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"Conformity is the jailer of freedom and the enemy of growth."
( John F. Kennedy - Address to the UN General Assembly-(25 September 1961.) -


Talk to Agender Wellington
Residency, Citizenship, Passports and Staying Married after SRS


To skip to a specific part of this page select one of the options below
Residency   Citizenship   Passports   Staying Married after SRS   Stress  



We found that people who arrived as ten pound Poms, or children on parent’s passports were sometimes not existing, as documentation over time had not been captured electronically, or had been lost or destroyed.

A friend who moved across country was told that she did not exist by Centrelink when she applied for the dole. She had to supply details of entry on her parent’s passport via Sydney in 1969 by BOAC flight. It took Centrelink 6 months to get the answer to this problem.

She applied for amendment of her residency status, and received back the following letter “If you have not made a valid application and if you are still in Australia after that date (Word/ no date) you will become an unlawful non-citizen on date (again word but no date). It appears that our fears of inconsistency concerning this matter are well founded.

I am also helping Ally in her quest for answers to the same problems here.

Quote from letter from DIAC

Dear Ms Noble

Thank you for your e-mail received by the Minister for Immigration and Citizenship,
Mr Chris Evans, on 9 January 2008 concerning issues faced by transsexuals resident
in Australia when confirming their visa status and having a "Recognised Details
Certificate" issued. The Minister has asked that I reply on his behalf.

I apologise if you have been passed between officers. Your e-mail has prompted a
review of the procedures used by staff in our FOI administration area and all staff are
now aware of the process that is required for clients with similar circumstances.

While I can confirm that your records have been amended to reflect your details in
the name of Kathy Anne Noble, for your information I will outline the process that
should happen to effect these changes. I note that you are President of Changeling
Aspects so this information may also be of use to your members.

The Freedom of Information Act 1982 (the FOI Act) provides a mechanism for the
amendment and annotation of personal records held by Commonwealth Government
agencies. Where clients consider that the Department of Immigration and
Citizenship (the Department) has recorded their details incorrectly they may request
under the FOI Act that the Department amends their details. To seek such
amendment/s of personal records as held by the Department, they will need to
complete a Form 424C (copy attached) and provide evidence of their correct details
as explained by the form. There is no fee to lodge an amendment request. FOI
Section is currently arranging to refund the $30 application fee that you have already
paid to lodge an FOI request to determine your visa status.

Once the amendment/s have been made, the next step is to apply for Certificate of
Evidence of Residency Status (CERS). This application is made on a Form 164
(copy attached) and has an application fee of $100.00
In respect of the visa/residency status of a person after gender reassignment, it is
unlikely that their visa/residency status would change. The visa/residency held by
the client is granted because the client has met criteria associated with that visa. If
the visa holder continues to meet these requirements, their visa/residency status will
not change.

Difficulties encountered by clients who may be permanent residents, but arrived on
parental passports relate mainly to difficulties in locating the record of the original
arrival in Australia. These difficulties arise due to the age of the records. For
example, the records may not be held electronically or in some instances may have
been destroyed. These difficulties, while regrettable, are likely to be encountered by
any client who arrived in Australia in the same circumstances. I can assure you that
the Department is committed to working closely with clients in this situation to find
alternative ways of establishing the information required.

If you would like to discuss these issues further, please contact Elizabeth Low,
Director FOI Section on ph (02) 6223 8565, in respect of the FOI matters and your
local departmental office in respect of matters about visa status (locations of
departmental offices in Australia can be found at

Yours sincerely
Louise Smith
Assistant Secretary
Review Coordination Branch
Telephone: (02) 6223 8120
Facsimile: (02) 6225 6511

As you can see from the letter, this is not just about Trans people, as it covers all who entered the Country under the ten pound Pom scheme.

I was told that in order to establish your residency status, as it is imperative to do so if you had been afforded permanent residency as a male and had then undergone SRS to become female, as the female did not exist until the details had been altered. This of course would be exactly the same if you were FtM. In the current situation in regard to terrorism, it is considered to be very important to have your new status confirmed.

