Psychiatrist Rob Lyons persists to form South Australian Gender Dysphoria Unit in 1996; fills trans services gap
South Australian Gender Dysphoria Unit, set up by psychiatrist Rob Lyons (left) with a team including gynaecologist Dr Rosemary Jones (right), filled the access to health care for the state's trans people, from 1996 until 2016,
Psychiatrist Rob Lyons stepped in to fill the gap in services for Adelaide’s transgender people left by Flinders Medical Centre Gender Clinic closing in 1988 and its founder Michael Ross moving interstate.
Ross was involved in lobbying that led to South Australia’s Sexual Reassignment Act 1988, making it the first state to offer a mechanism for 27 of 88 trans people who had surgery to obtain a certificate recognising their affirmed gender.
The hurdle in the Act was that it ruled that a gender reassignment procedure could only be done at a hospital approved by the South Australian Health Commission and by a medical practitioner approved by the commission. The drafters of the law envisioned that the South Australian Health Commission would approve the Flinders Medical Centre Gender Clinic and that trans health care would operate predominantly from there. Once that clinic closed in 1988, it became difficult for trans people to access health care and also for any health practitioner who wished to work in that space.
Psychiatrist Rob Lyons, with previous limited links to Flinders Medical Centre Gender Clinic, began to receive referrals and quickly became South Australia’s principal specialist working with trans clients. Lyons didn’t have a hospital position so he wasn’t authorised to do any medical or surgical reassignment procedures. Lyons could consult with trans clients and, if they fitted the diagnostic criteria, referred them to the Monash gender dysphoria clinic in Melbourne. This meant delays for trans people in South Australia to access affirming health care, although the South Australian patient assistance transport scheme covered travel costs to and from Melbourne.
Lyons continued psychiatric consultations with the trans clients while doctors from Melbourne prescribed hormones and did gender affirmation surgeries. Essentially, Lyons and other affiliated health practitioners skirted South Australia’s Sexual Reassignment Act by outsourcing the work to Melbourne. Lyons for years sent unsuccessful letters to the South Australian Health Commission and politicians explaining how the Act was denying health care to trans people.
In 1995, Lyons began to assemble a team and applied to the South Australian Health Commission to be an approved practitioner. He approached the Adelaide Clinic to provide supporting psychiatry and endocrinology while Hindmarsh Hospital agreed to sponsor any surgical procedures. In 1996, the South Australian Health Commission approved Rob Lyons setting up the South Australian Gender Dysphoria Unit.
Though a private practice, the South Australian Gender Dysphoria Unit operated similarly to the Melbourne unit with Lyons and other psychiatrists, psychologists, gynaecologist Dr Rosemary Jones, as well as plastic surgeons. The doctors could lawfully prescribe hormones and other gender-affirming treatment (usually by Rosemary Jones).
The team followed Harry Benjamin International Gender Dysphoria Association standards of care. A surgeon was available to perform top surgeries for both trans men and women as well as hysterectomies but any other bottom gender affirmation surgeries continued to be referred to surgeons in Melbourne.
From 1996 until 2016, the South Australian Gender Dysphoria Unit and affiliated doctors were the only approved providers of trans health care in South Australia. This meant significant waitlists of up to two years to access care, adding distress to transgender people and their mental health. There was the occasional general practitioner who prescribed hormones to trans clients regardless of the state law, including at least one doctor who had a reputation for doing this. They argued that their duty of care to provide medical care obligated them to prescribe hormones and overruled any state act.