Trans teen attempts self-mastectomy while waiting for surgery

The 18-year-old female to male transgender patient presented to an emergency department after "attempting a partial left mastectomy at home", according an article in the New Zealand Medical Journal.

The teen had a background of gender dysphoria and was taking testosterone, but faced a long wait for surgery in the public system.

The inability to afford a private consultation, combined with the "significant psychological stress of having breasts at an upcoming pool party", pushed him to try the surgery himself.

The teen prepared by watching a how-to video on YouTube, marked out the incisions and planned out ways to control the pain and bleeding.

He decided to seek medical attention several hours into the home surgery because he was worried about damaging a nerve.

At the hospital he underwent a mental health assessment before surgeons completed the left mastectomy as well as a "symmetrising" right mastectomy.

Researchers called the incident "an act of desperation" and revealed the "overwhelming unmet need for masculinising chest reconstruction" in New Zealand.

But Australian transgender psychology expert Associate Professor Damien Riggs said Australia also had serious limitations when it came to gender affirmation surgery.

"While both counties have social healthcare, only some of the cost is covered, most of it isn't," Professor Riggs said.

"I have absolutely worked with clients who have had to crowd fund to pay for the out-of-pocket expenses."

Crowdfunding for gender affirmation surgery has become increasingly common in Australia, with 413 funds raising more than $570,000 on GoFundMe in 2023.

GoFundMe senior manager Joe Satari said there had already been 173 funds set up in 2024, raising a further $173,000.

"One of the biggest challenges for those seeking gender confirmation surgery is the high cost. Medical bills can easily reach into the many tens of thousands of dollars, of which the majority is not covered by medicare," Mr Satari said.

"We have seen a steady increase year-on-year in fundraisers mentioning the terms 'top surgery' and ''gender affirming surgery' and this trend isn't showing any signs of slowing down."

Professor Riggs said Australia had more surgeons performing "top surgery" than New Zealand, but it was severely location dependent.

"If you live in a regional area how much choice and how much accessibility are you going to have?" he said.

"If you don't live in the cities where the surgeons operate then you would need to travel we need to stay there for a few weeks."

He said when it came to "lower surgery" the options became even more limited.

"There are much longer wait times and much greater costs, so that's why you have people going to places like Thailand, which has an amazing reputation."

Professor Riggs said some trans people confronted significant obstacles even to get on a surgical wait list in Australia.

He said the international guidelines dictated transgender people shouldn't require therapy before accessing gender affirmation surgery, but many were forced to jump through hoops.

"Some people will simply accept a letter from a psychologist, while others will say 'no, I expect you to have gone through extensive therapy'," Professor Riggs said.

He said the barriers to access in Australia weren't acceptable.

"This isn't cosmetic surgery. It isn't optional for people, it's essential," he said.

"If someone's living with extreme dysphoria to the point where they don't feel life is worth living, then this is life-saving surgery and there's no such thing as an acceptable delay."

He also warned the often toxic and hostile narrative surrounding gender affirmation risked surgical access slipping backwards in Australia.

"There are knock-on effects for [doctors] who are saying 'I'm fearful to work in this space'," Professor Riggs said.

"Many of the people doing this work are ageing and looking forward to retirement, so who is going to take their place?"

He said one prominent surgeon who had been doing "very good [gender affirmation] work" had suddenly stopped doing that type of surgery entirely.

"I can't tell you why I don't know why he stopped, but it creates a huge gap," he said.

"It can be as simple as losing one really good surgeon for there to suddenly be a massive gap."