How to go about this and apply to Immigration FOI is explained in the letter from the department. When we queried this further, we found that you need to send these details.

In the interests of assisting Trans community members who wish to make applications the Department of Immigration and Citizenship has provided the following summary of documentary requirements for some specific applications.

To apply to have departmental records amended under Freedom of Information provisions a person must make an application Form 424C - Request for amendment or annotation to personal records under the Freedom of Information Act 1982. There is no application fee for this application. Please note: all cases are assessed on a case by case basis.

  • Recognised Details Certificate, issued in Australia by Office of Births, Deaths and Marriages (RBDM) in States or Territories,
  • Equivalent overseas document,
  • Evidence such as surgeon’s and/or psychiatrists statement
  • Change of Name Certificate, if applicable, issued in Australia by RBDM (as no previous names are recorded on the RDC)
  • Evidence of when and how you arrived, such as entry stamp in passport or details of ship or flight.

Australian temporary or permanent residents may be required to provide evidence of their status to State or Territory authorities in the form of a certificate of evidence of resident status. You must make this application on a Form 164 - Certificate of evidence of residence status (also known as a form 283) and pay a $100.00 application fee. This certificate is not required for citizenship application purposes.
Note: the surgeon’s statement would contain information such as confirmation that the person has undergone a full gender re-assignment procedure. The psychiatrist’s statement would provide confirmation that the person is living as their chosen gender of identity, has undergone hormone treatment and shows no intention of reverting to their original gender

We also found that contrary to popular belief, that if you stayed the required two years as a ten pound Pom, you acquired citizenship automatically, this is wrong as many ex poms have found out.

The last paragraph in the above extract from the letter intrigued me, so I queried it and it was confirmed that non surgery is acceptable to the department that covers both immigration and citizenship

The new status for residency is acceptable by citizenship, so when applying for citizenship, or amending citizenship certificate those details are accepted.


It is desirable that the evidence of Australian citizenship reflects the person's new identity. Australian citizens applying for new evidence of citizenship should apply on Form 119 – Application for evidence of Australian citizenship and pay $55.00 application fee.  The following documentation should be provided in addition to those that are required for all applications:

  • Recognised Details Certificate, issued in Australia by Office of Births, Deaths and Marriages (RBDM) in States or Territories,
  • Equivalent overseas document,
  • Evidence such as surgeon’s and/or psychiatrists letters
  • Original citizenship certificate (which is to be cancelled and retained by the department)
  • Change of Name Certificate, if applicable, issued in Australia by RBDM (as no previous names are recorded on the RDC)

Note: the surgeon’s statement would contain information such as confirmation that the person has undergone a full gender re-assignment procedure. The psychiatrist’s statement would provide confirmation that the person is living as their chosen gender of identity, has undergone hormone treatment and shows no intention of reverting to their original gender

In cases of gender reassignment, it is desirable that the evidence of Australian citizenship reflects the person's new identity. Applicants should enclose with their application:

  • an Recognised Details Certificate (RDC); or either,
  • a statement from their surgeon confirming the full gender re-assignment procedure or a statement from their doctor/counsellor confirming that the person is living as their chosen gender of identity, has undergone hormone treatment and shows no intention of reverting to their original gender; and
  • their original citizenship certificate (which is to be cancelled and retained by the department); and if applicable,
  • evidence to support a name change


Dear Kathy Anne,

Thank you for the opportunity to discuss passport policy and clarify our requirements for issuing of Australian passports to transgender applicants.

As discussed, the Australia Passport Office (APO) does not play a role in registering identities in the Australian community. The Registry of Births, Deaths and Marriages (RBDM) and the Department of Immigration and Citizenship (DIAC) have this responsibility and the APO relies on information provided by these authorities to determine a person's identity and entitlement to an Australian passport. The document required (known as cardinal document) is either a RBDM birth certificate (for Australian born applicants) or a DIAC citizenship certificate (for overseas born applicants). All passport applicants regardless of gender, or whether they are transgender, must present one of these documents in support of their application for an Australian travel document.

