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Transmission on 4zzz Amplifying the trans and gender diverse community of Meanjin, Brisbane and beyond. Good morning, Meanjin. How you doing out there? You're listening to Transmission, which is all about amplifying the voices of the trans and gender diverse community, which means we are the first broadcast in the country to be doing so and have been doing so every week for four years. And I am EZ founder and creator and one of the announcers on the show and I'm part of an incredible team. So yeah, very, very grateful. And today we've got the Week in Community News, as well as an interview with Associate Professor Nicola Dean, who is one of Australia's most respected reconstructive surgeons and a national leading voice on gender affirming surgeries and healthcare. We'll be chatting with her this episode. We covered quite a lot of ground and it was really, really warm, really nice. So I'm looking forward to hearing what everyone thinks about this chat. But before we do get into that, of course is the Week in Community News. So let's get straight to it this

Week in Community News and events for 29 June. In world news, trans women prisoners in Scotland to be removed from female jails. Last week, Judge Lady Ross ruled that prison guidance allowing some prisoners to be held in jails matching their gender identity rather than their sex of birth was unlawful. She said sex segregation in prisons must be based on biological sex. The Scottish government said it would not appeal and that the policy had already been withdrawn. The decision follows a Supreme Court ruling last year won by 4Women Scotland, which found that the words woman and sex in the 2010 Equality act refer to biological sex and do not include trans women with a gender recognition certificate. The Netherlands has banned conversion therapy, with new laws receiving approval from the Country Senate. The legislation makes attempts to change or suppress a person's sexual orientation or gender identity a criminal offence. The vote saw 57 senators support the legislation, whilst 15 voted against it. The updated legislation now explicitly outlaws counselling based practises. Those found guilty face fines of up to €27,500 or equivalent to 45,000 Australian dollars and prison sentences of up to two years. Professional councillors may also face deregistration and be banned from future practise. In national news The Australian government declines all UN LGBTQIA rights recommendations In a media release, Equity Australia said that it is bitterly disappointed by the federal government's lack of action in response to the recommendations offered in a UN human rights peer review of Australia. More than 120 countries offered over 330 recommendations on improving our human rights protections. Amongst many recommendations, the Universal Periodic Review also urged reform on outdated federal discrimination laws, recommendations a removal of exemptions that allow religious schools to legally discriminate, a national ban on conversion and suppression practises, the federal banning of non medically necessary surgeries on intersex infants and public education campaigns and awareness raising activities. In a media release on Thursday, Equity Australia said the federal government has declined to accept a single one of these recommendations. This is bitterly disappointing for everyone in our community and demonstrates an embarrassing lack of care for us on the world stage, says Savant, international adviser for Equity Australia, who added that the LGBTQIA community was the only marginalised group for which no recommendations were adopted. Victoria's inquiry into anti LGBTQIA hate crimes began hearings June 24, conducted by the Victorian Parliament Legislative Council Legal and Social Issues Committee. The inquiry was established thanks to the Victorian Greens in February of this year. It followed a series of disturbing attacks targeting gay and bisexual men, many of which were recorded and posted to social media, which have been occurring across multiple states and territories since 2024. The inquiry hopes to examine the scale of these crimes and the role of influences like the far right manosphere in fueling the homophobic attacks, many of which have seen victims lured through fake dating app profiles. It also aims to examine whether Victoria's current response and support systems are adequate for victims. Over 80 submissions were made by affected individuals and advocacy groups and can be viewed online, though it's important to note that they should be read with caution as many of the materials describe confronting and distressing incidences of homophobia, transphobia and abuse. The final report will be tabled by 1st September 2026 and for local events Diverse Voices, free peer support and safe space Join us Tuesday 30th of June for a free low stakes, no pressure peer support drop in space for LGBTQIAs B community members Whether you're looking for a friendly chat, support with a life admin, help with a job application or cv, a body doubling space to stay on track, information about Diverse Voices services and volunteering, or simply a safe, inclusive space to relax and be around community, you're welcome here. It's from 12pm to 3pm at the Gabba Ward Office 263 Annerley Road, Woolloongabba. The entrance is also via the car park the Logan Pride March and Picnic Save the Date we're bringing back Logan's Pride March and picnic this July 4th. Meet us at the Red Bridge at 10am wearing your brightest rainbow outfits, ready for photos with Moose and Lady Saskatchewan. Then kicking off this momentous second Pride March will be Magogen's newest ballroom house House of LeSaid Vogue. Along with them as we strut through the park to the picnic grounds on the green. House of lesaid will give us Logan's first exclusive performance followed by a live DJ and band to be announced. Stick around for the stalls, the barbecue and the circus play space. Grab your mates, enjoy the vibes and the coffee and the entertainment. For more information, head to Loud and Proud Logan Pride Festival on Facebook and instagram. Transjustice Meanjin Project 491 fundraiser Join us for another fundraiser for Project 491 Bounce. As trans rights are under attack in Australia, we need to come together to support trans youth in accessing life changing and often life saving gender affirming care. Lets bring our community together to support trans youth and have a good time doing it. Wig snatching, competition and music all night long from local queer and trans DJs. Tickets are available from actionnetwork.org or through ransjusticemiangin on Instagram and Facebook. My name is Hazel and that's all in this week's community news and events.

