Jess has just turned 23, but in her eyes, she’s celebrating her first birthday

Ms Grayson, who started hormonal replacement treatment six months ago as an adult, did not get the chance to use the services at PCH – which was launched in 2015 – but regrets not deciding to transition sooner.

Growing up in the United Kingdom, Ms Grayson remembers feeling something wasn’t quite right. She dreaded going to the pool in her board shorts, longing to wear a bikini or swimsuit instead.

“My stepdad asked me if I felt I was a girl inside a boy’s body,” she said.

“I don’t remember having that discussion with him but he said I’d actually said ‘yes’.”

After withdrawing from social relationships and dating for about two years, Ms Grayson finally decided to come out as transgender with the support of her friends and family last August.

She has since spent about $10,000 on hormone replacement medication, doctor’s appointments, voice therapy, beauty treatments, and psychologist and psychiatrist care.

Jess Grayson during her childhood years. 

She has officially changed her name and legal documents and is now in the process of getting a referral to have gender reassignment surgery, an expensive procedure that can cost up to $30,000 and is only performed by a handful of Australian doctors.

“It’s a big thing to go through at the end of the day and it’s life-changing. You go through breast development, your skin changes, your fat redistributes around the body,” she said.

“Taking the hormones could cause chronic kidney failure, chronic liver failure, sudden cardiac death. It’s a risk, a lot to take in.”

In October, there were 392 children and young people accessing gender diversity services at Perth Children’s Hospital. Of those, 63 were in stage one, receiving puberty suppression treatment, and 62 were in stage two, receiving hormone treatment.

The number of children using the service has grown from 137 patients in 2016, or one to two new referrals a week, to four to five new referrals a week, with Transfolk WA claiming the wait time for an initial appointment had blown out to five years.

“This is untenable,” a Transfolk WA spokesperson said.

“It is five years of unnecessary pain, not just for individual children, but for families that must watch them suffer, and for families that struggle with their child’s gender identity.

“Many trans and gender diverse children will be unable to access puberty blockers at the appropriate developmental time to ensure that their body does not go through the irreversible changes that puberty brings.”

Child and Adolescent Health Service chief executive Aresh Anwar said there was a three-month wait time for an initial assessment, however the wait for a comprehensive mental health assessment with a clinical psychologist was 4½ years.

“Children and young people triaged as urgent may still wait a significant amount of time due to the increasing demands on the gender diversity service and we acknowledge that some wait times are unacceptably long,” he said.

“The GDS is concerned for the wellbeing of young people while they are awaiting further GDS care and encourages them to access other sources of mental health support and community peer support.

“Applications have been made to the Mental Health Commission for increased funding in the past and again recently to enable a large increase in service capacity.”

Of the 790 children referred to the service since it opened in July 2015, 77 patients were being prescribed estrogen or testosterone for gender affirmation at the time of discharge from the GDS and transfer to adult health care.

The gender diversity service, operated by the Child and Adolescent Health Service, does not provide surgical treatments, which are not currently funded by the public health system.

Dr Anwar said access to hormone treatment was generally for children older than 16.

“[Suppression and hormone treatment] can be provided when the young person’s gender identity and wishes for treatment are clear and stable for an extended period of time; when the young person has capacity to give informed consent to the treatment; and when the young person’s parents or guardians also give informed consent to the treatment,” he said.

The number of people applying to change their gender to the Gender Reassignment Board of Western Australia increased from 18 applications in 2014-15 to 42 applications in 2019-20.

Ms Grayson says she is still grappling with gender dysphoria.

She struggles to leave home without makeup and checks her reflection in mirrors and windows, constantly on the lookout for any masculine traits. She also avoids using public toilets for fear of being frowned upon and still worries about being assaulted or harassed in the street.

But she said her happiness was worth it.

“I always felt that I was holding something back from people because they didn’t know what was going on and I didn’t know what was going on,” she said.

“As time has gone on and I’ve branched out and I’ve started telling people, I’ve gained a lot more confidence in myself and talking to people about it.

“Life is not worth living if you’re not happy.”

Heather McNeill is a senior journalist at WAtoday.

Marta is an award-winning photographer and journalist with a focus on social justice issues and local government.