The Department therefore responds directly to what RBDM or DIAC agree to include on the birth or citizenship register. Provided the applicant can provide a birth or citizenship certificate in the reassigned gender, and meets all other passport application requirements (such as completing the application form correctly, paying the appropriate fee and providing RBDM evidence of name change if necessary) then an Australia passport will be issued in that gender. Where transgender applicants remain married, the APO will consider applications on a case by case by basis.

I hope the above is helpful. Please do not hesitate to call me if you wish to discuss any other passport matters.

Jane Luckhurst
Executive Officer
Passports Strategy, Policy and Coordination Section
Tel. 02 6261 2263

Thank you for your very prompt and concise answers to our questions. On the current APO Form PC1_0706 on page 5, 3C, Australian citizenship certificate, would we have to send a duly notated copy of our Citizenship Certificate attached to the application?
Page 2 of the notes pages "What documents will you need to provide with your application" states that documents must be originals. It also states that you need to provide ONE of the documents, which answers you second question below.

Also at 3B if we have a previous Australian passport that had 2 years validity or more that was issued after 20/08/1986 would we need to send this as well?
Revised forms are being introduced on 1 July and we will only be accepting birth or citizenship certificates in section 3. There is further information on the passport website.

Lastly, can we do all of this via the Post Shop, or do we have to send to a passport office, as the distances involved can be huge. Such as Townsville to Brisbane?
Applications can be lodged at a post office, all applicants in Australia are required to attend an interview if they use a PC1 form. If the applicant has the necessary documentation - i.e. their birth or citizenship certificate showing their reassigned gender, there should not be a problem at the post office. If the situation is not straight forward or advice is required,
I would recommend attending the interview at a passport office.

We now have the situation following on the Grace Abrams Appeal Court win, that a Trans person who stays married after SRS, can amend their Passport. In the case of a Trans woman, this would mean she will have a passport registered as female, but a male birth certificate, as the BDMRs will not amend the birth certificate unless divorced. Total farce!

I have now received the full list of requirements from the APO and these are very interesting.

Hi Kathy

As requested, please find the following requirements for people wishing to change their gender/sex on an Australian travel document/passport. Further to our conversation this afternoon, it seems that we are in the process of updating our website to include information regarding change of gender (Q & A page). However, due to staff absences in our systems area I am unable to let you know when this is expected to be released.

Please let me know if you have any other questions.


Susan Jeffery

Travelling for the purpose of gender reassignment

People travelling overseas for the specific purpose of gender reassignment surgery may be issued with:

  • a full validity passport which indicates their gender at birth as recorded on their birth certificate or citizenship record (as confirmed by DIAC), or
  • a limited validity passport (LVP) in their intended gender with sufficient validity to meet return travel needs up to a maximum validity of 12 months, whichever is the lesser, or
  • a Document of Identity, with a maximum validity of 12 months and the gender field left blank.

Limited Validity Passport (LVP)
Applicants issued with a LVP in the intended gender are required to:

  • Provide appropriate medical evidence from a registered medical practitioner, including that gender affirmation surgery is scheduled to take place.
  • Sign a statement acknowledging that difficulties crossing international borders may still be encountered due to the fact that the gender in the passport does not match the physical gender of the client, and that the passport has been issued in the intended gender at the client’s request.

Note - The LVP may be replaced gratis with a passport valid for the remainder of the 10 year period in reassigned gender only when the applicant submits a cardinal document reflecting the changed sex, evidence of a change of name registered with RBDM as well as other usual passport requirements

Document of Identity

Applicants issued with a Document of Identity in these circumstances should be advised in writing that:

  • Australian Documents of Identity are widely, although not universally, recognised as a valid travel document and the applicant should check with the relevant country’s diplomatic representative, prior to their departure from Australia, as to whether a Document of Identity will be accepted for entry to and exit from that country.