Yo, thank you so much. Hazy Wow. I always forget to let people know that sometimes the news is heavy and sad and painful. So just look out for yourselves and look after yourselves. Drink water, rest. Don't forget to look up away from your phone because that makes life a whole lot better sometimes. Also there's a lot of events going on, there's so many things happening and so many good fundraisers for Project 491 which is excellent. On that note, I want to announce this epic event.

Get your tit together for a great cause on Thursday the 23rd of July at the Cave Inn Together in Transition Fundraiser. A night of noise and solidarity. There's rapper prizes to be won such as Gender affirming packs, Shelf lovers, books, gay skate, merch and autograph vinyls. We have performances from the Snouts, Emmy Hour, Soft Cards all raising money for Project 491 supporting trans kids to access life saving gender care. Grab your $20 tickets or free concession and BIPOC Tickets from Humanity Transmission is a part of the team at 4zzz.

Oh my gosh Grab your t humanitiks. Come along, win a bunch of things. Come say hi to me and the transmission team. We're all raising money for Ozpath. Project491 and Ozpath have actually sent me a little thing to give you all an update. So I was having a chat to the CEO the other week or the director rather Eloise, for Auspath. And we're going to be giving you some updates every month or every so often on what progress has been going on with them. In case you don't know who Auspath is, OZPATH is Australia's peak body for professionals working in trans and gender affirming health care. They advocate for evidence based care, support clinicians across the country and generally work towards improving access, safety and equity for trans and gender diverse people and their families. And Project 491 is all part of that. Project 491 is particularly helping to support young people who are affected by the ban on gender affirming care through the public system. And an update from Ozpath is Project 491 continues to grow. We're now supporting 48 families with more than 54,000 and direct assistance already provided. If you know someone affected by the Queensland Government's ban and struggling to access gender affirming care, they can be referred to the Project 491 for financial support. A reminder that our provider page is live on the Auspath website for anyone looking for an informed consent. Medical professional community members are always welcome to recommend clinicians who are strong allies and should be part of the OZPATH network. If you're planning an event and want to donate proceeds to Project491 or Ozpath, take a look at the Crowdraiser option or on the donate page. And finally, public inquiries are always welcome. We now have the capacity to respond quickly, so reach out if you need information or support. To do that you can head to auspath a u s p a t h.org au or follow them on social media as welluspathorg. Cheque them out and keep supporting trans kids to access gender affirming care. And speaking of, of trans things as usual, we are now about to jump into an interview that I did about a week or so ago. I don't know how time works, so it could have been sooner than that. With Associate Professor Nicola Dean, who is one of Australia's most respected reconstructive surgeons and a leading national voice on improving access to gender affirming health care. She graduated in medicine from the University of Leeds in 1993 and completed her fellowship of the Royal Colleges of Surgeons in England and later migrated to Australia where she earned a PhD in breast reconstruction at the University of Adelaide. And she, she went on to complete specialist training in plastic and reconstructive surgery in 2007, obtaining her FRAX. Nicola served as the former President of the Australian Society of Plastic surgeons, which is ASPs, where she was a key advocate for strengthening surgical training, improving standards of care and expanding equitable access to reconstructive procedures, including gender affirming surgery. Overall, she. Over well, yeah, overall work places her at the forefront of national conversations about how Australia can better support trans and gender diverse people seeking surgical care, particularly around getting gender affirming surgeries on the mbs. So just some. Yeah, I'm just going to mention some, some terms that you might hear through throughout this interview and get an idea of what they mean. So MBS is medical benefit scheme. You may have heard of the pbs, it's kind of the similar thing. PBS is a pharmaceutical benefit scheme which is a programme by the government that subsidises prescriptions, medication, prescription medications, making them more affordable for citizens and permanent residents. It also provides access to, access to over 900, you know, essential medicines at reduced prices throughout pharmacies across the country. And the medical benefit scheme is a list of medical services that are subsidised, subsidised by the government, detailing types of consultations, procedures, tests, things like that that are covered by Medicare. It helps determine the fees for these services and what patients might need to pay out of pocket. So sometimes when you go to the doctor, if it's, if it's bulk billed, you don't pay anything. But sometimes there's these differences and so that's, you know, that's where the MBS helps as well. And then there's the msac, which is msac, which is the Medical Services Advisory Committee. This is the independent committee appointed by the Federal Health Minister who advises the government on public funding for health services and technology. So you're going to hear a bit about this, those two terms, MSAC Medical Services Advisory Committee, MBS Medical Benefit Scheme and then also we're chatting a bit about Medicare. And so generally this chat is mostly about how the heck can we get gender affirming surgeries under Medicare, how can we get these life saving surgeries at affordable rates and for the government to understand how important they are. So let's jump into my chat with Associate Professor Nicola Dean about all this. You're listening to transmission on 4 triple Z. Hi Nicola, how are you doing? How's your day good?

