What is our consent process?

Gender affirmation surgery is well documented to bring significant benefits to people experiencing gender dysphoria who have had appropriate preoperative management under the care of their treating physicians, including primary care, endocrinologists, and psychological care. We strongly prefer to follow the WPATH (World Professional Association for Transgender Health) ​ guidelines regarding preoperative consent, which requires:

WPATH Requirements

1. Persistent, well documented gender dysphoria.
2. Capacity to make a fully informed decision and to consent for treatment.
3. Age of majority in a given country ie 18 in Australia
4. If significant medical or mental health concerns are present, they must be well controlled.
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Although not an explicit criterion, it is recommended that patients also have regular visits with a mental health or other medical professional. The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery.

Please have available for your first appointment:

1. A letter from the doctor providing hormone therapy with evidence that you have been on hormone therapy for at least 12 months.
2. A letter of support from either a psychologist or psychiatrist managing the mental health aspects of your transition – preferably dated within 12 months of your appointment. We acknowledge that some people have not required the input of a psychologist or psychiatrist. This does not exclude you from accessing surgery, but it will be discussed as part of the consent process.

Whilst there is a move towards an “informed consent” model, it remains our preference to continue with the WPATH guidelines, as many years of experience have shown that this leads to a very low regret rate post-surgery of less than 1%.

What to expect at your first appointment:

Your first appointment with David Sofield will be scheduled for approximately 30 minutes. This is your opportunity to ask questions about the surgical options available, what they involve, the benefits and potential disadvantages of each approach, and associated risks and complications. We will have a detailed discussion about these and help you come to a decision regarding the best procedure for yourself. It is not necessary or expected that you will make an absolute decision about your preference of procedure or timing at the first visit.

Most procedures are carried out at Bethesda Hospital, Claremont, a small private hospital with excellent theatre and ward facilities.

We encourage your feedback, both positive and negative, about all aspects of your care process  to enable us to continue improving the patient experience.

Surgery booking and costs:

Gender affirming surgery in Australia is a highly specialised area, and costs are significant.

Our fees are comparable to those at other Australian and overseas centres. Being able to access your care in Perth can significantly reduce costs associated with travel etc.

Costs for surgery are made up of three components

• Surgeon and assistant fee
• Anaesthetist fee
• Hospital fees

If you have private health insurance, you may be able to claim part or all of your hospital charges and part of the doctors’  fees. It is highly recommended that you obtain private health cover to reduce initial costs and provide security that in the event of needing further hospital treatment you will face further large expenses.

Once you have chosen a surgery date, all aspects of fees will be discussed with our practice staff, and you will receive written information detailing exact out-of-pocket costs for your particular circumstances.

As a guide, major reconstruction ( vaginoplasty, vulvuloplasty, metoidioplasty) will range from $AUD 18- 22000 in surgical fees but, as above, this will depend upon the exact nature of your chosen procedure and insurance status.

The surgical fee covers the operation, daily reviews by your surgeon whilst in hospital, preoperative education with our physiotherapist and practice nurse, supply of dilators and douching equipment when required and the first postoperative visit to the clinic.

Consultation fees:

Initial consultation $495 for a 30-minute appointment (Medicare will rebate $86.15)

Follow-up appointments ( after the initial post-operative appointment) $135 ( rebate $37.65)

In the case that complications occur and further surgery is required, there will not be further out-of-pocket charges from Dr Sofield; however, this will not usually be the case for the anaesthetist ( who may vary from your original operation).

Compassionate release of superannuation: in some circumstances funds can be released from superannuation to cover medical costs. This should be a decision taken carefully, and we recommend obtaining independent financial advice. If this is something you are considering, please discuss this with our staff when making your booking for your first appointment, as the process can take some time.

Other issues to consider

Hair removal

• This is optional but recommended for patients undergoing vaginoplasty to reduce hair on the scrotum and underside of the penis
• Electrolysis or laser are widely used with varying success and can take 6-9 months to be effective
• In procedures using skin grafts, hair follicle scraping and diathermy are done to reduce hair growth
• Please do not shave the genital area within 3 weeks of surgery- this can lead to increased wound infections. Shaving where necessary will be done during the operation
• We recommend Livemore Ethical Beauty  https://www.livemoreethicalbeauty.com/

 

Weight

• Many people experience weight gain when on feminising hormone therapy
• Excess weight does increase surgical risks including
  • Wound infection and breakdown
  • Deep vein thrombosis
  • Difficulty achieving adequate vaginal depth
  • Anaesthetic problems eg chest infection
• It is necessary to weigh < 100kg and have a BMI of 30 or less for major reconstructions – full depth vaginoplasty or metoidioplasty
  • For some tall or muscular patients, a heavier weight may be fine
• The initial consultation may include a discussion about body weight- this is not meant to offend; rather, it is a very important aspect of your care to ensure the best possible outcome for you while reducing the risks as much as possible.
• Where appropriate, we can refer patients to an excellent rapid pre-op weight loss service

Other medical Issues, especially

• Diabetes
• Blood thinner use
• Weight loss drugs eg Ozempic

These all need to be carefully managed around the time of surgery, so please bring along a full list of any medications or previous issues with surgery or anaesthesia to your first consultation.

Supporting You Every Step

Finally, our primary concern is to ensure that you achieve your desired outcome in the safest and least stressful way possible and it is very important that you feel free to ask questions – however minor or “stupid” they may seem (there are no stupid questions!) and that you understand there is no pressure whatsoever to proceed to surgery until you are absolutely sure it is the right path for you.

We look forward to welcoming you to Align Gender Surgery.

Regards

Dr David Sofield FRACS(UROL) FRCSE

Reconstructive Urological Surgeon