Note - For LVPs and DOIs, the applicant must acknowledge the following in writing:

  • Their receipt of the letter from DFAT; and
  • Their agreement to the issue of a Document of Identity.

Change of Name

All applicants who have undergone gender reassignment and wish their passport to include a new name must provide the normal RBDM change of name/revised birth certificate to support the change of name.  Applicants travelling for the purpose of gender reassignment surgery and who request a different name on the travel document must provide the normal RBDM name change documentation to support the change of name, before it can be included in a travel document.

Full validity passports issued in new gender

Applicants must provide

  • For applicants born in Australia – a birth certificate from their state/territory RBDM showing the gender of reassignment;
  • For applicants born overseas – a revised citizenship certificate to reflect their new identity, or given current citizenship certificates no longer record a person’s gender, formal evidence from DIAC that it has accepted the reassigned gender and amended its citizenship records to reflect the new gender.

Exceptions - Full validity passport to be issued in new gender

Married Applicants
Applicants who claim that they are unable to obtain an amended cardinal document because they are married should provide the following documentation (note, this only applies to RBDM documents as DIAC will amend its records for married persons):

  • A statement from the relevant RBDM/Gender Reassignment Board that they have met all requirements for their reassigned gender to be recognised, except that they are married or medical evidence as set down in the relevant state or territory Registry of Births, Deaths and Marriages;
  • Evidence of living in the character of the other gender such as driver’s licence, medicare card, centrelink card, rates notices (or other PIDS documents);
  • Original birth certificate;
  • RBDM name change certificate;
  • Marriage certificate;
  • Statutory declaration stating that marriage has not been annulled.

Applicants who have not completed gender reassignment

Applications will be considered on a case by case basis by the APO where an applicant claims they are unable to obtain an cardinal document in their preferred gender because they are unable to complete gender reassignment surgery due to a pre-existing medical condition or because the surgery in the applicant’s case carries a higher than normal risk, with the result that completion of the surgery in the applicant’s case is considered by a relevant medical practitioner to be dangerous or life threatening. The following documentation should accompany the application:

1. Documentary evidence that the applicant has approached the relevant body in their State or Territory seeking recognition of their change of gender, and the body’s written advice as to why it has declined to recognise a change in gender.

2. A statement from the client’s medical practitioner providing the following information:
- confirmation that hormone therapy treatment has been on-going for at least two years.
- evidence of any initial surgery completed (e.g. mastectomy)
- details of the pre-existing health condition and advice why surgery carries a higher than normal risk
- confirmation that completion of sexual reassignment surgery would be dangerous or life-threatening for the particular applicant.

3. Documentary evidence from the client confirming that they live in the community in their reassigned gender, e.g. driving licence, Medicare card, credit card.


Other cases will be considered on a case by case basis by the APO.  (Note - This exception policy would generally be used for children who are indeterminate sex and unable to undergo surgery due to their age).
Applicants who claim that they are unable to meet requirements because of unique circumstances, including a failure to meet the requirements of the relevant state or territory legislation or by DIAC, should provide the following supporting documentation,

  • Statement (B11) of reason why the applicant cannot meet requirements;
  • Medical practitioner’s statement, where relevant, providing reasons for the applicant’s inability to undergo gender reassignment;
  • Evidence of living in the character of the other gender such as driver’s licence, medicare card, centrelink card, rates notices (or other PIDS documents);
  • Original birth certificate;
  • Name change certificate;
  • Passport Office Manager’s recommendation.

The relevant body in each State or Territory for recognising gender reassignment is listed in the table below.

