For Ash Russell, the journey towards embracing their authentic self has been life changing, but it hasn't been easy or cheap.
The 27-year-old began the process of coming out in 2020 but wasn't able to get an appointment for hormone replacement therapy until a year later.
"I recall going to a friend's house the night before my first appointment and crying all evening and we came up with tactics to help me make it through these appointments with minimal stress," they said.
It took another four months before they were able to access the medication.
"My journey is ongoing but so far we're three years in and I still haven't got close to where I want to be," they said.
Ash is just one person who took park in an Equality Tasmania survey which heard from more than 80 transgender and non-binary Tasmanians about their experiences accessing gender-affirming care.
It found the main barriers for people accessing care were the high cost and certain services being available interstate only.
"I am a very poor and a student. I managed to save money only due to the coronavirus supplement. I expected to receive this surgery maybe around age 30, after graduating and finding a stable job. Just got lucky I guess," one respondent said in the survey.
Ash said there have been delays in accessing hormone therapy sessions.
"When I went to access care I was made to wait a certain number of months before my next appointment, almost as a cooling down period, just in case I was going to change my mind about being transgender in that time which obviously didn't happen," they said.
"To access my first appointment for hormone therapy, I had to wait about six months from my first referral to actually accessing care.
"For surgery, I'm currently on a waitlist and I'm going to have to wait over a year to get into a hospital in Tasmania that will allow me to have that transgender surgery."
Report lead and researcher Ruby Grant says the survey notes the average wait time for people to see a medical practitioner was up to six months.
"It's important to understand that many trans and gender diverse people spend years coming to the decision to actually come forward and access care and support," she said.
"To wait an additional three to six months or more can be really distressing for some people."
An additional burden for some, according to Dr Grant, is having to travel interstate for a certain treatment.
"Sometimes the care they wanted just wasn't available [in Tasmania]. Sometimes they just really wanted to be more anonymous in their care or they saw it was just easier to go to Melbourne to access the care," she said.
Ash said they have been going through an "incredibly stressful" time.
"Luckily for me I didn't have to access gender-affirming care interstate because I was able to access what I needed here in Tasmania. However, the caveat of that is I have really long wait times," Ash said.
"Normally you go to a doctor, you get medicine quite quickly and that would help your symptoms. My symptoms I'm having to live with for years at a time before I can get care that can help with it."
Services cost tens of thousands of dollars
Services that fall under gender-affirming care may include puberty blockers, hormone therapy treatment or body reassignment surgeries — which can cost between $20,000 to more than $100,000, depending on the number of procedures.
"I've been able to afford hormone replacement therapy because that can be covered on the [Pharmaceutical Benefits Scheme] but surgery is still something that is not covered by Medicare and is prohibitively expensive," Ash said.
Dr Grant said one of the biggest findings from the report was respondents facing a negative reception from healthcare providers who did not have expertise in gender diverse people's health and wellbeing.
It's an experience Ash faced themselves.
"When I did actually manage to access care I had a really difficult time because I felt like I had to present a certain way — I felt like I had to present to gender stereotypes that they expected of me to be able to be taken seriously," they said.
One of the respondents of the survey said there should be mandatory education on the issue for "all people working in the medical community".
"I'm sick of gambling on whether or not the doctor I'm about to see will make inappropriate comments [or] have no understanding of the trans experience," they wrote.
Ash said they accessing services was life changing.
"It was like the world turned upside down. My life feels so different now and I'm just a much happier person because of it," they said.
While the report made recommendations to increase funding to the sexual health service, to address demand and reduce wait times, Ash hopes it also encourages health practitioners to approach care with more compassion and empathy.
"We are just the same as everyone else and we're just seeking medical care to better our lives," they said.
