For two years, Nick Dyball felt he was keeping a secret from his family.
“Captured is probably the first word that comes to mind,” the now 17-year-old said.
“It was as if something was weighing on me.”
As a nine-year-old, he finally told his parents he was transgender.
“Having that conversation was like getting that weight taken off of me.”
The change in Nick’s behavior was immediate.
“I remember very clearly that it was as if there was a tangible weight just lifting itself – he was dancing around after that,” said his mother, Rachel Cunneen.
The conversation triggered a flurry of activity.
Nick’s motto changed, and Mrs Cunneen took on the role of lawyer, helping her son navigate Canberra’s healthcare system – a task she described as “a full-time job”.
“It was not like there was a place I could go to access everything,” she said.
“It was this hiking trail to find out what was available, what might be important, and how people could help us navigate this thing.”
The ACT government recently released its LGBTIQ + Health Scoping Study, which highlighted serious barriers to access to health care for transgender and gender differences Canberrans, particularly young people.
“A shortage of available primary health care professionals, including GPs, mental health assistants and pediatric specialists with an understanding of LGBTIQ + health needs, has exacerbated the problems facing the LGBTIQ + community,” the study said.
“This has resulted in significant gaps in the health care of LGBTIQ + people in ACT … with too long waiting times, referral delays and high costs associated with interstate and international travel.”
Where to go out?
The first port of call for a transgender person after coming out is usually a general practitioner, but finding one in Canberra who is willing to treat transgender patients is not easy.
A handful of doctors who are passionate about this area of medicine perform the bulk of the work.
Among them is Dr. Clara Tuck Meng Soo.
Demand has grown exponentially in recent years, to the point Dr. Soo has closed her books to make sure her patients do not wait more than a month for an appointment.
“We’re seeing an increase from year to year of 20 to 30 to 40 percent,” she said.
Yet the pool of doctors open to treating transgender patients in Canberra has not grown.
“I think a lot of GPs feel that they have not got the experience or the training to work in this field, but in fact it is not that difficult,” said Dr. Soo.
“It’s like any other field of medicine we learn as we go.”
For young transgender people, puberty blockers can be an important step toward gender reassignment.
The problem with ACT is that there is only one pediatric endocrinologist who can administer them.
Nick first started seeing him seven years ago when he was 10.
“In the beginning, it was amazing – I was one of only a few trans kids,” he said.
“It was very one-on-one. We sat and chatted, we talked about my life, we caught up, and then we got all the cruel things out of the way.
“It felt like very personal care, and it was really important to me, especially at a time when I felt very alone at times.”
But as demand grew, so did the level of care Nick received.
“It got a lot harder – once I waited in the waiting room for four hours for a five minute check,” he said.
“I felt pretty neglected, and I did not trust my doctor as much as I once did.”
According to the Scoping Study, there are 20 young transgender people on the waiting list to be seen by Canberra’s sole pediatric endocrinologist.
Dr. Soo said some patients waited a year for an appointment.
“For a child who is actually going through puberty, where physical changes happen very quickly, a year can make a big difference,” she said.
“Those changes can be irreversible, so a child who is suddenly faced with it may find it very disturbing.”
Limited access to necessary medical professionals
Jenni Shoring is a proud transgender woman.
The 42-year-old started in hormone therapy on her 40th birthday and says the transition saved her life.
“The dark days are really over,” she said.
“I really see the world in colors as opposed to gray or black and white. Everything is so much brighter.”
Ms Shoring turned to A Gender Agenda – a community organization that supports intersex, transgender and gender differences – for help navigating the health care system after she came out.
She is now the organization’s operations manager and is daily reminded of how the system fails trans children.
She describes the wait times to see Canberra’s sole pediatric endocrinologist as “horrific” and said the mental health support available is grossly inadequate.
And that is in the private sector.
In the ACT’s public system, there is not a single pediatric psychiatrist available to treat patients under 18 years of age.
The Scoping study acknowledges that the ideal response would be to simply hire an additional pediatric endocrinologist and psychiatrist, but says that “these specialists must be appropriately trained and have a sympathetic attitude towards the treatment of transgender patients.”
It also adds that Australia is currently facing a shortage of both.
Support for mental health is essential, according to Nick.
He admits he was lucky to find his therapist after he came out – the cost was not a barrier and the therapists were not as flooded then as they are now.
“If I had not got it, sorry to say it, but I would have been dead,” he said.
“It’s so important. That’s all.”
A spokeswoman for Canberra Health Services says its CEO for Women, Adolescents and Children, Susan Freiberg, is leading a new work program to design a new care model that will better meet the needs of transgender patients and their families.
“The new care model will provide interdisciplinary treatment,” the spokeswoman said in a statement.
“It will provide patients and their families with holistic support from specialists in health, nursing and mental health teams in addition to medical specialists.”
The new care model is expected to be implemented next financial year.
Community hub is needed to connect services
What advocates say society needs is a gender hub – a centralized point that connects all the necessary services.
“It would be huge,” Mrs. Shoring said.
“It would give people a clear path in.”
Mrs. Cunneen repeated a similar feeling.
“Parents need a focal point – they need a point they can go to where there is good mental health care and information, medical advice and medical treatment.
“They pretty much need all the professionals to coordinate it for them.”
That’s what Gender Service at the Royal Children’s Hospital in Melbourne has been offering transgender Victorians since 2003.
When it first opened, the service received one referral every two years.
Last year, 821 young transgender patients were referred to the service.
“Victoria has been extremely fortunate with our state government that they have not only supported us with resources in the form of funding, but they have also invested in creating the systems across primary and secondary care so that we can meet this demand,” the service said. director, associate professor Michelle Telfer, said.
“Victoria has really pushed forward in leading the country in delivering this interdisciplinary collaborative care, and what we are seeing is that it is delivering amazing results.
Associate Professor Telfer is convinced that the model can be copied in ACT.
“The system is not sustainable with individuals working separately – the system requires coordination,” she said.
“But you can not do it without state aid – it absolutely is.”
The scoping study highlights that ACT is “the only jurisdiction that does not have a comprehensive gender-focused health service available either in private practice or through a publicly funded gender clinic”.
It states that having one is a high priority, but admits that “such a service can only be obtained over a number of years”.
The transgender community has waited long enough, said Dr. Soo.
“If we are to live up to our moniker of the capital of equality, more must be done now.”