When Dr Danielle Stewart first opened the doors of her monthly LGBTI specialist clinic in Darwin last year, she had no idea if anybody would show up. There'd never been anything like it in the tropical northern city. Dr Stewart couldn't even find a LGBTI health specialist in the NT, and had to resort to flying one up from down south on her own dime.
"Before I opened the clinic I spoke to NTAHC, the local AIDS council, and their guess was there might be maybe three children or young people who were gender questioning, and ten transgender adults in Darwin," Dr Stewart explains. In a city of some 142,000 people, that's miniscule. And if the numbers were right, it might make sense that the NT government had barely invested in LGBTI, particularly trans, health.
"But so far we've seen somewhere between 60 to 70 transgender people at the clinic… and I haven't actually looked at the exact numbers, but it's close to 10 children and young people," Dr Stewart says. They had to extend the clinic from one day to two, and are now considering a third to meet the demand. "It was a hidden need… Once the service was there, people came out and asked to be seen. They wanted to be seen by a doctor who knew about gender."
Those turning up at Dr Stewart's clinic are likely just the tip of the iceberg. US estimates suggest some 0.43 percent of people may be transgender. Across the NT, this would mean there are more than 1,000 trans individuals whose only specialist health care is being provided by a two-day clinic, once a month, run out of a small suburban doctor's practice.
"We received a limited funding grant from the Northern Territory Primary Health Network (NTPHN) which has been fantastic. But that's about to run out in September," Dr Stewart says. "Our future is uncertain after that."
Some 80 kilometres north of Darwin, across the Beagle Gulf, are the Tiwi Islands, home to the largest Indigenous LGBT community in Australia. The Sistergirls, or Sistagals, as they are known, is a broad group that welcomes members across the LGBTQI spectrum. But the remoteness of Tiwi makes the experience for trans Sistergirls particularly fraught, especially for those who wish to physically transition.
Getting good healthcare, let alone LGBTI specialists, up to Tiwi is hard and expensive. But it's not easy for the Sistergirls to get down to Darwin either: so far, Dr Stewart has only had two of them visit her monthly clinics. "A lot of Indigenous trans people haven't traditionally sought hormones," Dr Stewart explains, noting many trans people don't feel they need them. "But you would have to wonder how much that's been influenced by [the Sistergirls'] lack of access to hormones, as well."
Obviously, the simplest solution would be to fly specialist doctors up to Tiwi, and Dr Stewart has definitely considered that, but it's a question of money—something her clinic is quickly running out of. Right now, with the government funding deadline looming, she's scrambling to keep the doors open.
Dr Stewart says she's not sure what will happen if the clinic is forced to shut down. In the past, without access to specialist care, trans Territorians have just resorted to ordering their own hormones online from overseas. But this comes with risks.
"They aren't having blood tests done to monitor their levels, they're just self-treating … People end up guessing by how they are feeling," Dr Stewart says. "The main risks with hormones involve some of their side effects, particularly … putting up blood pressure, causing blood clots, having strokes and heart attacks."
As a doctor, Stewart doesn't want to see anyone having to resort to these measures to get hormones. If she's able to secure more government funding, she wants to expand the clinic's reach and provide financial assistance to patients who might not be able to cover the cost of visiting, or even the cost of hormones, which can be between $7 and $50 a month.
But there's a bigger battle to be fought here too, against the idea that LGBTI health is niche and shouldn't be a priority for doctors and for the government. "Another element is—whether it's conscious or subconscious—discrimination. People just overlook transgender needs," Dr Stewart says. "I think that for GPs they are probably put off, thinking it's an area they may not understand and they haven't had experience in."
This attitude is by no means limited to Darwin. It's even enshrined into our national law, like the fact sex reassignment surgery isn't covered by Medicare. Those wishing to go through a full physical transition face medical bills upwards of $10,000 because their surgery is designated "cosmetic".
"I think nearly every health professional I know who works with transgender people believes that it certainly should be subsidised by Medicare—that it's a genuine need [and that] it's not a 'cosmetic procedure,'" Dr Stewart says. "That's the problem; cosmetic procedures aren't funded by Medicare … [but] most people I know would regard it as an 'essential' cosmetic procedure, not a cosmetic one."
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