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Gender Diversity Service, Royal Perth Hospital, Perth (WA)

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The Gender Diversity Service is a multi-disciplinary service providing initial assessment and/or hormone therapy for individuals over the age of 18 years.

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Gender Reassignment Board

Welcome to the Gender Reassignment Board

The Gender Reassignment Board (the Board) was established under the Gender Reassignment Act 2000 (WA). The Board’s main function is to deal with applications from people who have undergone a gender reassignment procedure to be legally recognised as belonging to their new gender. If the person is successful in their application, the Board will issue a recognition certificate.

The Board is made up of the President and up to five members. The Board includes at least one medical practitioner, a person who has undergone a reassignment procedure, and a person with experience in equal opportunity matters.

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Who can apply?

How to apply, what happens next, at the board meeting, birth certificate, annual reports.

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Masada Private Hospital Part of Ramsay Health Care

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Trans Surgery

The team at Masada Private Hospital are passionate about the positive impacts reconstructive surgery can have on people’s lives.

Masada Private Hospital is proud to work with leading plastic and reconstructive Specialised surgeons,  Mr Alan Breidahl , Mr Andrew Ives ,  Mr Cheng Lo , Mr Gideon Belcher and Mr Stephen Kleid , each whom provide high-quality, comprehensive and compassionate care for those seeking trans surgery.

Why Masada?

Our exceptional nursing and support team and world class equipment makes our hospital a place where our surgeons can provide top quality patient care.

Masada Private Hospital’s philosophy is to provide a range of services to support the needs of every community member. Everyone is entitled to the highest level of respect. Our hospital offers a comfortable, welcoming, and discreet place for you to receive quality health care.

For more information about our Hospital  contact us .

Surgical options at Masada

Trans feminine genital reconstructive surgery.

This category of surgeries are performed to create female genitalia.  

Vaginoplasty

A vaginoplasty, which takes about 3-4 hours to perform, involves using the skin of the penis to create a lining of the perineum (opening to the vagina), and the lining of the vagina. Scrotal skin, if required, is used to line the top part of the vaginal cavity.

The testicles are removed. The head of the penis is used to create the neo-clitoris, so that most patients can retain the ability to have an orgasm post operatively.

Length of stay and recovery time

The usual length of stay is around 5-6 nights depending on which surgery you had. Dressings are removed on day 3.

If you are interstate, you will need to plan to stay in Melbourne for around 14-18 days in total.

Total recovery time can take up to 12 weeks, however most patients are able to resume work after 6 to 8 weeks or so, depending on your occupation and the surgery you have had.

Labiaplasty

Similar to a vaginoplasty, the labiaplasty involves the creation of a vaginal dimple instead of a neovagina. The final result looks the same as a vaginoplasty however patients do not have to dilate since they have no cavity.

Orchiectomy

An orchiectomy is a procedure that removes the testes. This procedure can be used to stop the production of testosterone or sperm, affirm gender or remove the need to taken an anti-androgen.

You will either stay overnight or be discharged on the same day – this will vary depending on your surgeon.

Recovery can take from 2 to 8 weeks. You won’t be able to do any strenuous activity, lift heavy objects or drive for at least a few weeks.

The specific instructions for your recovery will vary from surgeon to surgeon and depending on where and what specific surgical techniques are used.

Trans Masculine Genital Reconstructive Surgery

This category of surgeries are performed to create male genitalia.

Phalloplasty

A phalloplasty is a surgical procedure where a penis is created from existing tissue, this could be leg or forearm or elsewhere from the body. A phalloplasty is a multi-staged surgery that may include a variety of different procedures, including creation of the penis, lengthening the urethra to allow for standing urination, creating the tip (glans) of the penis, creation of the scrotum, removal of the vagina, uterus and ovaries and placing erectile and testicular implants.

These surgeries may be broken down into as many as three to four stages, with a period of several months to a year between each stage.

Please note, each staged surgical plan is unique to each patient and may or may not include some/all of the above procedures.

You may stay in hospital up to 2 weeks after each surgery with ongoing outpatient assessment once you’ve discharged. Healing from phalloplasty can take time so it’s vital to plan time to rest and recover for approximately 5-6 weeks. Please speak to your specialist about recovery times relevant to you.

Chest Reconstructive Surgery

Chest reconstructive surgery / top surgery.

The purpose of this surgery is to create a more masculine or androgenous chest. This includes contouring of the chest wall, removal of breast tissue and skin excess, reduction and repositioning of the nipple areolar complex, minimalization of chest wall scars and obliteration of the inframammary fold.

Length of stay and recovery time 

The usual length of stay in hospital is one night however this will differ from surgeon to surgeon. You will need to rest for about two weeks, with no heavy lifting or strenuous exercise for approximately 6 weeks.

Trans Feminine Breast Augmentation

The purpose of this surgery is to increase breast size to create a feminine chest. This procedure is likely to include breast implants.

Recovery from breast implants may take between 4-6 weeks, or several weeks longer depending on the surgical procedure. Often the surgery is conducted as a day procedure however this is dependent on your chosen surgeon.

Your surgeon may advise you to not do any strenuous activity or heavy lifting for the first 3 weeks, and wear compressing clothing, sports bras or specially designed garments, for the first month. You will wear dressings until you meet your surgeon for a check-up.

Facial Surgery

Facial surgery is the name for a range of surgeries that can be used to alter the appearance of the face and neck.

Plastic and reconstructive surgeons specialising in facial reconstruction are available at Masada Private Hospital. These surgeons can support patients with facial feminisation and masculinisation.

Surgical options

• Brow Lift (Browplasty)
• Cheek Enhancement
• Forehead reduction (and hairline lowering)
• Lip lift and reshaping
• Scalp Advancement

The length of stay and recovery time will depend on the type of surgery you undergo. Please consult your specialist for personalised information.

Ear, Nose & Throat Surgery

Ear, Nose and Throat surgeons can cater to specific surgeries to alter the appearance of a person’s nose (Rhinoplasty) or to reduce the prominence of a person’s Adam’s Apple.

Tracheal Shave (Chondrolaryngoplasty)

Chondrolaryngoplasty, also known as tracheal shave, is a procedure to reduce the prominence of the thyroid cartilage by trimming the cartilage and bone through a small incision on the neck (beneath the chin) to decrease the prominence of the Adam’s Apple. It is a common surgical procedure in the facial feminisation process. The procedure takes about 30 to 60 minutes.

For safety, patients will stay in hospital overnight, or at least 8 hours if they have no insurance, to observe for swelling and breathing difficulties.

There are no special post-operative instructions, apart from keeping the dressing dry for 3 days, then you may shower and get it wet.

• Rhinoplasty

Rhinoplasty surgery is a procedure whereby a surgeon reshapes and/or straightens your nose to appear more masculine or feminine. In trans nasal surgery or rhinoplasty, your surgeon will strive to create a natural-looking and unique nose.

The length of your recovery period after nose surgery will depend on your anatomy, general health and the specifics of your procedure. Whilst it depends on your surgeon, you will usually spend at least one night in hospital. The general rule is that you should allow at least 4-6 weeks for initial recovery following your surgery. Be sure you get adequate rest, good nutrition and don’t smoke.

You’re in good hands

Mr Andrew Ives

Mr Andrew Ives , is highly skilled with extensive experience and a passion for the positive changes that plastic surgery can make in people’s lives. He feels privileged to have such a rewarding career.

With years of experience behind him, Mr Ives provides top class surgical services. He also fully understands the human element that comes with surgery, offering personalised advice to support you to reach your surgical goal.

He performs between 170 – 200 gender re-assignments per year. Mr Ives' Nurse consults with all the surgical patients preoperatively and post operatively. All the patients must consult with a Psychiatrist or Clinical psychologist to obtain a WPATH report, before proceeding with surgery.

Mr Ives will take the time to understand your past medical history, general health and journey to date before providing advice on the operations available to you. 