State or Territory

Responsible Body

Contact Details

Australian Capital Territory

Births, Deaths and Marriages Unit
(02) 62070 460

New South Wales

Registry of Births Deaths and Marriages
1300 655 236

Northern Territory

Registry of Births Deaths and Marriages
(08) 8999 6119 / (08) 8951 5339


Registry of Births Deaths and Marriages
1300 366 430

South Australia

Magistrates Court of South Australia (
(08) 8204 2444 ((08) 8204 9599)


Registry of Births, Deaths and Marriages
1300 135 513


Registry of Births, Deaths and Marriages
1300 369 367

Western Australia

Gender Reassignment Board
(08) 9219 3020

Thank you Susan. We will have to live in hope that there will be a change so that those people who live in the preferred gender/sex by either choice, or lack of funds that they will be able to amend passports in the future. Many travel on their passport in their birth gender/sex and this can be hairy in some countries.

Love and Peace, Kathy

From: []
Sent: Friday, 8 May 2009 10:03 AM
To: kathy noble
Subject: Re: Query [SEC=UNCLASSIFIED]

Hi Kathy

All applications that do not meet the 'general' policy where RBDM or DIAC have issued a certificate in the new gender would be looked upon on a case by case basis and a decision made on the evidence/documentation/information provided (including any gender reassignment surgery already performed) and any other 'unique' circumstances affecting that person.

As far as I am aware, there are no current plans to extend the exceptions to those that cannot afford surgery or choose not to have surgery.


"kathy noble" <>
08/05/2009 07:27 AM









Hi Susan,

On page 2 under ‘Applicants who have not completed gender reassignment’ at 2 “Evidence of any initial surgery completed (e.g. mastectomy)”  Would also an orchidectomy be considered if the person met all other requirements?

I am pleased that those who cannot have surgery because it could be life threatening are included. There are two other categories that need to be looked at. They are, those who choose not to have surgery, but would meet all other criteria, and those who cannot afford surgery, but would meet all other criteria. I know of many Trans people who live full time in their preferred gender, but fall into the two categories that I have outlined. Can they be included in the above mentioned section?

It is gratifying to see that the children who maybe Trans are being considered as well. There are many of these coming out, and our feelings are, that there will be many more. It is understood that many who may consider themselves to be Trans will later retreat from that feeling and revert to their original gender/sex. This is now very much in the news with Re-Alex and puberty blockers to consider.

Once again, thank you for your help, and I will certainly keep in touch if any other problems arise.

Love and Peace, Kathy

This of course has had a flow on affect where staying married after SRS is concerned,


Staying Married after SRS

We started to question the fact that Government departments and agencies were deeming us to be no longer married. This affected the spouse, as they lost all of their rights under the Marriage Act 1961. The spouse and the Trans partner were now deemed to be a same sex couple. This meant that they were now paid at single rates if on a pension, lost their medicare rights to PBS, lost the right to pass on any defined pension to their partner on demise.

We asked questions of the Commonwealth A-G and finally started to get answers back after the Same Sex Act reforms were passed into law, with implementation as from July 1 2009.
In letters from the Commonwealth Attorney-General’s Office you will come to understand the total shift that we have encountered. From the second letter, dated the 17-03-2009 I have extrapolated the following hypothesis, which questions the legality/validity of the States to be able to force us to divorce in order to amend documentation.

Letter from the Federal A-G dated 19-01-2009

While the reforms do not expressly address the sex or gender diversity of specific individuals, they ensure that same-sex de facto couples and their families are recognised and have the same entitlements as opposite-sex de facto couples. A transgender individual who remains married after surgery will not be deemed to be no longer married as a result of the reforms. The effect of the reforms is that such an individual will receive the same treatment regardless of whether they are considered to be a member of a same-sex or opposite-sex couple. (My highlighting)

Letter from the Federal A-G dated 17-03-2009

In relation to your letter of 24 January 2009, I would like to clarify the Government's position. I can confirm that the Commonwealth Same-Sex discrimination law reforms will have no effect on the Marriage Act 1961. The Marriage Act provides that a marriage must be between a man and a woman. This is consistent with current Government policy and there are no plans to change the Marriage Act to allow for a marriage to be solemnized between same-sex couples.

