By Joanna Tucker
Transgender and gender diverse (TGA) Australians seeking surgical procedures can only go to a handful of specialists for gender-affirming surgery, and the process itself is lengthy and costly. OTR journalist Joanna Tucker reports on the journey faced by South Australians. (Image supplied: Dorian Lenoir)
Dorian Lenoir, 21, a non-binary queer individual living in Adelaide, spends their days working a typical nine to five job, and their nights performing under the stage name of Dorian Courtisan.
“In Australia, trans healthcare is relatively difficult to access, since there’s so little public information on it,” Lenoir says.
Performing around Adelaide for just under a year now at various venues and festivals, Lenoir says they prefer performing intimate acts where the audience gets to feel their energy up close.
“My style is a blend of drag, burlesque and even recently dabbling in a little bit of sideshow,” Lenoir says with a smile. They have had a passing interest in drag for a very long time, but only started performing in June of last year.
“I’ve relied on fellow trans-folk to help educate me on which doctors are good, the recovery process, and how to even begin navigating the medical system as a trans person,” they say.
Lenoir says that most medical professionals they spoke to, besides the surgeon, were not adequately knowledgeable on the process of ‘top surgery’, and that a lot of the information had to be given by Lenoir.
Top surgery, or reconstructive chest surgery, is a surgery typically sought by trans people who were presumed female at birth (PFAB), which includes men and non-binary people, to remove breast tissue and sculpt the chest into a pectoral form. With that said, not all trans people seek or want surgery, and being trans does not necessitate it either.
Lenoir began their drag journey through going to a show at My Lover Cindi in Adelaide, which featured local drag kings who gave Lenoir the advice and confidence they needed to take the jump into drag performing.
This led to taking a beginner’s burlesque class at Hot Sauce Burlesque to define Lenoir’s dancing skills, but ended up making them fall in love with the satirical element of burlesque. Recently, Lenoir has been training in sideshow and learning the history of the artform and safety tips from burlesque and sideshow performer Aleksandra the Great.
Sideshow performing is the act of using little-known methods to offer the elements of danger and excitement; such acts include knife-throwing, lying on a bed of nails, and more. Lenoir’s latest act uses some of these techniques, and includes stapling objects to their body, which Lenoir says is new for them. However, they have managed to find a new home on the stage with so many performers who have helped them grow into the person they are today — particularly their friends at Mega Drive Events and The Finest Filth, who have supported them since their very first show.
Lenoir says they still face negativity in the Adelaide drag scene due to society’s mainstream perception of drag being significantly limited, such as feeling unwelcomed due to comments about them not being able to perform drag as they don’t identify as a “drag queen”.
According to Lenoir, most people picture a cisgender man dressing up as a glamourous drag queen when they think of drag, but it is so much more diverse than that.
“There’s kings, things, queens, and all sorts of weird and wonderful flavours of drag,” Lenoir says. “Drag, at its core, is about exaggerated performances of gender, and that’s one of the best parts about it.
“I’ve seen everything from cis[gender] female drag kings to trans men who still dress up in super femme drag. Drag is so loosely defined that it can be almost anything, and that’s the beauty of it.”
After performing for about four months, Lenoir began their journey to get a consultation for top surgery. There are a limited number of resources for information on top surgery, but ShineSA, an organisation for sexual health that seeks to improve the sexual health and wellbeing of South Australians, recommends that to get gender affirming surgeries in South Australia, patients should first familiarise themselves with available surgeons and surgical procedures in the state.
Then, they are told to go to another website, TransHealthSA — a digital information and resource platform for all trans and gender diverse people in South Australia — which has an updated list of the 13 available surgeons currently willing to perform gender-affirming surgeries in South Australia.
These surgeries currently include chest reconstructive surgery — which is what Lenoir received — breast augmentation surgery, and facial feminisation and masculinisation surgeries. Twelve of the surgeons are transmasculine surgical specialists and three are transfeminine surgical specialists. There are no genital reconstructive surgeons in South Australia to the knowledge of ShineSA.
