The XX Men

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Words || Ashton Love 

Content warning: brief and undetailed mention of suicide

We can all agree that puberty sucks. Between changing bodies and surging emotions, our hormones put us through hell. You’re teased if you start earlier than your peers and you’re teased if you start later. Transitioning from primary to high school is already a difficult time without everything you know about your body changing too. I don’t imagine many people would willingly opt to go through it all a second time

However, I am one of the few that did. For transgender people like me, hormone replacement therapy (HRT) is often lifesaving. Some trans kids are able to access puberty blockers, which delay puberty until the person either decides to go through with their body’s idea of puberty, or to have HRT, so they only have to go through it all once. For those of us who didn’t have access to puberty blockers, or who didn’t talk to doctors about them soon enough, we get a second chance.

I am a transgender man, which means that I was assigned female at birth due to anatomy and those good ol’ XX chromosomes, but my gender is male. Some of us realise this when we’re kids, others when we start to feel uncomfortable about our bodies during an oestrogen-fuelled puberty, and others around menopause. While we can realise that we’re trans at any age, those are the three times when identity formation happens the most frequently.

So, I went about my childhood knowing that something wasn’t quite right from around the start of primary school, and there are so many times I look back on and wonder how it wasn’t obvious to me or the people around me that I wasn’t the girl they thought I was. But nobody had the words to help me figure it out because there’s so little accurate media representation of trans people, especially trans men. By the time I worked out who I was and what I wanted, it was too late for me to get any of the benefits of puberty blockers.
Luckily HRT is helpful at whatever age you start. It’s been more than two years since I started taking testosterone and it is undeniably like going through a second puberty, but this time it’s actually doing what I want, and each new change is exciting. It’s a very slow process when you’re desperate for things to change, and some of the most desired changes can take the longest. It can take as long as six months for your voice to break, and more than a year for facial hair to start growing in, but most effects happen a lot faster. Body hair gets thicker, periods stop, muscle becomes a lot easier to develop, and fat redistributes to be more around the waist than the hips. The timeline of changes is different for each person, but most of these things start to change within the first six months.

Despite not too many visible changes happening in the first few months, it’s definitely the most intense time, and not just because it was the time in my life between the start of the HSC and the end of year 12. Hunger and libido both skyrocket and acne can also get pretty bad. These all tend to settle down soon enough, but it’s best to stock up on some steak and skin treatments in the meantime.

But, obviously, the main difference between HRT and puberty is that HRT is externally induced, rather than controlled by your own body. There isn’t a simple way to induce it and have it run its course, so testosterone has to be continually administered for the rest of your life. The most common way of taking it is through injections, and I have mine every two weeks. Because of the frequency, most doctors teach you how to do your own injections because it’s a lot more convenient than visiting a nurse every fortnight, so I’ve given myself over 100 injections by now. It’s a very effective way of conquering a fear of needles, that’s for sure, as are all the blood tests to make sure everything is on track.
A big downside of this is that you need to buy the testosterone. It’s not too expensive, but the cost builds up over the years, and the Australian government has recently decided to screw us all over by taking the most common type of testosterone off the Pharmaceutical Benefits Scheme (PBS) this year. The PBS is what allows medications to be subsidised and for people who have concessional benefits (such as a Health Care Card) to pay a lot less. Since the concessional benefits are typically available only to people who can’t afford to pay for medications at their full price, taking testosterone off the PBS will hit the poorest trans men the hardest and many will struggle to pay more than five times the price for something that is widely considered lifesaving.

The costs of trans healthcare don’t stop there. To be allowed HRT or any surgery related to our transition, we have to be evaluated by a psychiatrist to say that we are capable of making the decision to go through with the medical process and that it is something that we need. On top of the psychiatric expenses (a single appointment can range from $250 to $500 and most psychiatrists ask you to come back a few times), it turns out that even the most common surgeries that trans men can have aren’t subsidised by Medicare at all. Top surgery (a double mastectomy with masculinising chest reconstruction) is the most common type of surgery for trans men and generally costs around $10,000 with no rebate whatsoever. Yep, we have to go through potentially thousands of dollars of psychiatric assessment to prove that this surgery is essential for our wellbeing, and then still have to break the bank to get it done. Or we can go on a waiting list to get it done on the public health system, which can lead to more than two years of waiting. To get the surgery we need, we either have to be rich or go through a few years of continued depression and danger.

Most trans men seeking top surgery are already taking testosterone and presenting as men socially, so having bodies that don’t align with what society expects of a man opens us up to transphobic hatred and violence. Trans men who haven’t had top surgery can use compression shirts (binders) to flatten their chests, but this is unhealthy long-term and can lead to less skin elasticity (which can limit the effectiveness of top surgery) and even fractured ribs. On a psychological note, both gender-based discrimination and body dissatisfaction lead to higher levels of depression, anxiety, and attempted suicide for trans people. Forcing those of us without a spare $10,000 to wait a few years for surgery really is a death sentence for many trans men.

And that’s not even going into bottom surgery (genital reconstruction). While there are a few different kinds of surgery, there are very few surgeons in Australia who will perform even the two main types (phalloplasty and metoidioplasty). It’s hard to find the exact number because a lot of information is outdated – a problem in itself – but there seem to be only two or three bottom surgeons in the country. Most trans men who have bottom surgery go overseas, which has extra costs for flights and accommodation. I wasn’t able to find prices for metoidioplasty in Australia, but for trans men who choose to have phalloplasty in Australia it can range from $50,000 to $70,000, without considering the costs of consultations and hospital fees.

To put it simply, medical transition isn’t as simple as a lot of high-profile transgender people make it look, where they can just disappear for a few months and re-emerge with their ideal body (*ahem* Caitlin Jenner). It’s a lifelong process that’s not even available to many of us and, with the precedent set by taking testosterone off the PBS, I worry about the future of trans men and all trans people in this country. Social acceptance may be getting better little by little, but it’s only one step in improving the standard of living for transgender people in Australia.

If this article has raised issues for you please call Lifeline Australia on 13 11 14, or MQCare at 1800MQ Care.

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