While New Zealand's laws surrounding gender reassignment are largely accepting for those who identify as trans, there's no Kiwi doctor currently willing to perform the surgery.
In fact there's only been one, ever. Plastic surgeon, Dr Peter Walker, founded the Gender Dysphoria clinic in Christchurch 1992 after undergoing 14 years of training overseas. He retired two years ago at age 72.
For New Zealand trans patients now, unless you win the gender reassignment lottery and become one of the four government-funded trans patients sent overseas for treatment every two years, the operation can be near impossible to come by.
For those wishing to fund it alone, surgery comes at roughly $30,000. That's without the cost to leave New Zealand for operations. Even without paying for surgery, the follow-up costs for hormone treatment are ongoing. Trans people are required to see a specialist once a year at $200 dollars a session, for the rest of their lives. A possible Labour party policy for free gender reassignment surgery was laughed out of parliament.
VICE spoke to Dr Walker about his experiences with the trans community, and the future for gender reassignment in New Zealand.
VICE: What drew you to gender reassignment surgery?
Dr Peter Walker: It was really a case of serendipity. When I qualified as a plastic surgeon, I went to England to get experience and during my time there I was exposed to gender reassignment plastic surgery. The general surgeon I was learning from was presented with a patient who'd had a vaginal prolapse, it was sticking out like a tennis ball.
Basically, I watched this surgeon create a vagina from the ascending colon of the large intestine, which was very nouveau. It was a success. Word spread and within a short time we became known through the world. There was such a huge demand that I came home and we set up the first transgender clinic here in New Zealand. My role, as a plastic surgeon would be to refashion the penis into a vagina, or vice versa.
How common were transgender females?
Oh, it's much rarer going the other way. Going from male to female happens for one in 37,000 people and going from female to male happens for one in 150,000.
I think the penis inversion surgery is quite well-known, how do you go the other way?
It's a very complex operation with hours and hours of micro-surgery. You take skin off the forearm and hook up those nerves with the nerves of the labia folds. That's how to create erogenous sensation. Then it's silicon rods that go inside the new penis so the patient can have penetrative sex.
What process do patients have to go through before they reach the operating table?
Basically all fetuses have testosterone in the brain, then a female hormone is necessary for the male brain to feel male. If that female hormone is not present, the default sex is female. So male patients wanting to become female will have female brains and their identity has to be diagnosed that way by therapists. It's gender dysphoria.
Did anyone opt to revert back in your experience?
New Zealand patients? Yes. It's so rare, it just wasn't something we reverse because the number coming forward were so small we couldn't get enough practice to become proficient at that operation. We would send them to a surgeon in Belgium.
Do you think New Zealand has embraced the transgender community?
Absolutely, New Zealand law has always been very open and advanced with transgender people. When our patients changed sex they could change their drivers license, their birth certificate (which is unheard of in any countries except Sweden and The Netherlands), then we've had a transgender MP.
If that's the case though, why aren't there more practicing surgeons like yourself?
For surgeons to qualify to perform gender reassignment, you need to train for 14 years. Doctors are not so accepting of that. I was lucky that then I found a group of doctors and psychiatrists that were incredibly accepting of transgender patients when I formed the clinic. But when we set it up, in 1992, it was groundbreaking in New Zealand. I retired in 2014, at 72.
Without you, New Zealand is obviously at a standstill with reassignment surgery. Do you see a future for transgender patients to be operated on here?
The New Zealand Association of Plastic Surgeons is aware of the need for a transgender surgeon, they're actively trying to get a fellowship in order to help a young qualified surgeon train overseas and trying to come back over here.
Do you miss it?
All the time, I really did enjoy the surgery. I found transgender people were the most interesting. Little boys who knew they weren't right at four, five years old. Then it's a great disappointment when puberty comes along and these boys start to develop the male sex characteristics. They are born into the wrong body.
It's so sad, isn't it?
It is really. Regardless of our laws, I would like all New Zealanders to be accepting of these patients. It's not a life choice. It simply is not.
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