Learn more  about  Mr Andrew Ives .

Trans surgeries conducted:

• Trans masculine/non-binary chest reconstructive surgery
• Trans feminine genital reconstructive surgery - Vaginoplasty, Labiaplasty, Orchidectomy
• Bilateral breast augmentation

A/Prof Cheng Hean Lo

A/Prof Cheng Hean Lo is a specialist plastic & reconstructive surgeon. He is the current Head of Department of Plastic & Reconstructive Surgery at Western Health, and is a senior medical staff at the Victorian Adult Burns Service (The Alfred).  His areas of particular interest include burn surgery and gender affirming surgery.

Learn more  about  Mr Cheng Lo

• MtF & FtM chest reconstructive surgery (including TOP surgery)
• MtF genital reconstructive surgery (including orchidectomy, labiaplasty, vaginoplasty)..

Mr Alan Breidahl

Mr Alan Breidahl is a specialist in post-traumatic and cleft lip-associated Rhinoplasty and has over 20 years clinical experience in all areas of Plastic and Cosmetic Surgery, including skin cancer, hand surgery, facial trauma and reconstruction, rhinoplasty, otoplasty, blepharoplasty, face lift, breast augmentation and reduction, liposuction and abdominoplasty procedures.

Learn more about Mr Alan Breidahl.

Surgeries conducted:

• Facial feminisation surgery
• Facial masculinisation surgery

Mr Gideon Blecher

Mr Gideon Blecher is an Australian qualified Urologist and Andrologist. As a surgeon who looks after male reproductive and sexual health issues, he has the experience and knowledge to manage complex problems. He has completed several years of overseas fellowship subspeciality training, in both andrology as well as robotic oncology in some of London’s most esteemed hospitals.

Mr Blecher specialises in a variety of areas including erectile dysfunction, penile prosthetic surgery, Peyronie’s disease, genital reconstruction, male infertility, male incontinence, testicular and penile lesions, as well as sexual dysfunction and general urology.

Learn more  about  Mr Gideon Blecher .

• Vaginoplasty, Labiaplasty
• Orchidectomy

Mr Stephen Kleid

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

Mr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincent’s.

Learn more about Mr Stephen Kleid.

• Tracheal Shave – reduction of Adam’s Apple

How to book or refer

A referral from a medical professional is required to have a consultation with a plastic and reconstructive surgeon. Please speak to your GP about a referral to the specialist of your choice.

Assessment prior to Surgery

Assessment and documentation of persistent gender dysphoria by a qualified mental health professional is necessary for initiation of surgical treatments.

Each procedure has a different set of criteria recommended to enable surgery to occur – these criteria are set by the World Professional Association for Transgender Health (WPATH). Further, each surgeon may have a different protocol they follow.

They key criterion are:

• Persistent, well documented gender dysphoria;
• Capacity to make a fully informed decision and to consent for treatment
• Age of majority
• If significant medical or mental health concerns are present, they must be reasonably well controlled
• In some circumstances, hormone therapy is a perquisite.

Psychiatrists and psychologists who can complete specialist gender-related mental health assessments. Please ask your GP for a referral to your chosen mental health professional.

Support networks

Below please find a list of the key organisations that provide services. This is not an exhaustive list and there are many other support services that operate within each state.

If you require immediate help and you are in Australia, please call 000. If you need counselling support now please contact Lifeline on 13 11 14, Suicide Call Back 1300 659 467 and/or Mens Line Australia 1300 78 99 78. 

Gender Support – Aleph Melbourne

Alep Melourne offers a safe and inclusive environment for people in the Jewish community who are gender diverse. If you are transgender, gender-fluid, gender questioning, gender neutral or gender queer, then you are welcome here.

Visit - https://aleph.org.au/gender-support/

Genderqueer Australia – Genderqueer peeps

Genderqueer Australia began in 2010 as a peer support group for Gender Questioning, Genderqueer and Trans people, and their family and friends.

We now inform genderqueer, gender diverse and LGBTIQ+ of events, information and call-outs.

Visit - https://www.genderqueer.org.au/

Rainbow Families

Rainbow Families Inc is the peak organisation supporting LGBTQ+ parents and their children. It works to reduce discrimination and disadvantage faced by children of LGBTQ+ parents so they can thrive and shine and is a support network for parents and carers, as well as future parents and carers.

The purpose of Rainbow Families is to build a community that fosters resiliency by connecting, supporting and empowering LGBTQ+ parents and their children.

Visit - https://www.rainbowfamilies.com.au/

Seahorse Club Victoria (seahorsevic.com.au)

Seahorse Victoria Inc was formed in 1975 as a support and social group for the Victorian transgender community and is the longest running organisation of its type in Australia.

Visit - https://seahorsevic.com.au/

Spectrum Intersections - The Rainbow Neurodiverse Group

The Rainbow Neurodiverse Group are a free peer led group for people 18 and over who identify as neurodiverse and on the LGBTIQA+ Spectrums.

This is a safe space and learning environment for people without fear of judgement, misunderstanding, harassment or abuse.

Visit - https://www.spectrumintersections.org

Transfamily

Transfamily is a peer support group for parents, siblings, children, extended family, partners, and friends of trans and gender diverse people.

They offer an understanding environment for friends and family of trans and gender diverse people to share experiences, ask questions, seek advice and support. They are based in Melbourne, Victoria where the group meets monthly, however support is extended and offered to the wider Victorian and Australian population whenever possible.

Visit - https://www.transfamily.org.au/

The Shed is a Melbourne based support group for trans masculine people, including AFAB people who are non-binary and those who are questioning or exploring their gender.

We meet up to support each other and build resilience through sharing personal experiences of trans life.

Visit - https://www.theshedsupport.org.au/

General Enquiries 03 9038 1300 Fax 03 9038 1309

William Macaulay Counselling

Counsellor & psychotherapist.

Phone 0401 316 977

for enquiries or appointments

William Macaulay Counselling Perth

Psychotherapy   *   Counselling   *   Cognitive Behaviour Therapy   *   Psychology   *   Therapy

Gender Therapist Perth, WA

Gender Diverse & Transgender Counselling Perth

Coming out as transgender can be a challenging journey for a number of reasons, including discrimination, social stigma, and lack of support from loved ones. Accepting and embracing one's transgender identity can also be difficult for some individuals.

If you are unclear about your gender orientation or experiencing excessive fear, stress , anxiety or depression as a result of the reactions of others, it may be helpful to seek support from a gender therapist. While therapy cannot change one's gender identity, it can provide a safe space for individuals to understand themselves better and navigate the challenges associated with being transgender.

In this article, I aim to provide a brief overview of various gender-diverse and transgender issues, with the goal of fostering a better understanding of this complex and often misunderstood topic.

Wh a t is gender?

Gender is a multifaceted concept that goes beyond the traditional categories of male and female. While biological sex is determined by physical and reproductive characteristics, gender is a broader concept that encompasses cultural, social, and psychological aspects.

Traditionally, gender has been understood within a binary framework, consisting of two categories: male and female. However, many societies and cultures recognise that gender is not solely limited to these binary categories and that a spectrum of gender identities and expressions exists.

Gender identity refers to an individual's deeply ingrained sense of being male, female, or another gender. Some individuals may identify as transgender, indicating that their gender identity does not align with the sex assigned to them at birth. Others may identify as non-binary, signifying a status that is neither exclusively male nor female, existing somewhere in between or beyond both genders.

It is essential to approach gender with respect, openness, and an understanding that individuals have diverse experiences and identities. Gender is a complex and personal aspect of human identity that varies across cultures and individuals. Understanding and respecting various gender identities and expressions are crucial for cultivating an inclusive and equitable society.

Cisgender versus Transgender

Cisgender refers to individuals whose gender identity matches the sex they were assigned at birth. Transgender is a word that defines people whose gender identity differs from the sex they were assigned at birth. This could mean in between, the opposite of or something entirely different from the sex they were assigned at birth.