Thank you. Yeah, good. It's good to be here.

Yeah, I agree. It's a, it's a nice time of year as well. Before we begin, I just wanted to ask, you know, like, so what kind of work are you doing now? What's your week usually look like? What areas are you working in?

Sure. Thank you. So I've got a few hats. My main one is that I'm a plastic surgery consultant, so a specialist plastic surgeon working at Flinders Medical Centre, which is a big public hospital in South Australia, the head of the unit there. And so a lot of my work is either kind of operating on people in the public system, but also kind of managing a team and doing some teaching of junior doctors, supporting various doctors and nurses in their day to day work. And then one of my other hats is that I'm associated with Flinders University and I love doing some research, so trying to understand how we can make health systems better and how we can make patient outcomes better when we do surgery. So they're my sort of two main hats. And I'm also lucky enough to have been very involved in the Australian Society of Plastic Surgeons. I was their president a few years ago and now I'm still working with them on looking at item numbers for Medicare and specifically at the moment, to do with gender Affirming surgery. Item numbers.

Oh, that is so exciting. A few years ago, back in 2023, was when we first met and that was to do with the Australian Society for Plastic Surgeons Gender Affirming Surgery Roundtable, and we were discussing the same thing, we were discussing Medicare. Would you like to give us a bit of an update on how that is where we're at?

Sure, yeah. Look, these processes are very slow and I think that, you know, I'm sure that the trans community find that incredibly frustrating. But I think what's really good about the Australian healthcare system is that at least they do have particular processes for trying to get public funding for certain types of operations and procedures and medicines. So everybody's probably heard of the pbs, which is the way that medicines are subsidised in Australia, but probably less well known is the mbs. So it kind of works in the same way, but there are all these big processes to decide whether certain procedures or operations are included on the Medicare schedule. And, you know, once something is included on the Medicare schedule, it doesn't mean that it's free and it doesn't mean that it's available for everybody all the time. But what it does mean is that if someone takes out Private health insurance, then it means that Medicare has an obligation to provide a rebate for part of the cost of those procedures that are done in private hospitals. And it doesn't have a direct carryover to the public hospitals, which are kind of administered by the states, but they kind of are interlinked and they kind of influence each other a bit. So it is a long process and the people that dispute decide on whether these operations should go onto the Medicare benefit schedule is called the Medical Services Advisory Committee. And they're a group of kind of eminent doctors and public health people and also just lay people, and they go through this very rigorous decision making process. So we started off the application for gender affirming surgery item numbers to be included specifically in Medicare. I reckon in 2023 we submitted the application and it's still not yet finalised. But I think what I find encouraging is that Medicare and the Department of Health have really, actually bent over backwards to fully assess all of the evidence. And they've also organised some ways of getting feedback from the trans community and special stakeholder meetings so that they truly do want to hear the voices of not only doctors, but of trans people and people that are potentially going to be the patients involved, which is really good. So that's a very long answer. We don't have a definite answer yet, but we do know that there's some further kind of homework that the MSAC have been doing, wanting to look at the kind of natural history of gender incongruence, that's what their term is, and also models of care. And those reports, I think, will be released, at least the summaries of those reports will be released to the public in the next couple of weeks. So I think there are some, some definite things that are still happening in that zone and means that there's still really good levels of possibility that that will happen.

