Sarah Adcock lives in Wagga Wagga, a town of 55,000 people five hours south-west of Sydney.
Eight years ago she realised she was trans and wanted to explore her options.
“When I first started looking for medical assistance, I didn’t ask my GP, I didn’t feel comfortable,” she told SBS.
“Right or wrong – and I might be selling them short on this – I didn’t have the resilience to go through the process of them not knowing what to do with me,” she said. “It’s a conservative place and doctors are conservative people.”
Adcock ended up going to Canberra for treatment. Back in Wagga, she found support in private Facebook groups, where she now provides supports for others.
“I was able to use Skype for specialists, which was fantastic,” she says.
"In the country there are a lot of trans people who have extremely limited access to transition related healthcare," said Teddy Cook, team leader in regional outreach for ACON, an organisation dedicated to LGBTI health promotion.
Many trans Australians end up driving hours and hours to metropolitan centres where they can see a doctor they feel comfortable with. Others move permanently.
In Albury–Wodonga, Dr Rachel Richardson, Sub-Dean Teaching and Learning at Charles Sturt University, struggled to find someone she was comfortable speaking with.
“I looked around all over,” she said. Richardson eventually scheduled an appointment with her GP. It was the first time she would tell someone that she identified as a woman.
“I was in tears, I could hardly speak,” she said.
“When I tell you this thing that I’ve never told anyone else before in my life, will you just please believe me,” Richardson remembers thinking.
“The GP, who was my long term GP, realised what strain I was under and did all the right things,” she said. “He fully admitted he had never encountered this before, he had no idea even who he could refer me to."
Richardson had done her research, and ended up with a referral to the Monash Gender Dysphoria clinic. She was also referred to a local psychologist, but that didn’t go so well.
Richardson says she presented as a somewhat feminine man at that point. “I think he just maybe thought I needed to man up,” she said.
“I don’t really know what to do, but would joining the local men’s shed help?” the psychologist suggested.
It's a problem many trans Australians encounter.
In close-knit communities it can be a struggle to find a doctor you can trust to keep your first disclosure confidential, and even more of a struggle to find a doctor who knows what to do when faced with a trans patient.
On specialist health issues, such as trans treatment, regional doctors suffer the same problems as their patients – isolation. Being disconnected from medical networks which share knowledge and advice can lead to ignorance, trepidation, or fear of litigation.
It's not just a problem in rural areas. Doctors told SBS that even in capital cities - such as Adelaide or Brisbane - the same problems persist.
SBS understands that in South Australia there is only one practicing psychiatrist with expertise in gender dysphoria.
It’s crucial for that first disclosure to go well, Richardson said, a lot of people are at the end of their tether by that point.
Trans people in rural Australia are more likely to self harm and more likely to commit suicide than their metropolitan counterparts, studies show.
“It’s a moment of social suicide, in their minds at least,” she said. “If it didn’t go well I would have been in a very, very bad place.”
Being transgender in rural Australia is a challenge one of Australia's most prominent trans icons, Cate McGregor, knows well.
She grew up in a Catholic family in Toowoomba, southern Queensland, in the 50s and 60s. McGregor remembers her mother flying into a rage when she discovered her young son trying on her dresses.
It was decades before McGregor would be able to come out as a trans woman.
"It’s amazing the bliss and ease in my own skin," she later said.
Access to trans healthcare can be particularly challenging, also, for children and teenagers struggling with their gender identity.
“They can’t find someone who will get them onto hormone therapy, and they have to go a major centre which can be a real barrier,” Sarah Adcock said. “The two things that constantly come up - access to hormones is problematic, and support from parents is an issue.”
“Those two things combined and you’re really up against it,” she said adding that traveling hours to see a specialist can be problematic for teenagers, especially if a family is hostile.
Puberty can be a particularly tough time for trans teenagers, with physical developments potentially exacerbating feelings of gender dysphoria (the feeling you're in the wrong body).
Puberty blockers can put a pause on sexual development, simplifying later transition treatment or allowing individuals more time to consider their options.
In some studies, young people have reported feeling overwhelmed by having to educate schools, teachers and doctors on trans issues - the very people they hoped to reach out to for help and advice.
But transition healthcare doesn't have to be as difficult to access as it currently is, Cook says. “GPs can provide access to hormones and local mental health professionals with counselling, if requested,” he said.
Sarah Adcock says she’s heard of cases where people are feel that they have to force their doctors into treating them, purchasing hormones online and later telling doctors they need to run tests because they’ve already commenced self-treatment.
Transition specialists strongly discourage this.
But it's not all bad news in regional Australia.
“Despite the challenges, many, many transgender people are more and more starting to live their gender truth,” Teddy Cook says. “Where there is social connection, there is better mental health.”
SBS spoke with Holly, a construction worker in Wagga Wagga who's just started hormone therapy to transition from male to female. It's going really well, she told us, "I've been accepted by not just my colleagues but also all our tradies and contractors."
Rachel Richardson also told us things are getting better. “Sometimes you feel like you're the only trans person in the village – but there are a lot of us,” she said.
“You see somebody that’s just like you and you realise, hey it’s going to be okay.”
Want to speak to someone?
Monash Gender Dysphoria Clinic: (03) 9556 5216 | GenderClinic@MonashHealth.org
Kids Helpline: 1800 55 1800
Beyond Blue: 1300 22 4636