/Nelson Mail
Jessie Mickell has started a Givealittle page for Felix Swanepoel to help pay for the surgery he needs.

In 2020, out of 36 referrals to the Canterbury District Health Board (CDHB) for publicly-funded top surgery, fewer than half were accepted. Of the 15, only five top surgeries to remove breast surgery were performed.

There were three people on the current waiting list for surgery, clinical director plastic surgery CDHB Chris Porter said.

In an Official Information Act response, the health board said the average time from referral to clinic assessment was four months and then another two months on the surgical waiting list.

Henderson, a first year University of Canterbury criminology student, has decided to fundraise for the estimated $15,000 to $18,000 for private surgery.

Despite an overwhelming demand, there were no plans to increase the number of surgeries, the CDHB said in an Official Information Act response.

There are at least five plastic surgeons across New Zealand who perform gender affirming surgeries – only one of whom is trained in genital reconstruction surgery. Those five surgeons either declined or did not respond to requests for an interview by Stuff.

Ahi Wi-Hongi, national coordinator of Gender Minorities Aotearoa, says gender affirming surgeries are not a “nice to have”, but “absolutely essential”.
ROSA WOODS
Ahi Wi-Hongi, national coordinator of Gender Minorities Aotearoa, says gender affirming surgeries are not a “nice to have”, but “absolutely essential”.

Ahi Wi-Hongi, national co-ordinator of Gender Minorities Aotearoa – an organisation offering trans people information, advocacy, and support, said there were many kinds of surgery people might need but were still difficult to access.

“Our health system has not been very adequate for managing trans people’s health across lots of different areas,” Wi-Hongi said.

One of the biggest unfulfilled demands were top surgery. This led many trans men to bind their breasts, a practice which had health risks especially when not correctly done, Wi-Hongi said.

“[Top surgery] is really important for people's sense of self and also a lot of the threats and violences people deal with can be eased off a bit – the more people recognise them [for who they are].”

Henderson, who binds his chest regularly, said surgery would increase his confidence.

“It would make me feel more valid I guess, I shouldn’t need to get surgery to be valid as a trans person but it would just make me feel validated in my gender and make me feel better about myself overall.”

He is a cleaner and a swimming instructor in his part-time work, and said he looked forward to being able to swim without a rash top and bind, which sometimes made it hard to breathe.

When he could have surgery was dependent on raising the money required, which he hoped would be next year.

Henderson says better understanding of dysphoria is needed, which drives many to seek surgery to feel more comfortable in their bodies.
ALDEN WILLIAMS/Stuff
Henderson says better understanding of dysphoria is needed, which drives many to seek surgery to feel more comfortable in their bodies.

Wi-Hongi said there needed to be more recognition that procedures like gender affirming surgeries were not a “nice to have”, but were “absolutely essential”.

People did not take steps towards surgery unless they were very certain they needed it, they say.

“For a lot of people, they feel like they can’t move on with their life until they get that surgery sorted,” Wi-Hongi said.

For Felix Swanepoel coming out as trans saw him lose friends and contact with his family.

His dysphoria made him unable to look at his own body, and at times he was so distressed he would throw up.

The 18-year-old’s assigned gender at birth is female but last July Swanepoel came out as trans. His family found it hard to accept, and he moved from Auckland to Nelson here he could be with his partner, Jessie Mickell.

Hundreds of trans people in New Zealand seek access to gender affirming surgery which has limited Government funding.
123RF
Hundreds of trans people in New Zealand seek access to gender affirming surgery which has limited Government funding.

He said he always knew he was trans, but it was common for people to still refer to him as female.

“People need to know it’s not a mental illness and it’s not a choice to be trans, or to be gay or to be a part of the LGBTQ+ community,” he said.

“I want to raise awareness about how hard it is to be trans. People don’t understand how difficult it is living in the wrong body and how traumatising it is.”

He was also fundraising for private top surgery.

Swanepoel and Henderson’s Givealittle pages were among 36 currently fundraising for top surgery.

In April, Swanepoel was able to get hormone therapy after being passed on from “nurse to nurse and doctor to doctor”.

Funding is available for a consultation to start hormones but due to the wait he decided to pay the $350 to seek private care.

Felix Swanepoel is amongst 36 people seeking help to pay for gender-affirming surgery on Givealittle.
BRADEN FASTIER / STUFF/Nelson Mail
Felix Swanepoel is amongst 36 people seeking help to pay for gender-affirming surgery on Givealittle.

Fortnightly visits to the nurse for an injection will be a regular routine for the rest of his life. However, already his voice had changed which gave him a new confidence.

Gender affirming surgery and health care came at a cost he did not believe should exist.

Wi-Hongi was encouraged to see more people were coming out at a younger age.

“We know that being in the closet isn’t good for people so it’s quite significant that people are now able to come out when they’re younger.”

Funding for genital reconstruction surgery had also increased with nearly $3 million approved in the 2019 Budget to supplement funding from the high-cost treatment pool.

The funding is limited to those aged 18 and older and enables 14 surgeries a year. Covid-19 delays meant only five surgeries were performed in 2020 and five have been performed so far this year. A further four were booked for between June and September, a Ministry of Health spokesperson said.

Henderson hopes to have access to hormone therapy this year, before being able to access top surgery next year.
ALDEN WILLIAMS/Stuff
Henderson hopes to have access to hormone therapy this year, before being able to access top surgery next year.

As of June 30, there were 297 referrals for a first specialist assessment with an expected waiting time of two to three years.

The current cost for the surgery in New Zealand ranges between $50,000 and $90,000 for male-to-female and $35,000 and $100,000 for female-to-male surgery.

“Historically there's been an enormously long waiting list… more than 50 years long,” Wi-Hongi said.

“Pretty much in all areas of life, trans people are still experiencing disparities compared with the general population.

“I think we are moving forward but we have to be really vigilant about making sure that things aren’t moving backwards at the same rate.”

Felix Swanepoel has moved from Auckland to Nelson to live with his girlfriend.
BRADEN FASTIER / STUFF/Nelson Mail
Felix Swanepoel has moved from Auckland to Nelson to live with his girlfriend.

Both Henderson and Swanepoel said they would consider genital reconstruction surgery but it was out of reach financially.

“I just want to be seen as Felix, and as a guy,” says Swanepoel.

“I want to look in the mirror and see who I’ve always meant to be and right now it’s not like that, I don’t look in the mirror.”