Important to note that being transgender is different from being gay. People who identify as transgender have the same range of sexual orientations as the general population, including being heterosexual, gay, lesbian, bisexual, pansexual or asexual.

Confused about your gender?

If you are confused about your gender, there are several options that you may want to consider. Important to note that there is no 'one size fits all' experience for people who identify as transgender. As everyone is different, these options should be matched against your current needs, level of comfort and support, age, mental health status, and financial circumstances.

Social transitioning

Accepting who you are:.

Accepting who you are is an important first step. It's okay to be unsure, and it's okay to take your time. Be patient with yourself. Acceptance may be a gradual process. Becoming well informed about transgender issues can help with the process.

Disclosure t o others:

It is your decision whom to confide in, when to do it and how. Do not pressurise yourself into talking about your gender before you feel ready to do so. Being transgender is normal, but it's not common. So, some people may react negatively at first and need some time to adjust. Try not to respond angrily or defensively. Acceptance may be a slow and gradual process. You may find reading my LGBT Coming Out article helpful.

Appearance:

Changing your appearance is another way in which you can experiment with expressing your gender. It may be important to you that your appearance aligns with your gender orientation. Ideally, your appearance should simply be whatever makes you feel comfortable.

Name change:

Sometimes people who identify as transgender decide to change their birth name to a name that better reflects their gender orientation. Important to note that it may take friends and family a while to adjust to using your new name. In Australia, you can change your name legally for any reason. However, if you are under 18 years of age, you will need parental consent.

Pronouns are other words we use as substitutes for people's names. There are gender pronouns such as he/his/him and she/her, as well as gender-neutral pronouns such as they/their/them. You may want to consider asking people to change to a gender-neutral pronoun when referring to you.

Speech pathology:

Speech pathology is vocal training to help change the pitch of your voice and speech patterns to something you're more comfortable with. There is no age restriction to access these services.

Medical tran sitioning

Medical transitioning is when a person who identifies as transgender decides to access medical options, such as hormones or surgery, to feel more comfortable in their own skin. As an experienced gender therapist, I can provide information and support on how to proceed with any of the following medical transitioning options.

Puberty blockers:

Puberty blockers are drugs that delay the onset of puberty, allowing you more time to figure out your gender identity. They work by blocking the hormones testosterone and estrogen that lead to puberty-related changes in your body. This stops things like periods and breast growth, or voice-deepening, Adam's apple and facial hair growth. 

Puberty blockers are most effective for people in the early stages of puberty. If you are under 16, this option may be worthwhile discussing with your parents and GP. Accessing puberty blockers requires psychiatrist approval, consent from both parents and an endocrinologist.

Hormone Replacement Therapy (HRT):

For many transgender people, hormone treatments are the first step in the process of transitioning and are often followed by surgical procedures. For others, taking hormones will be the only type of medical treatment they ever have. Hormone treatments for transgender people involve substituting the sex hormones of an individual's assigned sex with those of the opposite sex. For male to female, this means taking estrogens, and in some cases anti-androgens (to stop the production of male hormones), while for female to male, treatment means taking testosterone. Such treatments are used for two purposes: to reduce or eliminate secondary sex characteristics of an individual's assigned sex and to induce those of their new sex. Not all secondary sex characteristics will be eliminated or obtained, and the extent to which these goals are achieved varies from person to person. If the gonads (e.g. testicles or ovaries) are removed, sex hormone therapy is necessary for the remainder of the individual's life to avoid side- effects of hormone deprivation (e.g. Osteoporosis).

Research indicates that people who have undergone hormone therapy report both positive and negative aspects of the therapy. Careful thought and sound medical advice should, therefore, be considered before commencing with this option. Your GP, an endocrinologist or a psychiatrist can provide you with the appropriate guidance and information.

Gender affirming surgery:

As part of transitioning, surgery is sometimes performed on genitals, breasts and other physical features. While not considered the final stage of transitioning, as there is usually a period of adjustment post-surgery, surgery is often viewed as the central and major step in an individual's journey to transition. In Australia, access to surgery remains limited, and it is predominantly performed in Sydney and Melbourne.

Increasingly, studies have found that surgical interventions result in positive outcomes across a range of domains, including psychologically, socially, physically, and sexually. Extensive screening processes, psychological therapy and staged levels of treatment prior to surgery (e.g. hormone treatment, real-life test) are used to prepare the individual for the surgery and minimise the chances of regret after irreversible surgical procedures. Although disappointment after surgery has been reported to occur, satisfaction is generally high, and few have reported any regrets after such procedures.

Men tal health

Gender diversity in itself does not cause mental health problems. However, transgender and gender diverse individuals may experience a range of stressful occurrences that increase the likelihood of developing a mental health issue. Some may frequently experience harassment and stigmatisation, and sometimes violence because of social, cultural and religious norms. Some may become estranged from family and friends. Some may find it challenging to secure suitable employment and housing. And for some, the constant exposure to negative messages about their gender identity can have a devastating impact on their self-worth and wellbeing.

Sadly, these harmful exposures have resulted in people who identify as transgender experiencing higher rates of mental illness, self-harm, and drug and alcohol misuse , than the general population. A gender therapist such as myself can provide support and gender counselling to help you work through these issues.

Gender diverse terminology

As with any identity, individuals should choose their own language to describe or identify themselves. Always listen for and respect a person's self-identifying terminology. Also, the correct use of language to describe others demonstrates respect and encourages understanding. Here is a guide to some of the commonly used terms concerning gender:  

Crossdresser: a person who needs to express an alternative gender identity by dressing and being accepted in that role on a less permanent basis. Crossdressers are usually content with their biological sex.

Drag: a stage or theatrical performance involving a male performer dressed as a woman or a female performer dressed as a man to entertain others at bars or clubs.

Female to male (FtM): adjective to describe individuals assigned female at birth who are changing or who have change their body and/or gender role from birth assigned female to a more masculine body or role.

Gender binary: the classification of sex and gender into two separate categories of masculine and feminine. These two categories exclude many people who do not fit neatly into either category.

Gender dysphoria: distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth.

Gender expression: is how someone presents their gender to the world. This can mean through the way a person physically presents as well as the way they act. This can be through appearance, dress, mannerisms, speech patterns and social interactions.

Gender identity: refers to a person's internal sense of being male, female, something other or in between.

Gender nonconforming: adjective to describe individuals whose gender identity, role, or expression differs from what is normative for their assigned sex in a given culture and historic period.

Gender reassignment: the physical, legal and social process of transitioning gender – usually from the gender that society thinks the person should be to the individual's own sense of gender. This may include surgery, hormone treatment, a change of name, a different pronoun, and a change of birth certificate gender.

Internalised transphobia: discomfort with one's own transgender feelings or identity as a result of internalising societies normative gender expectations.

Male to female (MtF): adjective to describe individuals assigned male at birth who are changing or who have change their body and/or gender role from birth assigned male to a more feminine body or role.

Non-binary: a term used to describe individuals who may experience a gender identity that is neither exclusively male or female or is in between or beyond both genders.

Transgender: an umbrella term used to describe people who sit outside the gender binary of masculine and feminine, or whose gender identity is different from the sex assigned to them at birth.

Transsexual: a person whose gender identity is opposite to their biological sex. Many transsexuals will change their bodies through hormones and possibly surgery to better match their gender identity.

Transvestite: someone who dresses in clothes usually worn by the opposite sex for fetish or arousal purposes.

  🏳️‍⚧ T ransgender an d Gender Diverse Counselling and Support 🏳️‍⚧

How can seeing a gender therapist help? If you are confused or unclear about your gender identity and what this means for you or would like to discuss any of the issues raised on this page, please contact me to schedule an appointment. Overall, a gender therapist can play a crucial role in providing guidance, support, and resources as you navigate your gender identity journey , helping you achieve personal comfort and well-being. Click here to view the range of gender counselling services I offer .