Before all of this, Lenoir had an eight-month wait from their GP referral to their first consultation with a surgeon, and another consult to book the surgery, and then surgery three months after their second consult.
Lenoir says that although this may seem like not long of a wait to many, their diagnosis of gender dysphoria made it feel like forever. Gender dysphoria causes someone to feel distress when they feel like their sense of being male or female differs from the gender they are assigned at birth. For some, the difference between their gender identity and physical characteristics can cause significant and persistent emotional distress.
Christian Taylor, 21, a trans man, is a member of the Youth Advisory Council that works out of the Perth Children’s Hospital. Taylor’s work assists the Child and Adolescent Health Service (CAHS) of the hospital, which covers all of Western Australia’s public health for those under the age of eighteen.
Taylor says the only public health options for trans people in Western Australia are the gender diversity service for under eighteens or the Royal Perth Hospital Sexual Health Clinic, which is not a dedicated trans health team, and both options have wait times of up to a year or longer.
“I’ve been able to speak to the head of the gender diversity service [and] learn about how they treat patients, [as well as] the process for under eighteen trans health here,” Taylor says.
“We give feedback and advice on any changes around CAHS that need consumer input … so, new additions or changes to the hospital … and we look at frameworks for new policies and procedures,” he says.
“Being on that council allows me to give input that betters the experience for trans patients, as well as other LGBTQIA+ patients and neurodiverse patients, since there’s a massive overlap, as well as simple things like the addition of pronouns in emails and letters or addressing the public to help create a more inclusive environment.”
Lenoir states that top surgery was expensive to such a degree that it is essentially inaccessible to lower income trans people.
“I paid $7,000 out-of-pocket for the surgery alone, which only received a roughly $1,500 rebate from Medicare,” Lenoir says.
Along with this, you have to pay for the insurance excess, anaesthetist fee, post-surgery binders, multiple scar creams and any appointments with your surgeon before and after the surgery,” they say.
Luckily, Lenoir was fortunate enough to sign up for private insurance that completely covered their private hospital stay and theatre fees, which would have cost another $7,000.
“All up, I probably spent around $7,000 or $8,000 total of my own self-funded money. However, this will, of course, depend on your choice of surgeon and hospital,” Lenoir says.
“I wanted top surgery so that the way I looked on the outside could finally match the way I see myself on the inside,” they say.
“It’s very freeing finally being able to see myself in the mirror and know that I have the body I’ve always wanted, which seemed impossible years ago.
“It’s genuinely been one of the best decisions I’ve ever made in my life, and even through all of the recovery pain, I haven’t regretted it for a second.”
Lenoir received double incision top surgery.
“There are various types [of gender affirming surgery] available, depending on your anatomy and preference on how you would like your results to look, and double incision was my personal favourite, aesthetically,” they say.
“I’m grateful that I had no complications in my recovery, even living with chronic illness. I was very fatigued for a while, but I’ve been able to get back to regular life faster than expected.
“In all honesty, the drains are, by far, the worst part. It’s a gross feeling having your post-surgery fluids literally sucked out of you, but it’s worth it for the end result.”
This costly and lengthy process meant Lenoir had to take a break from any kind of performing or even rehearsing for a while, which did not improve their mental health as performing is such a key aspect of their life.
Recovery can be an isolating experience, considering all the rest needed after a major surgery, Lenoir says. They were able to attend light social events after approximately one month of recovery, and then was able to return to full-time work and nights out after approximately six weeks of recovery.
Lenoir is grateful to be on stage again, having recently performed in Singin’ in the Pain: Flare at My Lover Cindi. This open mic variety night was specifically for disabled and chronically ill performers, giving a platform for people to talk about their lived experiences of disability and chronic illnesses whilst performing whatever they would like.
“It’s a very special act to me, and a lot more vulnerable than I usually let myself be onstage,” Lenoir says.
SA Health did not respond to OTR’s request for comment on this story.
If reading this article has been difficult for you, TransHealthSA offers a list of crisis supports.