Transgender patients face a long, costly journey

THE ROAD to the operating table for gender reassignment surgery is a long and costly one. Physical and mental health issues need to be taken into consideration before transgender patients can go under the knife.

Although the public health sector makes provision for gender reassignment surgery, the wait to have surgery is a lengthy process.

Dr Kevin Adams is a plastic and reconstructive surgeon who has his own practice at Kingsbury Hospital in Claremont but also operates on patients at the Groote Schuur Hospital Transgender Unit.

The unit was established in 2009 and an academic study done in 2014, entitled Transgender issues in South Africa, with particular reference to the Groote Schuur Hospital Transgender Unit, points to the long waiting list for transgender patients.

Researchers of the study said: “Since 2009, the Unit has assisted 102 patients. Of these, 83% had realised they were gender diverse as adolescents or when younger, while 20% had co-existent psychiatric disorders.”

Adams said that since then the waiting list has tripled: “When we started in 2009, we were seeing four or five new patients every three or four months; at the moment, we are seeing somewhere between eight and 12 new patients a month.”

He added: “At that stage (of the 2014 study), we had 100 people on the waiting list, we now have over 300.” At the Groote Schuur unit, they are only able to do four surgeries per year. An operation can take 8-12 hours, sometimes even longer.

Research is crucial to guide the medical fraternity to be able to respond to the changing needs of patients.

“If we go back 10 years and we look at the medical literature there were papers that came out of the Netherlands which thought that the number of people in a given population who were transgender was somewhere in the region of 1 in 135000 people. Then in 2018, at a congress in Buenos Aires, the feeling was that it was far more like 1 in 200,” said Adams.

A transgender patient wanting to have gender affirmation surgery undergoes psychotherapy and hormone therapy before having the reconstructive surgery. The duration of both differs from patient to patient, but can be fast-tracked if the person can afford private health care.

Adams cautioned that the costs vary in private health care depending on the patient’s medical needs and physicality: “For a transgender man, the biggest issue would be having the mastectomies done, costs would differ, but in general terms, it would be between R60 000 to R80 000. A transgender woman who would need breast implants… it could cost R40 000 to R50000.”

Adams said: “For 10 years, I have been the only surgeon doing the pelvic surgery ... to the best of my knowledge, on the continent. I suspect that there are a lot of surgeons that do this type of surgery, but don’t publicly acknowledge that they do.”

He said were plans for him to assist countrywide as the need was great.

“We are finding good doctors out there that want to help. It is a super speciality of many specialities.”

Adams said: “We are looking at a programme where I go and do some outreach teaching in Umtata, because they have recently appointed a plastic surgeon who has recognised that there are people there who need this type of surgery.”