Gender re-assignment surgery has never, of itself, changed the status of a marriage which was valid at the time of solemnization. It has always been the case that a validly solemnized marriage would continue, irrespective of whether one of the parties subsequently underwent gender re-assignment surgery. The same-sex reforms due to come into force on 1 July 2009 do not change that position.

The legal recognition of the sex of transgender persons is primarily a matter for the States and Territories, as they are responsible for maintaining their respective Registers of Births, Deaths and marriages. All States and Territories have legislation which enables post-operative transgender persons to obtain either a recognition certificate or an amended birth certificate recording their preferred sex in certain circumstances, unless the person is a married person. Again, the same-sex reforms have no impact on this.

The Government's same-sex reforms amend 84 Commonwealth laws to remove discrimination against same-sex couples and their children. They extend to same-sex de facto couples the same entitlements and obligations that apply to opposite-sex de facto couples.

From your correspondence I now understand that you are also asking about the policy positions taken by other Commonwealth departments and agencies, including Centrelink. I understand that those policy issues are currently under review by the relevant departments and agencies.


Dear Sir,

Your letter of the 17 March 2009 in answer to my previous correspondence. I am sending this letter to John Boersig in answer to that letter.

Thank you for your letter dated 17-03-2009. I was in Canberra that day for the launch of the AHRC Trans Report.

In your letter, we note what has been written in paragraphs 4 and 5 and are very pleased to know that the situation of staying married after Sex Re-assignment Surgery (SRS) is to be recognised fully within the Same Sex Act, after 1 July 2009. This will alleviate much trauma and heart ache by my friends, who are involved in this way. They look on Marriage as a life long commitment and the sanctity of marriage and their deep love for each other. This is of paramount importance to them.

It does raise the question, if this is a Federal Law ‘Marriage Act 1961’ then how can the States and Territories “FORCE” us to divorce in order to amend documentation?. This appears to be the same situation that the German Government faces after being told by the German Constitutional Court, that they must repeal the Act “FORCING” people to divorce in order to amend documentation, as this is “UNCONSTITUTIONAL”

I have looked at the Australian Constitution under States and it states

Commonwealth Of Australia Constitution Act

Chapter V. The States.

109. When a law of a State is inconsistent with a law of the Commonwealth, the latter shall prevail, and the former shall, to the extent of the inconsistency, be invalid.
This seems to be the sticking point and needs clarification as to the legality of the States and Territories “FORCING” us to divorce, as the marriage Act 1961 is a Federal Law, administered by the States and Territories.

I must also question paragraph 6, as it states “all States and Territories” It is true that all States and Territories will amend Birth Certificates if born in that jurisdiction, providing you are “over 18, single (read divorced) and have undergone SRS” All of them do not provide Recognised Details Certificates for those residing in those jurisdictions and born off shore. This can make it very hard to be fully recognised in your preferred gender/sex. Currently, only South Australia, Western Australia, Victoria and NSW (on stream as from 01-03-2009) offer this facility. The question of remaining married is raised above.

I thank you for the detail concerning Commonwealth Departments and Agencies including Centrelink, as this was of great concern to us.

I await your answer with interest. 


Yours Sincerely, Kathy Anne Noble.

I received this answer from Centrelink. With regard to my query about how we were to be dealt with by them. It was fast, as it only took a week to get this answer.

PO Box 452 Cleveland QLD 4163


Australian Government

giving you options

Kathy Anne Noble
PO Box 897
Cleveland Qld 4163

7 May 2009


Dear Ms Noble

I refer to your recent enquiry about Centrelink's policy in regard to the introduction of the Government's same-sex reforms.

From 1 July 2009, a couple who are legally married and not living separately and apart from one another on a permanent or indefinite basis, despite one of the members of the couple having undergone gender re-assignment surgery, can be assessed in the same way as any other legally married couple.

I hope that this answers your question. Please contact me if I can be of further assistance in this matter.