LGBTIQA+ Changing Gender

To legally change your gender in WA, you must apply to the Gender Reassignment Board (the Board) for a gender recognition certificate. Before you can apply to the Board, you will need to have undergone a ‘reassignment procedure’ and meet other eligibility criteria. The eligibility criteria differ depending on whether you are an adult or are under 18, and are explained below.

This page has information that may help you if you are gender diverse and want to know how to legally change your gender in Western Australia or have questions about your health rights.

Are there laws about legally changing your gender in WA?

Yes. The Gender Reassignment Act 2000 (WA) sets out how you can legally change your gender in WA. Legally changing your gender means:

• you will be officially recognised as your reassigned gender in all matters in Western Australia,
• you will be protected against discrimination on the basis of your gender history under state (WA) discrimination law, and
• you can ask the Registrar of Births, Deaths and Marriages for a Birth Certificate recognising your reassigned gender.

What is a ‘reassignment procedure’?

The High Court of Australia has previously said that a person does not need to surgically change all of their gender characteristics to be recognised as having had a ‘reassignment procedure’. However, they must have altered their gender characteristics sufficiently through either a medical or surgical procedure so that they can be socially identified as their preferred gender. It is important to get legal advice, as what is legally considered a ‘reassignment procedure’ is complex and may be decided by the exact circumstances of your situation.

Eligibility to apply if you are an adult

If you are 18 or older, you can apply directly to the Board for a gender recognition certificate. To be able to apply, you must have undergone a ‘reassignment procedure’ and :

• your ‘reassignment procedure’ was carried out in WA
• you were born in WA, or
• you live in WA and have lived in WA for at least 12 months.

To be successful with your application, the Board will then need to be satisfied of all three of the following criteria:

• you believe your true gender is the gender to which you have been reassigned
• you have adopted the lifestyle and the gender characteristics of a person of the gender to which you have been reassigned, and
• you have received proper counselling about your gender identity.

Eligibility to apply if you are under 18

If you are under 18 years old, you cannot apply directly to the Board for a gender recognition certificate. Your parents or guardians must make the application for you and there are strict rules about this. You might need to get legal advice if your parents or guardians are unwilling (or unable) to make the application for you.

For your parents or guardians to be able to apply, you must have undergone a ‘reassignment procedure’ and :

To be successful with the application, the Board must then be satisfied that it is in your best interests for a gender recognition certificate to be issued.

What information needs to be given with an application? 

To apply for a gender recognition certificate, you will need to pay the application fee (currently $40) and provide the following documents to the Board:

• a completed application form (available from the Board's website)
• a letter from the medical practitioner who performed or supervised your ‘reassignment procedure’,
• a letter from any other medical practitioner who has been involved with your ‘reassignment procedure’
• a letter from a psychiatrist, psychologist or other recognised counsellor confirming you have had counselling on your reassignment
• letters of support from friends, family or colleagues stating that you are now recognised as female or male in your daily life.
• your birth certificate or extract of entry of birth
• any documents relating to any change of name you have had
• photo identification, and
• if you were not born in WA, documents confirming you have been a resident here for at least 12 months.

What if the Board rejects my application?

You may be able to appeal the decision. You should get legal advice as soon as possible because there are deadlines (time limits) for appealing the Board’s decision. More information about how to apply for a gender recognition certificate and what happens next is available from the Gender Reassignment Board website.  

Useful documents

More information

• Gender Reassignment Board website

Reviewed:  4 March 2021

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• LGBTIQA+ International Human Rights
• Changing names

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Gender affirming surgery

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

• There are many different gender affirming surgeries and procedures.
• Gender affirmation might also include social affirmation, legal affirmation or medical affirmation.
• Everyone affirms their gender in different ways, and that may or may not include surgery.

What is gender affirmation?

Gender affirmation is the process you go through when you start to live as the gender with which you identify.

Gender affirmation might include:

• social affirmation — such as changing your name, pronouns, hair or clothing
• legal affirmation — such as changing your legal name or gender
• medical affirmation — which can include puberty blockers, hormones or surgery

Read more about gender incongruence and gender affirming care.

What is gender affirming surgery?

Surgery is just one option for gender affirming care. This includes top and bottom surgeries, as well as other surgeries like facial feminisation surgery.

All trans and gender diverse people are unique. You can choose to affirm your gender in a way that feels right for you.

This article talks more about gender affirming surgery.

What happens during gender affirming surgery?

Gender affirming surgery is usually done in adulthood.

There are many different gender affirming surgeries and procedures. They may include making changes to your:

• other body parts

Not everyone with gender incongruence has surgery.

Male to female surgeries

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

• Breast/chest surgery — augmentation with insertion of breast implants.
• Facial feminisation — changing the shape of the lips, eyes or nose.
• Voice surgery — shortening the vocal cords for a higher, more feminine voice.
• Tracheal shave — reducing the size of the 'Adam's apple'.
• Lipofillers or liposuction, to achieve a more feminine shape.

Bottom surgery (genital reconfiguration surgery) involves changes to the genitals. 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 mixture of the following procedures:

• Removing the testicles (orchiectomy).
• Removing and reshaping tissue from the penis to make a vulva (penectomy) — this includes creating external labia or lips, and a clitoris (vulvoplasty).
• Shortening the urethra (tube that you urinate from).
• Creating a vaginal canal (vaginoplasty) — some people choose to skip this.

After vaginoplasty surgery, you need to use vaginal dilators to maintain the shape of your vaginal canal.

Female to male surgeries

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

• Breast/chest surgery to create a male chest.
• Lipofillers and liposuction to achieve a more masculine shape.
• Pectoral implants.

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

• Hysterectomy and ovariectomy — removal of your uterus (womb) and ovaries.
• Removal of the vagina (vaginectomy).
• Creation of a penis, which may include metoidioplasty or phalloplasty.

Metoidioplasty involves making a small penis using tissue from the clitoris after it is enlarged by testosterone hormone therapy.

Phalloplasty uses tissue from your body to make a penis. This tissue usually comes from your arm, thigh or back. Phalloplasty is a multi-stage process.

You may choose to have urethral lengthening, so that you can urinate from the tip of your new penis. This can happen about 6 months after your first surgery.

The final stage of surgery involves testicle implants and a device that may help you to have 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. Doing your own research and talking with experts will help you decide what's best for you. Surgery doesn't make you more or less trans.

When can I have gender affirming surgery?

Before you can get gender affirming surgery, you need to meet certain criteria. You need to:

• have a history of gender dysphoria (for 6 months or more)
• have the ability to make a fully informed decision
• be over the age of 16 years for top surgery, or 18 years for bottom surgery (some surgeons will provide surgery to younger people in specific situations)
• ensure that any physical or mental health conditions you have are well managed

You will also need letters of support from a mental health professional before having gender affirming surgery. The letter needs to state that surgery is:

• appropriate for you
• likely to help affirm your gender
• likely to reduce any gender dysphoria that you have

For top surgery, one letter is needed. For bottom surgery, 2 letters are needed.

For bottom surgery, you are also required to have 'lived as your current gender' for 12 months. This means that you have socially transitioned.

If you are taking gender affirming hormones, you should do this for at least 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

What questions should I ask my doctor before surgery?

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

Questions to ask your surgeon include:

• Am I a good candidate for the procedure?
• What different surgical techniques are recommended for me?
• How long will the recovery period be?
• What are the possible risks and complications?
• Where will you perform the surgery?

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

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 you can expect after each surgery.

You may want to ask:

• How long will I spend in hospital?
• When can I shower?
• Will I need any special dressings or surgical garments?
• When do I need to return for 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. Some people may need another surgery to get the best results.

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 their gender dysphoria is not fully resolved.

Make sure you discuss any difficult feelings with your doctor or psychologist.

Complications from gender affirming 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.

However, research suggests that very few people who have gender affirming surgery regret their decision.