Wow. And so does this mean that if this all goes through, what does that model of care look like? How does it shift from what we have now to post all these? Hopefully being successful?

Yeah, yeah. Thank you. So I think what's important to understand is that some operations are currently covered if you have private health insurance, but it's not very clear that they're for trans people or for gender affirming surgery. So a good example is mastectomy. So mastectomy just basically means surgical removal of the breast and that's an operation that already has. Has a Medicare item number, but it's a bit fuzzy about whether that's for anybody and everybody or whether it's really designed for CIS women with breast cancer or that kind of thing. And so it is important to note that there are some item numbers that are there that can be used at the moment. But the real shift is that this application is really pushing to say that trans people and gender affirming surgery, that's all important and it's valid and it's not something that should be just slipped through as something else. So I think the question about the model of care is really interesting. So a model of care means how you go from A to B to C, and that's one of the things that the Department of Health has been looking at in more depth recently. And I'm really encouraged that they've been listening to the frustrations of people about the idea of gatekeeping and that people face a lot of time barriers, like a lot of delays, and also a lot of frustrations with having to seek lots of assessments from people that might not be very trans friendly. And I think that the new model of care isn't yet determined, but I really get the feeling that they are interested in not just rubber stamping the operations, but also trying to make a whole system of care in Australia more truly affirming, rather than a kind of difficult or humiliating or challenging thing to go through. And they certainly have mentioned things like the importance of peer support and lived experience and, you know, nurse practitioners and all sorts of people that are involved now. There's limits to what Medicare can provide and their kind of terms of reference are to have item numbers for professional services. So their job is not to develop hospitals or infrastructure or stuff like that, but they can still sometimes have some influence on those things. So I know that what they have done is looked at various models of care around the world because obviously there's gender affirming care in lots of different places in the world and they've been looking at that very closely. So I cannot answer exactly how it's going to look in the future, but I think that the vibe is good so far.

I mean, we're moving in the right direction, which is wonderful. And taking a lot of consultation with community really helps. I know that back in 2023, when we had that roundtable, it was wonderful to have so many surgeons, not just like nationally, but internationally, and other, you know, trans advocates in the space as well, all from all over the country as well. And we were discussing a myriad of things. It was a very big day at that roundtable and there was a few notable moments from that day, you know, things that I Hadn't thought about. As someone who's received gender affirming surgeries, I've had, you know, a double mastectomy and I've also had radical hysterectomy. So, you know, I've, I've had almost all the surgeries you can have short of phalloplasty. And my experiences with that have been, I've been very lucky, I've been very fortunate, I've had very positive experiences. And that also, you know, I have that privilege because doing the show means I get to meet wonderful surgeons like yourself and get great direction. However, you know, that's not always the case for, for a lot of people. And in particular you mentioned medical gatekeeping. And gatekeeping is not just something that affects the surgical pathways, it affects a myriad of pathways for trans people trying to access medical care. One of them is, which is always really tricky, is the psychiatric letter that you have to have and you know, it has to fall within a certain amount of weeks close to your surgery. And there was a situation where, you know, some surgeons won't see a patient without a psychiatrist letter and some psychiatrists won't even write a letter without that surgical booking being made. And it's a kind of Kafka esque loop where you're sort of stuck in this cycle of, well, I can't book the appointment in without the letter, but they won't give me the letter without the appointment being booked. So what do you think about the system?

Yeah, yeah, sure. I have to make it clear as well that currently I do not do general firming surgery and the reason that I don't is that I am a full time in a public hospital in SA Health and that currently SA Health don't allow gender affirming surgeries in the public hospitals. So I do want to be clear about that. It's something that I'm hoping that we'll be able to. I'll be able to be doing soon.

Wow, that's so frustrating for people, I'm sure.

But you know, I'm kind of working in this space because I recognise how important it is in terms of the psychiatric letter thing. I think the context to me, and what I've been arguing in our submissions to the Medical Services Advisory Committee is that that letter has come essentially from a very American model. It's in the usa. The health insurance companies are very, very powerful and it's almost the health insurance company that is the one that pushes for that psychiatric letter because otherwise the insurers won't pay for the procedures to be done with the surgeon. So I visited the US and saw some surgeons there. And in fact, it's not necessarily the surgeons there that are pushing for these letters anymore is this private health insurance system. So that very American mindset has been what has determined the kind of guidelines, I think, in wpath, which is the world's professional association of trans health. And I think that in Australia, because there's so few surgeons doing these procedures at the moment, a lot of them feel that really, just for their own safety, so that they're not sort of super criticised or anything, that they have to follow that model. So it's not necessarily that the surgeons are thinking that you have a psychiatric illness if you're a trans person, but it's just they feel that because Australia doesn't have its own standards, in the same way that they feel for their professionalism, that they have to follow that.

