Gender affirming surgery is life changing care that keeps people healthy and saves millions.
Tell the Malinauskas Government to fund public gender affirming surgery now, because a broken system is no excuse for a broken promise.
SA Health promised safe, timely, and evidence-based gender-affirming surgery in public hospitals by 2025.
Instead, they quietly pulled the rug out from under our community – claiming the public system lacks capacity and denying surgical waitlists exist.
Nearly 400 South Australians have been left stranded without access to essential public healthcare or psychological support, placing trans communities into immediate psychological distress.
Scapegoating hospital strain to deny care is cruel and short-sighted. Discrimination doesn’t fix hospital pressure – preventive healthcare does. Investing in gender-affirming care keeps people healthy, out of emergency departments, and saves the health system millions.
TAKE ACTION: Don’t let the Malinauskas Government walk back on lifesaving public care. Demand that Health Minister Blair Boyer stop hiding behind system strain and keep his government’s promise to fund public gender affirming surgery.
SA Health shelves plan for gender affirming surgery at Flinders Medical Centre
The Advertiser, 6 Aug 2026
I’m on a public hospital waitlist for gender affirming surgery. What does this mean for me?
Since the announcement, many trans folks have contacted us with official letters confirming their referral was accepted for appointments with public hospitals across the state (including SALHN Plastic Surgery clinics and RAH Facial Feminisation care).
Receiving an official acceptance letter means your GP or specialist submitted a valid clinical referral, and SA Health formally acknowledged that you met the criteria for care. Despite SA Health’s recent public statements, your referral letter remains physical proof that public health pathways were promised and communicated to you.
We are working to get more information from SA Health about what this means for you. In the meantime, we recommend taking the following steps:
Hold onto copies of your referral forms, acceptance letters, and any official email correspondence from SA Health or hospital networks (including postal mail). If you’ve lost yours, you can:
- Contact the hospital you were referred to and ask staff to look up your details in the electronic medical record system to confirm your waitlist status.
- Request a copy of your referral letter from the hospital by making a Freedom of Information (FOI) application. (Note: If it takes the hospital more than 2 hours to locate the document, processing fees may apply).
- Ask the GP or health practitioner who referred you for a copy of any confirmation they received.
SARAA is collecting patient experiences to demonstrate the true scale and impact of this decision. If you’re comfortable sharing your story, email hello@saraa.org.au with:
- A short summary of your healthcare journey.
- De-identified copies or photos of any referral, waitlist, or acceptance letters.
- Your age and suburb, if you are open to sharing an anonymous quote (e.g., “Trans person, 28, living in Prospect”).
Having real evidence directly powers our fight to hold SA Health accountable. We will only share your information in ways you explicitly approve – whether that’s an anonymous social media quote, speaking with media outlets, or lodging a formal regulatory complaint.
If you were denied care or had promised pathways cancelled, you can make a formal complaint to the hospital network or an independent body. You can find out more about hospital complaints processes or seek advice directly from the independent Health and Community Services Complaints Commissioner (HCSCC).
Need mental health & peer support?
This news is heavy, but you don’t have to carry it alone. Please reach out to community support services:
QLife: Call 1800 184 527 (3PM – 9PM everyday) or chat online at qlife.org.au
Thorne Harbour Health SA: Mental health support services at thorneharbour.org
You can find more support at Trans Health SA, a community-operated directory of health practitioners, medical and legal information and support groups across South Australia.
Find out more
What is gender affirming surgery?
Gender affirming surgery refers to a range of procedures that a person may undergo to align their body with their gender identity. This can include:
- mastectomy (‘top surgery’) to masculinise the chest
- breast augmentation to feminise the chest
- genital reconstructive surgery like vaginoplasty or phalloplasty (‘bottom surgery’)
- facial procedures like reshaping the jaw or reducing an Adam’s apple
- vocal surgery to raise or lower the pitch of your voice
- a hysterectomy to control menstruation.
What is the Statewide Adult Gender Affirming Surgery Service?
Gender affirming surgery is a safe, effective and medically necessary treatment that many trans and gender diverse people describe as lifesaving. A systematic review of 81 peer-reviewed publications found that gender affirming surgery correlates directly with lower levels of depression, decreased psychological distress, and significantly improved health-related quality of life.
Yet significant barriers to access gender affirming surgery persist. Few surgeons currently provide this care and out-of-pocket costs can reach tens of thousands of dollars, even with private health insurance, as care is not subsidised under Medicare.
To improve access to care, SA Health released its Statewide Gender Diversity Model of Care in 2023 following extensive consultation with trans and gender diverse people, their families and health practitioners. The model formally committed to gender affirming surgery in public hospitals – including top surgery by 2025 and bottom surgery “within 3-5 years”.
Designed by Southern Adelaide Local Health Network (SALHN) in consultation with trans communities, the model was submitted to the Department of Health and Wellbeing in early 2026 for funding consideration.
What are the mental health risks of denying gender affirming surgery?
Rates of mental ill-health and suicidality are already significantly higher among trans and gender diverse South Australians.
Delays or denials of gender affirming care carry severe, well-documented mental health risks (AHRC). Inquests at the Victorian Coroners Court into the suicides of five transgender young people echoed these findings (Giles, 2024).