Talk to your doctor or psychologist if you are feeling any distress after surgery.

How much will gender affirming surgery cost?

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. There may be extra costs for:

• specialist visits before and after surgery
• surgeon and anaesthetist fees
• hospital and theatre costs
• any other products or services you need

The costs of some procedures may be covered by Medicare. You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online .

Unfortunately, most gender affirming surgery in Australia is done privately. If you have private health insurance , it's important to check with your health fund about:

• what is covered
• what your out-of-pocket costs will be

Legal affirmation

Changing your gender on your passport, licence, Medicare card or birth certificate all require separate processes. These processes can vary between states and territories.

In some states and territories, you must have gender affirmation surgery to change the gender marker on your birth certificate.

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

Resources and support

The Australian Professional Association for Trans Health (AusPATH) lists healthcare professionals who are committed to strengthening the health, rights and wellbeing of all trans people.

TransHub has information about gender affirming surgery and updating your gender marker on identity documents

The Gender Centre (NSW) offers resources and support.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

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

Last reviewed: May 2024

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Medicare Coverage and Gender Reassignment Surgery

Not all trans* people seek surgery as part of their transition, but those who do often find the financial burden of medical procedures associated with transitioning hard to afford.

Shelley Argent, national spokeswoman for lobby group Parents and Friends of Lesbians and Gays (PFLAG) told OUTinPerth her concerns about the medical costs of gender reassignment surgery and the repercussions for individuals who may need the surgery but cannot afford it.

‘This surgery is extremely important to be covered by Medicare because most people in need of surgery can’t afford it due to lack of opportunity of paid work, either due to the fact no one will employ them while they are transitioning, or the individual is suffering from mental health issues either because of the stress of rejection, or due to the lack of private funds to have the surgery done, which leaves them in limbo.’

In her public statement, outlining the reasons for performing the surgery herself, trans woman Jessica Johnson stated ‘for the past 15 – 16 years I have had approval to undergo gender reassignment surgery from two psychiatrists … and have written to both the Queensland Government & the Australian Federal Government endless times requesting assistance with having my surgery as I cannot afford it.’ She goes on to list the costs of surgery in Australia and other countries.

Kayleigh Bourquin, an administrator for the facebook group WATSUP (WA Trans Support, Unity, Pride) also expressed similar frustration.

‘I really struggle… I struggle being able to buy books for university on my own, let alone something as expensive as reassignment surgery…it’ll be over 5 to 10years before I can even entertain that idea. I’ve been transitioning for 4 years now and… sometimes [not being able to afford surgery] really gets me down and can be a trigger for depression and anxiety.’

A recent studyconducted by Latrobe University called Private Lives 2 shows that the depression and anxiety affect many others in the community.  In a sample of 4,000 LGBT individuals, nearly 80 per cent of people had at least one episode of intense anxiety in the 12 months previous to the survey. Trans male and trans* female respondents were considerably more likely to have experienced these, with trans* males nearly 2.5 more frequently than males in the same population.

Aram Hosie, spokesperson for WA Gender Project, says, ‘Currently, many of the major surgeries that may be required for trans people are covered, in part, by Medicare, the difficulty is in the ‘gap’ that exists between the Medicare payment for surgeries and the amount charged by health professionals – very often in the thousands of dollars. In addition, there are a number of other surgeries and medical treatments – such as some facial surgeries and hormones that are not covered by Medicare at all.’

Claire Elise Manchesi-MacLennan, Media and Public Awareness Officer for the Chameleon Society of W.A. expresses a similar sentiment about medical treatments that are not at all covered by Medicare. She explains, ‘We need [Medicare coverage] for other trans* stuff like breast improvements, facial surgery… hormone treatments…’

One major important factor regarding gender reassignment surgery that a number of trans* community members and lobby groups agree on is a lack of trained medical professionals in Australia. Mr Hosie says, ‘I do have some concerns… that even if treatments were to be fully covered by Medicare, there are currently few, and in some cases no, surgeons or health facilities with the expertise to actually provide the treatments required.’

Robyn Edwards of TransHealth Australia expresses a similar concern, ‘… there are no capable surgeons in Australia … surgeons here are 30 years behind in their skills and there have been quite a number of reports that their [surgical] attempts have failed. The cost over in Thailand including airfares and accommodation can be as little as $10,000 but [for some trans people] that may as well be $10 Million.’

Shelley Argent concurs ‘ We need more doctors trained in improved techniques to benefit patients.’ In terms of what changes PFLAG would like to see, Argent says ‘We would like the Government to recognise this as a real issue for many people with Gender Identity Disorder, and then work towards improving their quality of life by providing options quickly to minimize the long term mental health issues that can and do arise…I believe we can learn from countries like Argentina, Cuba, The Netherlands, Brazil and some US States who perform this surgery through a variety of health schemes.’

Mr Hosie stresses that ‘Getting full Medicare funding is just one part of the puzzle. I think the reality is that we need to simultaneously address a whole range of issues if we’re going to make a real difference to trans people’s lives, including discrimination protection, legal identity recognition, education of service providers (including doctors) and ensuring more affordable access to health care.’

So what can the wider LGBT community do to support trans people and organisations? Mr Hosie says ‘A number of trans advocates and organisations are already working to improve things for trans people in Australia – so the best thing that others who want to lend support could do would be to donate to or get involved with one of these groups. Examples include the WA Gender Project and The Chameleons here in WA, or any one of the trans organisations from around the country involved with the LGBTI Health Alliance.’

Claire Alexander

• Medicare Cover for Trans* People
• Medicare Coverage Gender Reassignment
• Surgery Cover for Trans* People

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For me.. personally.. I still am struggling to afford basic medical costs.. I try not to think so far ahead.. the pain of merely thinking about the costs of surgery are hard to deal with. Something needs to change

all the info ive seen so far makes me wana cry

i need to find a way to afford surgery or I don’t want to be here!

I have payed a forthune in fees now I want to be a woman I can’t that’s not fair

This artical make transgender sound like a mental illiness or disorder.

It’s been for me 20 years living as a woman but constantly unable to work I can’t take it anymore I feel more often I can’t go on anymore.

[…] Medicare Coverage and Gender … – The concern that gender reassignment surgery is not fully covered by Medicare has been in the spotlight over the last month, following a Queensland trans … […]

I am with Emma.. All I want to do is cry too..

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Care of trans, gender-diverse and non-binary children and adolescents

By Dr. Julia K. Moore MBBS (Hons), FRANZCP, Cert Child Adolescent Psychiatry Consultant Child and Adolescent Psychiatrist, CAHS Gender Diversity Service

The HealthPathways WA Transgender Health and Gender Diversity HealthPathway is now LIVE.

Transgender health care across the life span is a core area of clinical skills for all health professionals.  Trans and gender diverse people have always been around, evident in culture, language and history from around the world, for example Indigenous Brotherboys and Sistergirls, Maori whakawāhine and tangata ira tāne, Samoan fa’afafine and fa’atane, and Indian Hijra people. Medical understanding has progressed from past stigmatizing perceptions of gender diverse people as “disordered” or “confused”, to now recognising the spectrum of gender as a normal part of human diversity. Transgender health care is not new, hormonal and surgical treatments were offered to adults in Berlin in 1918, and the treatment of gender-dysphoric adolescents with puberty suppression and hormone treatments commenced in the Netherlands around 1991. People may first express gender dysphoria or transgender identity at any life stage.  The US Transgender Survey (2015) of 27,715 adults found that 15 per cent first told someone that they were transgender under age 15, and 37 per cent between age 16 and 20 – even before social media and increased awareness of gender diversity, “coming out” in adolescence was frequent. Identifying as non-binary is increasingly frequent. It is important to understand that some people are trans, and this is OK. “Conversion therapy”, or efforts to deliberately change gender identity or sexual orientation, is ineffective, harmful, and unethical. Some trans and gender diverse people request medical or surgical gender-affirming treatment and experience it as medically essential; some do not want treatment. Treatment decisions are led by the person’s expressed wishes and needs.