Sort of like covering your ass a bit.

Yeah, so. And I think that really, that that roundtable was really good because it brought together surgeons and trans people and psychiatrists and sexual health physicians and everybody. And I think it allowed everybody to see each other's perspectives a little bit. And hopefully it allows some of the trans people to see. Oh, yeah, okay. So maybe these surgeons are a little bit worried about what their peers might think of them or what their hospitals might think of them. And. And it's a way of them still being able to work in this area. And so, you know, hopefully that gives a little bit of understanding. I think, however, what's really good is that the evidence in the medical literature, like in the journals and stuff, is now getting clearer and clearer and clearer and clearer that being trans is not a mental disorder. And, like, it feels so wrong to even say that to you, but, you know, but it used to be classified as a mental disorder and I know that it's not, and you know that it's not, but on paper that was what it used to be classified as. And I think that there is now super strong evidence to say that it's not a mental disorder. And in the international classification of diseases, it's now been taken out of the mental disorders bit and put in sexual health. And I think that that's fantastic because really, it's totally illogical to say that the first thing you have to do is see a psychiatrist if the problem that you have is not a psychiatric problem. I think psychiatry can do a lot of good things. And I think that because. And this is my understanding from what I've learned in the last Five years. And you can correct me if I'm wrong, but minority stress and being discriminated against and being ostracised and being bullied has a toll on people's mental health, for sure. And I think that we know there's very high rates of depression and stuff like that, and so sometimes psychiatrists can be really helpful. And I think that what we should be doing is treating gender affirming surgery like any other kind of surgery. So, for example, I see women who've had breast cancer, who've had mastectomies when they definitely don't want mastectomies, and they have a reasonably high rate of depression and they have some trouble with their body image. And quite often if I see them in a consultation and they're really having difficulty looking at their bodies, or they've got a lot of trouble going out because they feel so depressed, then I will sometimes ask them to go and talk to one of my psychiatry colleagues. But that, that's a very different way of doing it because really that's about psychiatry supporting their journey through surgery rather than being a gatekeeper.

I would imagine that seeing a psychiatrist in that position, having lost a part of you that you identify with heavily, especially around gender, that that psychiatrist appointment for that cisgendered woman who's lost her breast is a way for her to be taken care of while she then goes through gender affirming surgery, essentially.

Exactly. Yeah, exactly. And so I think psychiatry definitely has a really good role, but I think it's, it's for those people that it will help. It shouldn't be a barrier and it shouldn't be the first thing that people come up against.

Would you say that from a surgical perspective that having the more psychological support for that patient means better outcomes for their surgery?

Yeah, definitely. And I mean, what I often do is say to people, look, I can see you're really distressed about this at the moment. And sometimes we do surgery and you think it's going to solve all of your distress straight away. But often we need to kind of work on the body and the mind in parallel. And so if, if you do that, it tends to mean you can get a better outcome. So I think that's, that's a good way to look at it.

Yeah. Great. And, you know, there is this growing demand of gender affirming surgeries in Australia. Are we training enough surgeons to meet this demand? Are they in the pipeline? Are there some trans and gender diverse surgeons in the pipeline? Where is this at?

Yeah, that's, that's Great. So I'm excited to tell you that the national curriculum for Plastic and Reconstructive Surgery trainees now has a whole section on gender affirming surgery, which I can't share with you or tell you in detail, but it's there. And it means that every single Australian trainee coming through the pipeline will learn about gender affirming surgery and it'll be on their exams and they'll have to know about it.

Oh, that's so good.

Yeah, it is so good. And look, I think there will be still quite a lag before there's a lot more surgeons that do that stuff. But a lot of surgeons go away overseas and learn for a year with another surgeon. And I think that there will be more and more plastic surgeons that do that so that they can acquire the skills and they can also go and learn off local surgeons.

That's going to be so good. A few years ago I, I spoke to Dr. Elise Sailor, who's based here in Fortitude Valley, Brisbane's local top surgeon. Top, top surgery surgeon, I like to say. And you know, she loves working with, with trans patients. She said she sort of stumbled into intergender affirming surgeries really, and then just has loved the, the sculpting element of this kind of work. But more than that, she's also, I think, really loved the, the client base. The base. What's your experience with gender affirming surgeons? What's the sort of general theme that they have with working with trans people?

