THE EXPERIENCES OF AN AUSTRALIAN COHORT NAVIGATING MEDICAL SERVICES IN PURSUIT OF SRS

Purpose – Sex reassignment surgery (SRS) has long been recognised as a successful treatment option for alleviating the distress associated with gender dysphoria for the vast majority of its recipients. From an Australian context, little research has been undertaken on the experiences of trans* people pursuing SRS. Thus, in part, the purpose of this PhD project was to understand the psychosocial experiences of Australian trans* people who had undergone SRS, how they navigated that life changing event, and if they perceived that their needs were met. Furthermore, another aim of this study was to discuss the implications of the findings in relation to the Standards of Care. Materials and Methods – Based upon a theoretical framework based upon some key tenets of social constructionism, embodiment and narrative, fourteen trans* people (9 trans* men and 5 trans* women ranging in ages from 25-78) were interviewed. Following a voluntary drawing activity to elicit thoughts and feelings of the SRS experience, an unstructured interview based upon the pictures was conducted. Data generated from the interviews was analysed with a structural framework employing the notion of narrative borders, which explains the three components of a narrative; a discernible topic, the plot, and the formation of themes, which I refer to as narrative concepts. Results – In navigating the medical self, six narrative concepts emerged from the data; negotiating the system: institutional power, surgical readiness: an (un)informed approach, professional and gendered language: (dys)respectful communication, post-surgical medical supports and follow-ups, and (Un)met needs. In relation to the Standards of Care, three areas were explored; readiness and eligibility, communication and psychotherapy with a view to suggesting possible changes to the SOC. Conclusion – The findings suggest that in the Australian context based upon the participants’ accounts, the notion of the gatekeeper still exists in relation to access to SRS, and is a role that reinforces the pathological notion of being a trans* person and in some ways coerces SRS applicants to relate a scripted tale to access surgery. While some participants perceived being supported and their needs being met in their encounters with health professionals throughout the SRS process, other participants accounts suggest an abuse of medical power creating a sense of powerlessness and vulnerability, not being supported and feeling humiliated in their interactions at the medical level. Thus, the approach to providing psychosocial support is inconsistent. Equally inconsistent was the use of appropriate language when dealing with trans* people. These inconsistencies can best be dealt with by the formation of collaborative relationships. In discussing these findings in relation to the SOC, changes are suggested in the area of communication with trans* people and consideration to a more thorough explanation of psychosocial issues facing trans* people, which may help increase knowledge of those medical professionals with little expertise in gender dysphoria.