It is normal and healthy for children to have interests, activities and friendships that do not conform to cultural ideas of “masculine” and “feminine”. This doesn’t need assessment or diagnosis. Some children are distressed by their sex registered at birth, and make strong statements, wishing to live as their identified gender, at home and school. Observational evidence and clinical experience indicate that this child-led social transition is associated with positive psychosocial outcomes. This is a family decision, which should be led by the child’s expressed wishes, not imposed by adults.  No medical or surgical treatment is offered for gender dysphoria before puberty commences. Prepubertal children only need love, support, and listening.  Some become comfortable with their birth-registered sex and gender during late childhood to early puberty, so it is important that children who socially transition are supported to “change back” at any time they wish. In childhood and adolescence, it is important to facilitate access to mental health care for common problems including social anxiety, depression and suicidality, autism and ADHD if present, alongside gender-affirming care.

Puberty suppression with gonadotropin releasing hormone agonists can be indicated when gender dysphoria continues through to adolescence, with distress at the body changes of early puberty.  Puberty suppression is ideally commenced at Tanner stage 2 – 3, early enough to provide long-term benefit by preventing breast development or voice deepening and facial masculinisation.

Some young people first experience gender dysphoria peripubertally; this is common, and puberty suppression may still be offered to provide relief of distress and allow time for clarification of identity and wishes. A person can decide to stop puberty suppression at any time, and its effects are largely reversible. Most people who start puberty suppression remain stable in their gender identity, and go on to testosterone or oestrogen gender-affirming treatment in later adolescence or young adulthood

Oestrogen/anti-androgen and testosterone treatment can be provided to more mature adolescents with long-term stable gender identity, who have developed the capacity to give informed consent to these treatments, including appreciation of the risk of regret. This requires repeated consultations, and specific counselling regarding fertility.  Many do not have preceding puberty suppression. Masculinising chest reconstruction is sometimes done under age 18 but is not provided in the public health system in WA. Genital surgery is not done under age 18 in Australia. Many trans people do not want genital surgery, but for some it is extremely important.

The treating medical practitioner must obtain the active informed consent of all legal guardians before providing gender-affirming puberty suppression, oestrogen, testosterone, or surgical treatment for a person under age 18, regardless of whether the young person is Gillick competent, according to the Family Court of Australia judgement Re: Imogen [2020]. The risks of any treatment need to be weighed against the risks of having no treatment.  Withholding treatment against a young person’s wishes is not a neutral option.

The CAHS Gender Diversity Service (GDS), based at Perth Children’s Hospital, is a multidisciplinary team that provides information, support, links to other services, assessment, and (where wished-for and appropriate) gender-affirming medical treatment with puberty suppression, oestrogen and testosterone in liaison with the adolescent’s general practitioner. Unfortunately, GDS referrals far exceed capacity, and many older adolescents can’t be seen before they “age out” of the paediatric service wait list.

There is a pressing need to develop capacity in WA for gender-affirming care of adolescents and young adults outside of the single hospital specialist setting. Models exist in other states for treatment in primary care with collaboration between GPs and psychologists, with other specialist consultation as appropriate. GPs can help to support open communication and improve understanding between parents and young people. Providing accurate information often helps relieve family anxieties. Peer support from other parents, through TransFolk of WA or Transcend Australia, is very helpful.

Supporting trans, gender diverse and non-binary people to access appropriate and inclusive healthcare

Related articles, heavy menstrual bleeding – new clinical care standard for australia, health data linkage pilot to better understand the needs of gps and their chronic heart failure patients’, healthpathways wa now clinician assist wa – register today.

Personal message from Mr Ives

Ceasing of genital reconstructive surgery - vaginoplasty & labiaplasty.

After much deliberation and thought I have made the hard decision to stop performing all Vaginoplasty & Labiaplasty surgeries at the end of 2022.

This will be a shock and disappoint to some, however it is not a decision I have made lightly and is a personal decision.

Moving forward, I will be continuing with Top surgeries and Orchidectomies.

My staff are endeavouring to contact all patients who this decision may impact. In the event that you have not heard from my staff by now, please contact the Rooms should you wish to discuss your circumstances.

Please be respectful in those conversations with my staff, and remember they are there to help you. However, any inappropriate or aggressive behaviour will not be tolerated.

Mr Andrew Ives

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Important Update

Mr Ives has recommenced performing Genital Reconstructive Surgery - Vaginoplasty & Labiaplasty (no vaginal cavity) operations. If this procedure is of interest to you, or you have any enquiries, please contact the Rooms.

Andrew Ives M.B. Ch.B(UK), FRACS(Plast.Recon.Surg.)

One of australia's foremost experts in transgender surgery, andrew ives., m.b. ch.b(uk), fracs(plast.recon.surg.), one of australia’s foremost experts in transgender surgery, transgender surgery, we offer high-quality, comprehensive and compassionate care for those seeking the different gender surgical procedures and treatments we have available..

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Find out more about the Trans Feminine procedures  Mr Ives performs.

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Mr Ives is one of the country’s leading Transgender Surgery experts. He performs a range of gender based surgeries and treatments at his practice.

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

Meet mr ives.

As one of the country’s top gender related surgeons, Mr Andrew Ives, a Fellow of the Royal Australasian College of Surgeons (FRACS), believes in providing the best professional care to his patients. With a thriving practice in Melbourne, Mr Ives has been a contributing member of the Australian Professional Association for Trans Health (AusPATH) since 2010.

Mr Ives performs a range of procedures to help a patient with the surgical alternatives available to them on their journey.

If you wish to learn more about the procedures offered by Andrew Ives,  please fill out the contact form here and a member of our team will respond to your query.

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The Gender Reassignment Controversy

When people opt for surgery, are they satisfied with the outcome.

Posted March 16, 2018 | Reviewed by Ekua Hagan

In an age of increasing gender fluidity, it is surprising that so many find it difficult to accept the gender of their birth and take the drastic step of changing it through surgery. What are their motives? Are they satisfied with the outcome?

Gender may be the most important dimension of human variation, whether that is either desirable, or inevitable. In every society, male and female children are raised differently and acquire different expectations, and aspirations, for their work lives, emotional experiences, and leisure pursuits.

These differences may be shaped by how children are raised but gender reassignment, even early in life, is difficult, and problematic. Reassignment in adulthood is even more difficult.

Such efforts are of interest not just for medical reasons but also for the light they shed on gender differences.

The first effort at reassignment, by John Money, involved David Reimer whose penis was accidentally damaged at eight months due to a botched circumcision.

The Money Perspective

Money believed that while children are mostly born with unambiguous genitalia, their gender identity is neutral. He felt that which gender a child identifies with is determined primarily by how parents treat it and that parental views are shaped by the appearance of the genitals.

Accordingly, Money advised the parents to have the child surgically altered to resemble a female and raise it as “Brenda.” For many years, Money claimed that the reassignment had been a complete success. Such was his influence as a well-known Johns Hopkins gender researcher that his views came to be widely accepted by scholars and the general public.

Unfortunately for Brenda, the outcome was far from happy. When he was 14, Reimer began the process of reassignment to being a male. As an adult, he married a woman but depression and drug abuse ensued, culminating in suicide at the age of 38 (1).

Money's ideas about gender identity were forcefully challenged by Paul McHugh (2), a leading psychiatrist at the same institution as Money. The brunt of this challenge came from an analysis of gender reassignment cases in terms of both motivation and outcomes.

Adult Reassignment Surgery Motivation

Why do people (predominantly men) seek surgical reassignment (as a woman)? In a controversial take, McHugh argued that there are two main motives.

In one category fall homosexual men who are morally uncomfortable about their orientation and see reassignment as a way of solving the problem. If they are actually women, sexual interactions with men get redefined as heterosexual.

