Lauren Salerno has given up on simple things such as putting her hair in a ponytail, afraid it will reveal her receding hairline.

The 53-year-old transgender woman was put on hormone treatment in the UK some years back, but unfortunately, this is not yet provided by Malta’s public healthcare services and she cannot afford it on her salary.

As she puts her treatment on hold, Ms Salerno continues with life, feeling that people are all the time judging her.

Ms Salerno moved to Malta last year, as recommended by her therapist, and soon after settling down here and even finding employment, the depression and anxiety that she had been experiencing dissipated.

However, she was informed that her gender reassignment treatment and hormone regime could not be provided by the public sector. She decided to challenge the decision and submitted an official complaint with the National Commission for the Promotion of Equality.

The NCPE decided in her favour, calling on the Health Department to implement a concrete plan enabling free access to gender reassignment services.

The decision brings new hope for her, but the delay in her treatment also means that those things that remind her of her male body are creeping back in.

She said she spent all her life fighting for dignity and was now feeling exhausted.

“It’s just like Chinese water torture. Most of the time I can deal with the drips, but if they become quicker, it just takes one drip to break you,” she said.

Brought up in Wales, Ms Salerno, born to a Maltese father, knew she was transgender from when she was a toddler.

“I remember being at school praying that I wake up the following day as a girl. I started crossdressing when I was around 13 years old, and luckily for me, that was around the same time that the punk and new wave era emerged.

I remember being at school praying that I wake up the following day as a girl

“I was able to cross-dress and be myself because of that scene.”

Ms Salerno’s life took several challenging turns and she enrolled at a rehab centre that included conversion therapy.

When she came out of rehabilitation in her early 20s, she knew she had to suppress her gender identity. She spent 20 years living as a man but still felt the need to cross-dress.

“I would go shopping, buy dresses and put them straight into a charity bin, never wearing them.

“I spent 20 years trying to keep busy. I was a probation officer and an LGBT rights advocate, but all the time I suppressed my identity.”

When Ms Salerno would look in the mirror, her mind would tell her that she was a woman, but her body would say she was a man. By the time she was in her mid-40s, she started cross-dressing again.

“I felt more myself, human and real. I was losing my grip on the reality that I had created, while the reality of who I was gradually became real.”

As Ms Salerno transitioned, she started hormone treatment. But the transition saw her lose everything: her job, home and friends.

“I spent my 51st birthday at home on my own. I hadn’t heard from anybody for a couple of weeks.”

Depression and anxiety locked her indoors, and her therapist urged her to change her environment. That is when she reached out to her family in Malta.

Disappointingly, despite Malta being at the forefront of LGBT rights, she had to put her treatment on hold.

But thanks to the NCPE decision, she now hopes she can help exert further pressure for free access to hormone treatment and gender reassignment services.

When contacted, human rights NGO Aditus Foundation joined the transgender community in urging the authorities to act on “this significant NCPE decision”.

This could be achieved by completing the notable work already done in this area and securing full access to the healthcare services required by transgender people, director Neil Falzon said.

Aditus was contacted by this newspaper as a rights organisation and not because it was acting on behalf of Ms Salerno.

Asked why gender reassignment treatment should be covered by the State, Dr Falzon said hormone and other treatments were fundamental for most transgender people, as they enabled them to live and express themselves in a manner that corresponded to their identity.

“These are not mere cosmetic changes made out of vanity but interventions that have the potential to dramatically improve a person’s quality of life and sense of dignity,” he said, adding that this had been recognised in Malta by the Gender Identity, Gender Expression and Sex Characteristics Act.

Government has to kickstart process

The government has to kickstart the process for free gender reassignment treatment for transgender people, the national equality commission has ruled.

It was commenting on Ms Salerno's case, who filed a complaint against the Health Department alleging discrimination on the grounds of her gender identity, among others.

The fact the commission had decided in her favour was not only a victory for her but also for those who were skipping lunch to afford even part of the treatment, Ms Salerno, who has dual UK-Maltese citizenship, said.

The National Commission for the Promotion of Equality concluded that Ms Salerno had been indirectly discriminated against on the basis of gender.

Commissioner Renee Laiviera recommended the Health Department implement a plan to enable free access to gender reassignment services. She also called on the government to put in motion a legislative process to address the legal situation of transgender people over free healthcare. This called for a concrete time frame and the budget and resources to implement free access.

Ms Salerno's is the first such case known to human rights NGO Aditus, which urged the authorities to act on the “significant” decision.