A trans woman is appealing to the Government to increase funding for gender reassignment surgeries to help ease the backlog of almost 200 people.
Wellington-based Kate Collyns, 30, is grateful for the Government's latest funding boost for publicly-funded surgeries but told Newshub it's not enough to keep up with the high demand.
"It felt really good to be recognised and to have that need appreciated, even if I think the extent to which the Government is funding it still needs to increase significantly."
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"I think what really needs to happen is not necessarily an ongoing increase in funding, but a significant boost, perhaps even a one-off, to get that backlog cleared."
The surgery waiting list has grown significantly in the past year. Ministry of Health figures show there were 105 people on the list in mid-2018, and it would have taken over 50 years to complete.
There are 198 people on the waiting list today, and Collyns is one of them.
Documents obtained by Newshub show the advice given to Associate Health Minister Julie Anne Genter last year by the Ministry of Health recommending an increase in the number of surgeries and increasing funding for it.
The ministry advice said in the "face of increasing community expectations", the number of surgeries being offered by the Government was not keeping up with demand.
It said trans and gender-diverse people's mental and physical wellbeing is "markedly worse than that of the general population", with research pointing to a higher risk of suicide.
Kate said it wasn't an easy process getting on the waiting list.
"I put myself on the list in the expectation that changes would be coming, I knew there was quite a lot of advocacy going on in that area, and that people were beginning to listen to us.
"This is a need that hasn't ever really been addressed, and I was one of many, many people who had been not putting their name on the list out of a sense of hopelessness.
"Eventually, I had to go through a loophole to find a doctor that was able to refer me to the list and she eventually did that on her own time - out of generosity rather than an obligation."
A report last month revealed almost half of all transgender and non-binary New Zealanders have been the victims of attempted rape, and 56 percent of respondents said they'd seriously considered attempting suicide.
Genter was advised last year to change the commitment of delivering a maximum of three male-to-female and one female-to-male surgeries every two years, and making it a minimum commitment, and this was met.
The advice said increasing the number of surgeries provided could help to improve access to the ballooning list, but the amount of funds available and priority against other surgeries "would remain as constraints".
So the Government allocated $3 million to increase access to surgeries in Budget 2019. It followed reports the waiting list had reached 30 years for some people.
Gender reassignment surgery is expensive. Ministry figures say the average cost of female to male surgery over the last 13 years is $218,000. But for male to female it's less than half of that at $53,000.
The same ministry figures show how much it would cost to clear the backlog.
- 8 surgeries per year: $1.2-$1.6 million
- 16 surgeries per year: $2.3-$3.2 million
- 24 surgeries per year: $3.5-$4.8 million
- 40 surgeries per year: $5.9-$8 million
On top of those costs, the ministry also recommended the Government consider increasing access to other masculinisation and feminisation procedures, such as "top surgery", or breast reduction.
It can cost up to $16,000 per person.
A transgender man on the waiting list Newshub spoke to, who asked not to be named, said he's saved up enough money to live his dream of travelling.
But he's conflicted, because he desperately wants the surgery, and is trying to decide if he should just fund it himself, rather than having to wait more than a decade.
Kate told Newshub she's considered getting the surgery overseas in Thailand, but can't afford it.
"I know that the surgeon in New Zealand, she wants to get through more people than she's been funded to, so she is offering private surgery.
"But also there are incredibly talented expert surgeons doing this in Thailand, who have a worldwide reputation, and I've looked into that... But at the moment I don't see that financially it's possible for me."
Newshub spoke to the surgeon Kate mentioned.
Dr Rita Yang, a private specialist in plastic and reconstructive surgery, said there's an unmet need in society, and that a year into her practice, her experience is that there is high demand.
She said the waiting list "significantly underestimates the true demand for gender surgeries".
"Because of the perceived long waiting time and previous lack of local expertise, some trans people choose not to apply to [the waiting list]."
She said complications associated with gender surgeries can include excessive bleeding, undesirable appearance or unexpected functional issues and chronic pain.
But she said most of the complications related to those who have overseas surgery, and the issues could have been avoided if there had been appropriate follow-up care.
"Increased trans visibility and acceptance in our medical environment means there will continue to be more evidence-based data on this aspect of gender surgeries, which is very important."
Genter told Newshub the Government removed the cap on surgeries and put more money into addressing the long waitlist, to accelerate the process.
She said clearing the waiting list won't happen overnight, but the extra funding will make a difference, and that the Government knows access to surgery is critical for many transgender peoples' wellbeing.
Down the line, Genter added, the Government is looking at establishing a sustainable surgical service, but she didn't put a time frame on it.