Yeah, look, I think overall, the surgeons that work with trans people, they often love it and they find it incredibly rewarding. It really helps to achieve goals for people that have been usually waiting a long time and have a lot of personal investment in having this surgery. So I think that they really do enjoy working with trans people. I think in some ways, another good thing about that gender Affirming Surgery roundtable that we ran was that there are some surgeons who are a little bit in the closet about doing gender affirming surgery. So there are some that do top surgery, but they kind of don't really tell anybody they do it. And I'm really pleased that kind of in the surgical community, I think there's been a change gradually in how it's seen that it used to be something that was a bit taboo to talk about or you didn't really tell your colleagues you did it. And I think that that's changed and I really love that. I think that it's something that those surgeons didn't know each other were Doing it as well. You know, I think that it's bringing together the surgical community as well as the trans community.

It's fascinating because when we were there, the quote that I got from the notes was, under the radar was a common phrase, you know, that trans people are made to feel that they are not legitimate and recipients of surgical health care. And part of that was that surgeons felt that they had to operate under the radar. And I think that was true for trans people receiving this health care. It was sort of like, hey, we'd ask each other in the community, hey, do you know a surgeon that could do, you know, facial feminising surgery or this. Or this or this? And. And it's like, yeah, I know a guy who's in Melbourne. You gotta do this.

Yeah.

You know?

Yeah.

And it was all word of mouth.

Yeah. And I think, you know, what I hope is that this last sort of two, three years is a sort of gradual coming out of the closet process for the surgeons and for the whole field, you know, that this is not something we should be hiding that we can do and we're capable of. And I think it's great also that we can link up with surgeons of different disciplines. So, you know, urologists do quite a lot of the genital surgery as well as plastic surgeons. And, you know, the more that we can work together and communicate openly, then the better results will get. The problem with things being under the radar is that it does make people feel kind of weird about, you know, is it legitimate that I'm having this? And the surgeons feel, is it legitimate that I'm doing this? And I think it's better to kind of put a bit of light on it and say, hang on, it is, you know, but the other problem about it being really under the radar is that it means that there are no outcome studies and there are no statistics. And so one of the other hats that I mentioned to you was that I am passionate about high quality patient reported outcomes research. And that's really important because what we need to know is how do people go through the surgery in Australia, not just in other countries. And up to now, we've had really not very much information on how surgical care has affected people's lives. So the other kind of element of that kind of coming out into the open is that it means that we can do some research together with trans people to look at their outcomes from surgery. So I'm really excited about that. I've got a wonderful team of people around me that have made a research group and we've got several trans researchers on our group and they've helped guide us on what things we should be studying. And I've got a fantastic PhD person called Hester Lyce. So she's a, a surgical doctor who wants to be a plastic surgeon, and she's doing her PhD on outcomes of gender affirming surgery. So that is really exciting as well, because if we can show to Medicare and the Department of Health that actually we can measure how much this kind of surgery changes people's lives, then that's

incredibly powerful with the outcomes of, you know, for surgery. And also, you know, there's a lot of misinformation and disinformation, particularly in the sort of mainstream, about what, you know, trans people getting these irreversible surgeries and all this regret and that, you know, fueled by hatred and. Yeah, misinformation and a lack of understanding about transness. Are there surgeries being performed on children? Are there? Like, what's, what is. How do you answer some of these questions where people are sort of like they're mutilated bodies and so on?

Yeah.

What's your thoughts on, on this?

