Kia Ora,

When it comes to trans-health care in Aotearoa (NZ), I have no complaints in how I was treated, throughout my transition, all involved were caring professionals...The transition obstacle course was relatively straight forward, no major hurdles or hoops to jump over or through...

The pros of the Kiwi trans-healthcare is the National Health System and the possibility of Government Funded Surgery for those who can't afford it (however the amount of surgeries are limited to 4 every 2 years *3 M2Fs* *1 F2M* with no choice of what type of surgical procedure-for m2fs it's colonvaginoplasty or nothing )....

Some Kiwi trans-people feel (from what I gather) they have been put through hell and are definately no happy with the system...So....................................

On a personal level, how would you rate your treatment by your local country's/state's/county's "health care system" when it comes to trans issues...

Are you happy with what's on offer ?

Do you think you have been fairly treated by the system? 

Metta Anatta

Considering the norm is to not cover trans related care, it isn't good.
Some of the people I've had to deal with in hospitals and emergency rooms is far less than fun, kind or funny.

A lot of swedes complain about the system here, but for me everything has gone smoothly.
A week after seeing a psychiatrist I got a letter from the stockholm gender identity team, with my first appointment a month later (april 2012). After a year of seeing their psychiatrist, psychologist and/or counsellor once a month I got a call from the psychiatrist saying that all treatments were green-lit (june 2013).
At the end of june I had my new name and was living full time RLE. Mid august I started electrolysis. Early september I was on HRT. Late september I began my voice therapy, and being done with it in early december. Sometime in the next few months my counsellor and I will fill out an application for GRS, and a legal decision *should* be done within 4 months after that.

What I'm getting (virtually) for free: voice therapy, electrolysis of the face, chest arms and thighs, GRS, breast implants, hormones for about 9 months of the year, monthly meetings with a counsellor. In the last 2 years I've spent more money on books for college than on transitioning.

So I'm not gonna start complaining any time soon

My country (Norway) is currently under fire from Amnesty for violating human rights in their transgender healthcare program.

The main problem is that the gender marker in official documents, ID cards, passports and so on can't be changed without SRS (or in the case of FtM, hysterectomy). Second, only "classical transsexualism" (F64.0 in the ICD) gives the right to welfare-funded treatment, and their criteria are a bit off; basically, they use any excuse they can get to turn patients away. If you are older than 30 years when referred, the chances of getting the diagnosis are very slim. Being on the autism spectrum means no treatment, since they have the idea that the higher prevalence among autists means the condition is caused by autism in those cases and hence isn't "real". Even being gay or bisexual could cause them to deny treatment. Not least, if you express any doubt that you want SRS, they label you GIDNOS and refuse treatment. Only 20% of patients who are referred receive treatment. The diagnostic process (mainly standardized questionnaires) takes at least a year, often more - I've heard about cases where they, after three to four years of this diagnostic process, decided to reject the patient.

Those who don't get the F64.0 diagnosis have to get hormones from other doctors, who have traditionally been persecuted by the official gender clinic for prescribing then. HRT is then not covered by public insurance, and if you want SRS, you'll have to go overseas. Getting the identity papers changed afterwards is a hassle. Speaking as someone with Asperger's syndrome, I'd prefer being uninsured in the States - at least HRT is less expensive there because of lower general prices.

There's an ongoing review of the entire system, though, ordered by the authorities last fall. They have until January to present proposed changes, and there is hope that it will, together with the criticism from Amnesty (and EU and UN, if I remember correctly), cause the authorities to make the necessary changes, introduce the right to a second opinion (which until now has only been formally in place - the second opinion has been done by the same person who did the first diagnosis...), and perhaps remove the monopoly on diagnosis and welfare-funded HRT. They did a similar review only a few years ago though, which proposed similar changes but still didn't result in any change. Hopefully the increased pressure since then will prevent that from happening again.

America is probably dead last in trans care.  In fact there is NO trans care here other than the occasional doctor who is willing to offer care but you have to really look hard for one. Insurance doesn't pay for it so most just don't want to deal with it.  No money in it.  Also, there's still a cowboy mentality in this country which feeds a lot of bigotry and hatred for anything that isn't God and county.

France has a system a bit like the NHS in the UK. There are are certain number of centers (Paris, Lyon, Bordeaux, Marseille and Nice) where pluridisciplinary teams are supposed cover everything from therapy & HRT through to GRS. Apart from the fact that this means that there are no centers apart from Paris covering all of the northern half of France, these teams are totally underresourced and today there is only one decent GRS surgeon in the whole country, based in Lyon, with a waiting list of 18 months to 2 years once you have been approved for GRS on public funding. Once you are admitted to the publicly administered system I believe HRT and maybe a couple of other things like voice training are also publicly funded but nothing like FFS or BA is. 

Both because of the very limited interest in getting involved in a programme which puts all of the decision making about how you manage your transition into the hands of others for little benefit other than a publicly funded GRS, I believe that anywhere between 80 to 90% of French TG's manage their transition outside of the system. This is my own case and the case of all the people I personally know in France. Happily there are quite a number of trans friendly medical professionals to turn to and my own GP has been brilliant in every manner.

However, end of the day, apart from my medical appointments and medical tests (blood work, X-Rays, électrocardiogrammes...), I have paid for every step  of my transition from my own pocket, even HRT.

Getting name and gender changed in France is just as bad. For both it is a full fledged legal procedure requiring the services of an attorney, putting together a file containing medical history and evidence that you are already living full time as a woman, a real Catch22 requirement since living as a woman with a male ID can be very complicated . Lastly, you have to produce evidence that you have made irreversible physical  changes to align with your "chosen" gender. For most jurisdictions, these means GRS. However, even then and no matter how good your file, the judge has total discretionary power to grant the change or not. For example I have heard of cases where the certificate delivered by a foreign surgeon was rejected by the court.

In my own case, I filed for a civil identity change last September, my request was approved by the public prosecutor in November but, since then, the court has simply sat on the file and I have absolutely no idea when my case will be heard.  Legal costs to date ~ 4000$

The consequences of this are quite dramatic, having certainly contributed to the loss of my present job, totally preventing me from looking for alternative salaried employment and also preventing me from setting up my own business until it is sorted out. As things stand, since the date for my hearing has still not been set, I have no hope of getting my situation sorted out before the end of the year at the earliest.  Fortunately I have the means to hold out for a while but without that, given the way things work here I would be facing total destitution.

Not a good story and on a scale of 1 to 5 for supposedly developed countries, I couldn't rate France higher than a 1. My "Aggggghhhh" moment!
Donna

P.S. Just to attenuate this very negative story, I'd have to say that while the laws and administrations are a real bitch, by and large, the people I have been interacting with have been mostly great, both my friends and everyone from my doctor to my hairdresser.