McHugh argued that many of the others seeking reassignment are cross-dressers. These are heterosexual men who derive sexual pleasure from wearing women's clothing. According to McHugh, surgery is the logical extreme of identifying with a female identity through cross-dressing.

If his thesis is correct, McHugh denies that reassignment surgery is ever either medically necessary or ethically defensible. He feels that the surgeon is merely cooperating with delusional thinking. It is analogous to providing liposuction treatment for an anorexic who is extremely slender but believes themselves to be overweight.

To bolster his case, McHugh looked at the clinical outcomes for gender reassignment surgeries.

Adult Reassignment Results

Anecdotally, the first hurdle for reassignment is how the result is perceived by others. This problem is familiar to anyone who looked at Dustin Hoffman's depiction of a woman ( Tootsie ). Diligent as the actor was in his preparation, his character looked masculine.

For male-to-female transsexuals, the toughest audience to convince is women. As McHugh reported, one of his female colleagues said: “Gals know gals, and that's a guy.”

According to McHugh, although transsexuals did not regret their surgery, there were little or no psychological benefits:

“They had much the same problems with relationships, work, and emotions, as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled (2)”.

Thanks to McHugh's influence, gender reassignment surgeries were halted at Johns Hopkins. The surgeries were resumed, however, and are now carried out in many hospitals here and around the world.

What changed? One likely influence was the rise of the gay rights movement that now includes transgender people under its umbrella and has made many political strides in work and family.

McHugh's views are associated with the religious right-wing that has lost ground in this area.

Transgender surgery is now covered by medical insurance reflecting more positive views of the psychological benefits.

Aspirational Surgery

Why do people who are born as males want to be women? Why do females want to be men? There seems to be no easy biological explanation for the transgender phenomenon (2).

Transgender people commonly report a lifelong sense that they feel different from their biological category and express satisfaction after surgery (now called gender affirmation) that permits them to be who they really are.

The motivation for surgical change is thus aspirational rather than medical, as is true of most cosmetic surgery also. Following surgery, patients report lower gender dysphoria and improved sexual relationships (3).

All surgeries have potential costs, however. According to a Swedish study of 324 patients (3, 41 percent of whom were born female) surgery was associated with “considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

1 Blumberg, M. S. (2005). Basic instinct: The genesis of behavior. New York: Thunder's Mouth Press.

2 McHugh, P. R. (1995). Witches, multiple personalities, and other psychiatric artifacts. Nature Medicine, 1, 110-114.

3 Dhejne, S., Lichtenstein, P., Boman, M., et al. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study of Sweden . Plos One.

Nigel Barber, Ph.D., is an evolutionary psychologist as well as the author of Why Parents Matter and The Science of Romance , among other books.

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China Man Awaiting Sex Change Surgery Sues Hospital, Says He Was Given Electric Shocks

In china, having a sex change procedure is viewed as disrespectful to parents..

iulongshan Hospital said during the hearing that they had "done nothing wrong."

A man in China who was waiting for sex reassignment surgery has filed an 80,000 yuan (Rs 9.4 lakh approximately) lawsuit against a hospital, claiming he was coerced into receiving electroshock treatment, as per a report in South China Morning Post. The 27-year-old is a live-streamer from the northern Chinese province of Hebei and posts videos of himself donning women's clothes and makeup. The man said that he received electric shocks for several days while being forced into a hospital for 97 days.

Despite being born a male, he informed Hongxing News that he identifies as a woman. The social media star started taking oestrogen, one of the main female sex hormones. As a result, he developed long hair, lost facial hair, and softened his voice. He claims that he has been putting aside the money he earned from live-streaming in the hopes of undergoing surgery to change his gender.

However, Linger's parents disapproved of his choice. Since the Chinese traditionally believe that a person's body is a gift from their parents and that a person's gender should not be changed, they were unable to accept their son's gender transition, which caused several disputes within the family. Notably, in China, having a sex change procedure is viewed as disrespectful to parents.

Linger told Hongxing News that he agreed to visit a hospital in 2022 to avoid any other conflicts. Although he was aware that the facility was for psychiatric patients, he did not believe he was mentally ill. A doctor there diagnosed him with "anxiety disorder" and "ego-dystonic sexual orientation," a mental illness characterising a conflict between a person's intended and real sexual orientation. Soon after, the medical personnel took away his phone and forced him to stay in the hospital for 97 days. "After being admitted to the hospital, I was tied to the bed with ropes, and many doctors controlled my body and administered electroshock therapy for days," Linger said.

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He sued the hospital for violating his human rights, requesting 80,000 yuan in damages. However, on August 13, Jiulongshan Hospital said during the hearing that they had "done nothing wrong" and the shocks were given to control the emotions to enhance the self-awareness of psychiatric patients.

According to the hospital, Linger's mother signed a consent form. The legal case is still being heard in court.

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Plastic Surgery Expert Expounds on Insufficient Evidence to Justify Trans Surgeries for Minors

At least seven ASPS members are being sued by detransitioners, according to Manhattan Institute fellow and pediatric gender medicine expert Leor Sapir.

The president of the Plastic Surgery Foundation, the research arm of the American Society of Plastic Surgeons (ASPS) told “EWTN News Nightly” that as of now, the research on chest and genital surgery for adolescents with gender dysphoria “simply isn't strong enough to support any definitive recommendations” for such surgeries.

The ASPS recently made headlines for breaking with a perceived medical consensus, as many leading U.S. medical organizations continue to support both hormonal treatments and surgeries for minors with gender dysphoria.  

“As members of the multidisciplinary care team, plastic surgeons prioritize evidence-based medicine,” Dr. Scott Bradley Glasburg , president of the Plastic Surgery Foundation, told EWTN News Nightly anchor Catherine Hadro on Tuesday. 

“We have a responsibility to provide comprehensive education and maintain a robust and evidence-based informed consent process,” he continued. “Currently, the research on chest and genital surgeries for adolescents with gender dysphoria simply isn't strong enough to support any definitive recommendations from our society,” he stated.

When asked if the professional association experienced any political pressure to arrive at a particular decision, Glasburg responded that “plastic surgery is a specialty guided by evidence, and we're not influenced by external sources or by politics.” 

“We believe that more high-quality research in this rapidly evolving area of health care is what's needed, and our priority remains focused on patient safety and informed decision-making,” he added.

At least seven ASPS members are being sued by detransitioners, according to Manhattan Institute fellow and pediatric gender medicine expert Leor Sapir, who first published the statement from ASPS on the lack of evidence for justifying “transgender” surgeries.

For instance Kayla Lovdahl, 18, sued an ASPS doctor and two other physicians last year for allegedly pressuring her into sex-change surgeries when she was a child. ASPS member Winnie Tong and two other doctors performed a double mastectomy on Lovdahl when she was 13 years old and gave her puberty blockers when she was 12, according to her legal complaint .

Lovdahl “detransitioned” shortly after, at age 17, and received psychotherapy treatment for her mental health symptoms. 

When asked about the ASPS’s recent statement on the quality of referenced evidence, Glasburg further explained: “We believe that the level of evidence in these studies are of low quality. What that means is every study has strengths and limitations that can tell us something interesting. But it's important to take a step back and look at the effects that we see and analyze the larger body of evidence that accumulates over time.”

Uncertainty Over Long-Term Efficacy

“When we say there‘s uncertainty as to long-term efficacy for the use of certain surgical interventions for the treatment of adolescents with gender dysphoria, we mean that there’s uncertainty at many different levels,” Glasburg continued. “We're unclear, really, what the outcomes [and] data show, what the long-term effects of these treatments might be or could be.”

“We feel a responsibility to remain committed to that evidence-based approach and seeing out the research necessary for the society to make any firm recommendations or come up with any guidance or guidelines” he said. 

Glasburg explained that ASPS will be following the evidence closely in the future, focusing on “patient safety” and “the clinical evidence available.”