Yeah, I think again, you have to understand everybody's perspectives. And I think that people who have never met a trans person and don't really understand it do have fears that, you know, this is all about operating on children who don't know what they're about. And that is very far from the truth. So this application that we've done is very strictly for adult, so it's for over 18s. I think that I'm not an expert on children at all, and I don't claim to be, and I'm not an expert on hormonal treatment or anything like that. I think in terms of the question of regret, I think again, that's not an unreasonable thing to ask about, but you have to kind of pick apart what people are actually asking. And I think from what I understand, what people are really asking about is how common is it that people re identify with their sex assigned at birth or their sex presumed at birth is perhaps a better term. So what proportion of, of people who were born and assumed female have masculinizing surgery and then say, oh, actually I really identify as a woman. And I think that understanding that the true concept is that re identification. There's been a lot of work done by some other very prominent people in Australia about race rates of reidentification, and Ken Pang is one of them, and Ashley Lynn, I think, has done some work on that. But the rates of re identification with sex at birth is very, very, very tiny. And usually if it does happen, it happens before anybody has any surgical intervention. So the idea of of an adult having surgery and then re identifying as the birth gender after is very small for adults. As I say, I'm not a big expert on the children. So I think in terms of other regret, what I think is missing from the debate on that or the discussion on that is what's the rate of regret for every other kind of surgery? Like if you have a knee replacement? I reckon the rate of regret about having a knee replacement is probably about 18%, you know, and nobody mentions that. And I think that's where there's a little bit of bias and unfairness that you're not asking what's the rate of regret for having your tonsils out or for having an ear operation or anything else else? Because surgery does have regrets for sure. But what is now known is that the regrets that people have for having gender affirming surgery are quite often things like, I wish I'd had the scar in a slightly different way, or I wish I'd had a different type of operation, or I wish I hadn't had the operation in the middle of summer, I should have had it in the winter. Or so those kinds of nuanced regrets about type of surgery or timing of surgery are pretty universal through every type of surgery. So I think that that's one type of regret. But the issue that often the kind of broader community you're asking about is what, what's the rate of re identification with birth sex? And I think that's incredibly small.

I also think that for people that do regret entirely with the surgery, which is a very small percentage, is that you can actually have surgery again to correct that if that is the case as well. I know of trans people who had top surgery and then later went off those hormones and regrew breasts. And we're quite happy to have those breasts regrow. And it's quite like, okay, well, I think this comes back to bodily autonomy, you know, the ability for people to go, this is my body, I'll grow it and change it how I like, Just as any CIS person might as well with any kind of cosmetic surgery, whether that be gender affirming and or aesthetically affirming for whatever reason.

Yeah. And I look, I think that idea of bodily autonomy is important, but I guess as a surgeon, I do have have a little bit of a caveat around that in that I think that trans people know their own bodies and they know what will feel right for them. But I do also think that there has to be an element of shared decision making. So surgeons have to take at least some of the responsibility for the risks of surgery. And quite often we have to kind of help people change track a little bit, because we think that the risk of a particular operation is too much. And I think that something that is hard to swallow sometimes, and I think part of the reason that it's hard to swallow is that you. So far, I've often had to jump so many hoops to get to be sitting in front of a surgeon, and by the time you get there, you say, this is what I want, I've got to have this operation. Whereas for most surgeries, what happens is you meet the surgeon first and then you talk over the options with the surgeon and talk over the pros and cons. And again, it comes back to what. What's normal in surgical practise and what's safe. And so if there's trans people listening to this, I think one of the things that I would say is try to have an open mind, because there might be some elements to the surgical procedure that you're thinking you want that you haven't thought about and you don't know about, and your surgeon might be able to help you talk through the pros and cons. And so I think that idea of having shared decision making is really important because we're not technicians, we're doctors, and so we have a responsibility to holistically care for you, not just do your operation. So it's not like going shopping for something. You know, we, we. I like to think that good surgeons work in partnership with patients to holistically care for them. And so we, we want to have a shared conversation and shared decision making with you, to work out what you feel is right for your body, but also what is safe. And I think that's really important. One of the problems that's led to this kind of pre deciding exactly what operation you want is partly this system of the kind of. I think partly it's come from this idea that you have to have readiness for surgery assessments. And to me, as a surgeon, I find that really frustrating. It should be a surgeon that's deciding whether you're ready for surgery. How can someone that has never been in an operating theatre decide whether you're ready for an operation? It just doesn't make sense. So I think, you know, if we, if we can change that, then that

will help, like you said, put the expertise in the expertise, hands in terms of trans. For trans people listening and trans people who might be considering getting a career in surgery, what would you want them to know about entering this field?

Yeah, that's great. Look, I would love to have a plastic surgery trainee who is trans. That would be so fantastic. I think that you have to know that surgery is hard. It's a long road, but it's a very rewarding profession. And I think that working alongside your patients and really listening hard to them gives you enormous satisfaction and allows you to be a good doctor. So I think if there is people out there that want to be a surgeon, keep trying, don't give up, it's worth it.

And to give you a call when they're ready, you know,

hook me up.

The other thing was too that. And you can tell me if you don't want to discuss this, but I setting up a gender affirming surgery clinic in where you are in South Australia. Are you allowed to talk a bit about that?

Oh, maybe it's up to you.

I was just going to give you the option if you wanted to.