Yours Sincerely,

Paula Nightingale
Cleveland Customer Service Centre
Ph 3383 0130

giving you options

This is the response that I received from Professor Alan Berman to my query.

kathy noble <> 05/11/09 12:28 PM >>>
Dear Alan,

Is there a law in place in Australia that enables States and Territories to 'FORCE TRANS PEOPLE TO DIVORCE?"  For that matter is there a law in this Country that forces anyone to divorce.

It appears to me that someone has invented this law to affect only the Trans community, so who was it, and when did it first raise its ugly head?

I have been told by divorce lawyers, that this situation cannot arise or, for that matter exist. They are totally disbelieving when I tell them that is the case so far as we are concerned.


Dear Kathy:

This is not my area of specialty but I have conferred with a family law specialist and he provided the following information.
There is no law to force people to get divorced. The removal of discrimination on 15 March 2009 (to take effect in respect of Centrelink on 1 July) means that the old “marriage like relationship” is now redundant. That phrase excluded same sex couples, so that they could obtain Centrelink benefits or greater Centrelink benefits that they would have been entitled to if they were married or heterosexual de facto relationship. Couples who had been excluded, now are being included, but with adverse impacts on their finances.

Those who are legally married will be considered by Centrelink as being legally married, therefore affecting their benefits.

I hope this is helpful.

With kind regards,

Alan Berman


I have sought answers from 3 legal people, one a professor about my reading of section 109 of the Constitution and also the possible affect this could have in light of the German Constitutional Courts ruling, plus the fact that Austria did this in 2006.

I am now awaiting answers to my query concerning our Constitution, as I feel that this when taken into account with the Austrian and German shift away from FORCING PEOPLE TO DIVORCE IN ORDER TO AMEND DOCUMENTATION, could have a World wide knock on affect


Please don’t forget that we are the only minority group that is forced to amend every piece of documentation, some 40 plus pieces, either before or after SRS. This can lead to unbelievable STRESS. 




Quotes from abroad

To overcome the stress factor and make the process more user friendly, each department should provide a page on their web site explaining just exactly what they need Trans people to do, when applying to amend documents. This is being done in the UK to explain how to apply for an identity card. It will be on the web site, hot line, and booklet that can be obtained from the department

Transsexualism is now understood to be innate and somantic rather than a lifestyle choice. Deprived of appropriate treatment, trans people are likely to function less well and suffer ongoing health problems resulting in a greater strain on the National health System

Parliamentary Forum on Transsexualism (2005); Guidelines for Health Organisations Commissioning Treatment Services for Individuals Experiencing Gender Dysphoria and Transsexualism; London, Parliamentary Forum on Transsexualism

GID if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death…delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and substance abuse problems, which further endanger patients’ health and strain the health care system

American Medical Association House of Delegates Resolution 122 (2008)


The personal accounts of transsexual people and their clinicians further demonstrate that surgical considerations often represent, quite literally, a matter of life or death

Kotula D. (2002) In The Phallus Palace, W.E. Parker (consulting editor) Alyson Publications, Los Angeles

Delays in the ‘system’, whether clinical or financial, cause a great deal of stress, While the inability to access timely treatment may also be a cause of suicidal feelings. As well as suicide, a number of other risks are identified:
Stress leads to a number of trans people to self-harm and even to attempt suicide…. These feelings may occur at any time, but they are often associated with the realisation that it is impossible to continue life in the pre-transition role. For some, the choice is stark: either the gender issue is addressed, or there is no future… Through frustration or anxiety, or both, some trans people self-harm by cutting their arms and legs and, occasionally, their offending sex characteristics, such as breasts (trans men) or the penis and scrotum (trans women). Alcohol and other substance misuse may also be a factor, especially where there is family breakdown and social isolation

GIRES et al. (2008) Guidance for GPs, other clinicians and health professionals on the care of gender variant people; document issued by the Department of Health (UK)


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