“It‘s all about the evidence for us,” he said. “Again, we’re separate from politics. We're separate from outside forces.”

“We are committed to being a scientific organization of surgeons who want to do right by our patients and want to provide the education necessary to our members to make the right choices that are in the best interests of our patients and that of patient safety,” Glasburg noted.

Catholic Bioethical Take

In a separate interview with EWTN News, Catholic bioethicist Dr. Joseph Meaney, president of the National Catholic Bioethics Center, also weighed in on the issue. 

“Particularly with young people, that these irreversible changes should not be done to young persons who don't really understand the lifelong consequences,” Meaney explained. “I think American medical societies are more and more going to realize this.” 

“I think also that they are going to be aware of the legal liability that doing this to children could come back in the form of lawsuits later on saying, ‘Wait a second, I did not have proper informed consent as to how life-transforming this would be, and I regret that decision,’” he noted.

The American College of Pediatricians in June called on all medical institutions to stop gender transition medication and surgeries for minors, urging organizations to treat mental health instead.

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Missouri quietly made it much harder to change gender marker on driver’s licenses

The Missouri Department of Revenue used to allow the signature of a physician, therapist or social worker before approving the change of a gender designation. Now, it requires residents to provide either documentation of gender reassignment surgery, or a court order.

It became much harder this month for Missourians to change the gender marker on their driver’s licenses following a quiet change by the state Department of Revenue.

The department, which issues state driver’s licenses, switched from requiring the signature of a physician, therapist or social worker to approve a change in gender designation to mandating documentation of gender reassignment surgery or a court order.

The shift happened earlier this month, though it was not announced publicly by the department. The Wayback Machine , which archives web pages, shows the gender designation change request form requiring physician signoff, known as Form 5532, was available Aug. 6. The next day, the web page with the form was offline.

A spokesperson for the Department of Revenue told The Independent in a statement that “Form 5532 is no longer needed.”

“Customers are required to provide either medical documentation that they have undergone gender reassignment surgery or a court order declaring gender designation to obtain a driver license or non-driver ID card denoting gender other than their biological gender assigned at birth.”

According to the Movement Advanced Project , which maps states’ policies affecting LGBTQ residents, Missouri is one of 10 states with this policy. Just three states do not allow residents to change their gender markers.

PROMO, Missouri’s largest LGBTQ advocacy organization, reached out to the department after hearing that people could no longer make changes to their identification using Form 5532 and heard that “an incident” spurred the move, said executive director Katy Erker-Lynch.

The policy change took place soon after controversy erupted earlier this month over a transgender woman who used the women’s locker rooms at a private gym in Ellisville.

Elected officials held a press conference outside the gym Aug. 2, and Missouri Attorney General Andrew Bailey announced an investigation into the incident the same day.

State Rep. Justin Sparks, a Republican from Wildwood, spoke to reporters at the press conference about the Department of Revenue’s policy. He said on a radio appearance that the transgender woman “displayed a state ID describing (herself) as female.”

“We are going to get to the bottom of what happened in the Department of Revenue and that form they issued several years ago,” he said. “It was inappropriate and in my opinion, it is not legal.”

Later that evening, in a live broadcast via Facebook, he told followers that he had been in contact with the department.

“I have assurances from the Department of Revenue that they are going to change their policies and their form,” he said, promising to follow up with the department.

The form had been in place since 2016.

“It seems the mere mention and threat of a potential investigation into the policies and practices of the Department of Revenue caused Director (Wayne) Wallingford to end a policy that worked to help people,” Erker-Lynch said. “This decision reflects a state and state departments run by fear and intimidation — not a state run to serve its residents.”

PROMO is gathering stories of those who are struggling to change their gender marker on their state identification, calling the campaign “The ID for Me .”

Sparks did not respond to a request for comment.

This story was originally published by the Missouri Independent.

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Plastic surgery expert expounds on insufficient evidence to justify trans surgeries for minors

By Kate Quiñones

CNA Staff, Aug 21, 2024 / 12:30 pm

The president of the Plastic Surgery Foundation, the research arm of the American Society of Plastic Surgeons (ASPS) told “EWTN News Nightly” that as of now, the research on chest and genital surgery for adolescents with gender dysphoria “simply isn't strong enough to support any definitive recommendations” for such surgeries.

The ASPS recently made headlines for breaking with a perceived medical consensus, as many leading U.S. medical organizations continue to support both hormonal treatments and surgeries for minors with gender dysphoria.  

“As members of the multidisciplinary care team, plastic surgeons prioritize evidence-based medicine,” Dr. Scott Bradley Glasburg , president of the Plastic Surgery Foundation, told “EWTN News Nightly” anchor Catherine Hadro on Tuesday. 

“We have a responsibility to provide comprehensive education and maintain a robust and evidence-based informed consent process,” he continued. “Currently, the research on chest and genital surgeries for adolescents with gender dysphoria simply isn't strong enough to support any definitive recommendations from our society,” he stated.

When asked if the professional association experienced any political pressure to arrive at a particular decision, Glasburg responded that “plastic surgery is a specialty guided by evidence, and we're not influenced by external sources or by politics.” 

“We believe that more high-quality research in this rapidly evolving area of health care is what's needed, and our priority remains focused on patient safety and informed decision-making,” he added.

At least seven ASPS members are being sued by detransitioners, according to Manhattan Institute fellow and pediatric gender medicine expert Leor Sapir, who first published the statement from ASPS on the lack of evidence for justifying “transgender” surgeries.

For instance Kayla Lovdahl, 18, sued an ASPS doctor and two other physicians last year for allegedly pressuring her into sex-change surgeries when she was a child. ASPS member Winnie Tong and two other doctors performed a double mastectomy on Lovdahl when she was 13 years old and gave her puberty blockers when she was 12, according to her legal complaint .

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Lovdahl “detransitioned” shortly after, at age 17, and received psychotherapy treatment for her mental health symptoms. 

When asked about the ASPS’s recent statement on the quality of referenced evidence, Glasburg further explained: “We believe that the level of evidence in these studies are of low quality. What that means is every study has strengths and limitations that can tell us something interesting. But it's important to take a step back and look at the effects that we see and analyze the larger body of evidence that accumulates over time.”

Uncertainty over long-term efficacy

“When we say there's uncertainty as to long-term efficacy for the use of certain surgical interventions for the treatment of adolescents with gender dysphoria, we mean that there's uncertainty at many different levels,” Glasburg continued. “We're unclear, really, what the outcomes [and] data show, what the long-term effects of these treatments might be or could be.”

“We feel a responsibility to remain committed to that evidence-based approach and seeing out the research necessary for the society to make any firm recommendations or come up with any guidance or guidelines” he said. 

Glasburg explained that ASPS will be following the evidence closely in the future, focusing on “patient safety” and “the clinical evidence available.”

“It's all about the evidence for us,” he said. “Again, we're separate from politics. We're separate from outside forces.”

(Story continues below)

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“We are committed to being a scientific organization of surgeons who want to do right by our patients and want to provide the education necessary to our members to make the right choices that are in the best interests of our patients and that of patient safety,” Glasburg noted.

Catholic bioethical take

In a separate interview with EWTN News, Catholic bioethicist Dr. Joseph Meaney, president of the National Catholic Bioethics Center, also weighed in on the issue. 

“Particularly with young people, that these irreversible changes should not be done to young persons who don't really understand the lifelong consequences,” Meaney explained. “I think American medical societies are more and more going to realize this.” 

“I think also that they are going to be aware of the legal liability that doing this to children could come back in the form of lawsuits later on saying, ‘Wait a second, I did not have proper informed consent as to how life-transforming this would be, and I regret that decision,’” he noted.

The American College of Pediatricians in June called on all medical institutions to stop gender transition medication and surgeries for minors, urging organizations to treat mental health instead.

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• Gender dysphoria ,
• Transgenderism

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