“Why am I having to pull out my super [pension] to pay for this healthcare that should be free…?”: financial barriers to accessing gender-Affirming care in Australia

Background and Aim Transgender, gender-diverse, and non-binary (trans) people in Australia experience significant barriers to accessing gender-affirming care (GAC), including hormone replacement therapy and gender-affirming surgery (GAS). Australia represents a particularly acute policy context, with GAS unavailable through the public hospital system. This study examined the financial experiences of trans people seeking GAC in Australia, focusing on the economic barriers that influence access to healthcare.Methods This article draws upon 43 in-depth semi-structured interviews with trans adults residing in Australia, recruited through trans-specific community organizations. Drawing on the notions of cisnormativity and epistemic injustice, participant data were analyzed using Braun and Clarke’s reflexive thematic analysis.Results Applying Braun and Clarke’s six phases to generate and define themes from the data resulted in three themes capturing participants’ lived experience of financial barriers to accessing GAC in Australia: 1) Cumulative Cost of Ongoing Care; 2) Exclusion of ‘Cosmetic’ Care; and 3) Gender-Affirming Surgery is Structurally Inaccessible. Together, these themes illuminate a healthcare system that formally acknowledges the clinical necessity of GAC yet fails to provide the financial infrastructure required to make this healthcare accessible.Conclusions This study identifies the evidentiary asymmetries applied to GAS as an expression of institutional epistemic injustice enacted through cisnormative frameworks. Further, findings indicate that urgent policy reform is required, wider adoption of informed consent models of care, and investment in community-led services for Aboriginal and/or Torres Strait Islander peoples and culturally and linguistically diverse trans communities.