Unilaterally withdrawing promised care places trans South Australians into immediate mental health crises, heightening vulnerability and compounding psychological distress. Research demonstrates that timely access to gender affirming care is a vital form of suicide prevention and essential long-term mental health care (AIHW).
How many South Australians want gender affirming surgery?
Without Census data that captures gender identity and with limited national research available, it’s difficult to determine the exact number of trans Australians who want gender affirming surgery.
The Australian Bureau of Statistics estimates roughly 0.7% of South Australians aged 16 and over are trans or gender diverse (around 10,200 people).
With Australian research showing that approximately 47% of trans individuals desire some form of gender affirming surgery in their lifetime, an estimated 4,800 trans South Australians may require access to life changing, often life saving gender affirming surgical care.
Is gender affirming surgery banned in SA public hospitals?
SA Health’s outdated Restricted Elective Surgery policy explicitly restricts “gender reassignment surgery” (bottom surgery) in public hospitals.
While there is no explicit policy restriction on other forms of gender affirming surgery (such as top surgery or hysterectomies) community members report being routinely denied access to these procedures in the public system simply because they are transgender.
Meanwhile, procedures like mastectomies, breast augmentations, hysterectomies, and facial reconstructions are performed daily in public hospitals for cisgender patients.
Who decides what treatments public hospitals provide?
Each state and territory government manages their own public hospital system and budgets, with consistent rules laid out under the National Health Reform Agreement (NHRA).
Renegotiated in 2026, the Agreement is underpinned by the principles that ‘all Australians should have equitable access to high quality healthcare’ and ‘Australia’s health system should promote social inclusion and reduce disadvantage’.
Do public hospitals in other states provide gender affirming surgery?
Yes, public pathways exist in varying forms across Australia.
The Monash Health Gender Clinic states that some gender affirming treatments are offered within the Victorian public system and discretionary financial support is available for chest masculinisation and genital surgery.
According to the Medical Services Advisory Council, the New South Wales and Victorian governments have also begun to implement plans to publicly fund a specialised gender identity clinic.
The Royal Adelaide Hospital’s Cleft and Craniofacial SA (CCSA) clinic provided public facial feminisation procedures for nearly 20 years up until mid-2025.
Historically, Flinders Medical Centre performed genital surgery from 1978 to 1988 before care fell through intergovernmental funding gaps.
What about the private system? How much does gender affirming surgery cost?
With no public surgical pathway and very few local private surgeons, trans South Australians are forced to seek costly private care or travel interstate and overseas – paying tens of thousands of dollars out of pocket.
While total costs vary depending on the surgeon, hospital, and Medicare rebate eligibility, typical out-of-pocket costs in Australia include:
- Top surgery (chest masculinisation / feminisation): $7,000 to $20,000+
- Bottom surgery (genital reconfiguration): $30,000 to $100,000+
- Facial feminisation surgery: $5,000 to $40,000+
Even with private health insurance, patients face massive out-of-pocket fees for surgeons, anaesthetists, and hospital facility costs. Because private care is financially out of reach for most, many trans South Australians are forced to raid their superannuation early, take on high-interest debt, or go without care.
Is gender affirming surgery subsidised under Medicare?
The Commonwealth Government subsidises the cost of private healthcare through the Medicare Benefits Schedule (MBS).
Currently there are no Medicare subsidies for gender affirming surgery.
The independent Medical Services Advisory Committee (MSAC) are considering an application to create dedicated Medicare Benefits Schedule (MBS) items for gender affirming surgeries.
In April 2025, MSAC formally acknowledged the significant unmet need for gender affirming surgery across Australia, explicitly praising SA Health’s initial plans for a public service before the state government halted the rollout.
What will gender affirming surgery cost the health system?
Gender affirming care not only saves lives, it saves public healthcare dollars.
2026 research from Melbourne University found that gender affirming surgeries lead to sustained, multi-year reductions in crisis mental health appointments and prescriptions. Over a five-year period post-surgery, government spending on mental healthcare drops significantly – saving an average of $1,769 for trans men receiving chest surgery and $3,416 for trans women receiving bottom surgery.
Investing in public surgical pathways ultimately saves healthcare dollars by preventing acute downstream mental health crises.
Do people generally support gender affirming surgery?
Yes. A YouGov poll commissioned by Equality Australia in July 2020, found overwhelming support among Australians for transgender Australians, including gender affirming healthcare.
There is strong support for the availability of health services for transgender patients (75%) and not allowing doctors to refuse treatment, or ridicule, a patient who is transgender (78%).
Can children get surgery?
No. The Statewide Adult Gender Affirming Surgery Service is only intended for adults.
Gender affirming surgery is generally not available for people in Australia under the age of 18 (AHRC).
In exceptional circumstances, young people with severe dysphoria about their chest may access top surgery if they, their parents and their treating medical professionals agree the treatment is appropriate (HLRC, Re Matthew, 2018).
For more information about your legal and medical rights while under 18, visit TransHub’s Under 18s page.
Where can I find gender affirming care?
Trans Health SA is a community-operated resource bringing together medical and legal information, support groups, and a directory of affirming healthcare practitioners across South Australia.
👉 Visit www.transhealthsa.com
TransHub is a national digital platform for trans and gender diverse people, their loved ones and health providers.
👉 Visit www.transhub.org.au
