I'm used to
living with rules and regulations around my
transitioning. I live in Adelaide, and South
Australia's "Sexual Reassignment Act" sets out
rules for which doctors and psychiatrist I see,
who may prescribe me testosterone, who may
perform surgeries and at which hospitals they
may be performed. I have become accustomed to
negotiating my way around statutory obligations
and restrictions, as unlike other places, there
is no real option to transition here outside of
the official programme - unless you go
interstate. I have become obscenely aware of
laws, regulations and penalties which
circumscribe and put boundaries on my experience
of transitioning. This is part of my
transitioning reality. The health care and
transition of anyone transitioning is determined
by this Act. These laws were progressive when
they were first introduced in 1988, but have
become increasingly out of date with
improvements in the treatment of trans*
people.
One of the first
discussions I had with my GP after I had been
accepted onto the programme was around
testosterone, Medicare and the Pharmaceutical
Benefits Scheme. I had already heard about
authority scripts and getting them or not
getting them from being on mailing lists. My GP
is great. He is very clued up about the rules
and regulations, as he has been treating trans*
people since before the South Australian
legislation came in. He is super aware of what
he is able to do for me legally and we talked a
lot about the restrictions around authority
scripts for T.
The Pharmaceutical
Benefits Scheme (PBS) which subsidises the
cost of many medicines doesn't apply to
everything, and doesn't apply to every condition
for which a drug can be prescribed. Lots of
medications are restricted on PBS for lots of
reasons. You have to meet the criteria
associated with certain medical conditions
listed in the schedule. If you don't qualify for
an authority script, it doesn't mean you can't
have the medication. It just means you don't
have a condition that the PBS will subsidise
for, and you will pay the full price on a
private script. The government is entitled to
subsidise medications for some conditions and
not for others, as the advice I got from the
Human Rights and Equal Opportunity
Commission said.
Testosterone is
restricted on PBS to a certain set of conditions
associated with androgen deficiency in adult
males, and puberty conditions for males under
18. It isn't subsidised for transitioning. If
you don't have "M" on your Medicare record,
then, according to the schedule, it is
physiologically impossible to have one of the
conditions eligible for the PBS prescription
subsidy. Keeping in mind I'm talking "on paper"
identity here. Medicare has developed a protocol
for correcting the paperwork in recent years,
requiring two pieces of documentation from
medical professionals confirming at least two
medical and/or surgical procedures which have
changed one's (bodily) sexual characteristics.
With a protocol in place, there are less
possibilities for people continuing to 'slip
through the gap.'
We both think this
stinks, my GP and I, but his professional
practice depends on abiding by the regulations.
I have no desire to see my most important
medical ally disciplined or worse for bending
the rules. After nearly two years on
testosterone and having had chest surgery I am
almost at the point of being able to correct my
"on paper" identity and qualifying for an
authority script.