Look, I think what I can talk in broad terms is that each state and territory has its own public health services and some of those are more embracing of gender affirming care than others. We know that in Melbourne there's an amazing service and Dr. Ada Chung is one of the endocrinologists there, but it doesn't yet have a public gender affirming surgery component to it. I think in New South Wales there's a good model of care and some surgeries provided in the public system. So I'm a doctor in South Australia and in 2023, SA Health published a really good model of care for gender diversity, they called it. And I was really proud of SA Health for having done that. And what it does is it very much acknowledges the validity of seeking gender affirming care. And there are components of that model of care that are now well set up. So there's the service in the northern part of Adelaide, which is the adult hormone clinic, and there's a service for children and young people, which is the medical clinic and all sorts of supports. But as yet there's no formal surgical component. So the surgical component is in there in that policy. And we're hoping that SA Health will continue along the right line and go ahead and implement that surgical part. And I've been very lucky to work with Varo, who is a trans person, who has given us a lot of good advice on how to design such a surgical service. And I've also got a fantastic nurse consultant called Tracy Smart, and we've been really working hard to listen to the voices of trans people as to what they would want that surgical component of SA Health's model to look like. But it's not quite got over the line for implementation yet.

Still on the back burner, simmering away. You've got a lot of hot plates on, I can tell, Nicola, which is great. I have one last question for you.

Sure.

If you could change one thing tomorrow to improve access to gender affirming surgery in this country, what would it be?

Oh, having a trans Minister of Health, perhaps.

All right, we'll get the bells.

Look, I'm. I'm sorry that I can't give you a good answer. I'm a surgeon and to me we make a lot of decisions very quickly and we have to get on with things quickly. But actually, the more I'm in this space, the more I realise that it's not about one big decision and it's not about one single thing. It's about incremental, small things. It's about building awareness. It's about more trans friendly posters in the hospital, it's about more education of the nurses and the cleaners and the orderlies in the hospital. It's about making surgeons feel more comfortable to disclose that they do gender affirming surgery. It's lots and lots of little things. But I think crucially, if you've got a broad base of a billion little things, you're much more likely to get there.

It's that whole, you know, it's not about the winning the battle, it's about winning the war. It's about, you know, it's about the long haul, not the short outcome. Yeah.

And it's about not building something super quickly that's going to fall over in five years. You know, we want this to last forever.

Thank you so much, Nicola, for taking the time to chat with me today. I'm so grateful to finally get you here.

No, that's great. As I really enjoyed it.

All right, before I stop the recording, was there anything that you'd like to say before? Before then?

Yes,

go for it.

I just want to say that actually I'm so grateful to all of the trans people, I'm getting a bit teary, who've taken the time to educate me on what it's like to be a trans person, because before 2020, I had never knowingly, at least met anybody who was trans and knew absolutely nothing about it. And so I think I'm really, really grateful to have my ignorance corrected so patiently by so many people. And so that that's. Yeah, I just really want to say thank you for everybody that's had to correct my pronouns and kind of correct my ignorance on this stuff because I really didn't understand it and I think that I, I just am really grateful for that.

Oh, well, we're grateful for you to be patient as well, because it's a long journey to change how we, we think and it's a long journey to unpack the things we've been taught all our lives. So thank you for doing the work.

No worries, I'll keep going.

That was my chat with Associate Professor Nicola Dean about a week or so ago. And since then the Medical Services Advisory Committee Application 175, there's been some details and progress on that which you know. This application seeks the creation of a new Medicare benefit scheme items and amendments to existing items to support gender affirming surgeries and related consultations for adults experiencing gender incongruence. The outcomes are looking good. You can cheque them all out. I'm going to pop the link up on in our episode descriptions as well and on our socials, if you can take a look at that. And Nicola just had a couple of words she wanted to say, which she sent me this morning relating to this. Hi. Yes.

Since our interview a few days ago, I just wanted to let you know that the Medical Services Advisory Committee that I was talking about has now released a couple of important reports. One of them is on multidisciplinary care and care pathways. And it would be really great if as many trans people as possible can read the summaries of these reports and give their feedback to the Medical Services Advisory Committee. I believe that the committee is really trying to understand trans people's preferences for care. And so it would be really super if people can fill in the survey attached to the report and get it back to that Medical Services Advisory Committee. I think they really are trying.

There you go. If you can, click that link, have a read and if you've got some time, it all helps us get the best possible care we can possibly ask for. You've been listening to Transmission on 4zzz. See you all next week. Bye. Thanks for listening to Transmission. Catch us every Monday live on 4zzz from 10am or listen to our podcast on the community radio plus applause.