Dr. Ada Cheung in clinic

Austin Health researchers write the first guidelines on transgender care

A team lead by Austin Health endocrinologist Dr. Ada Cheung has written the first ever set of guidelines to guide doctors in the care of transgender and gender diverse Australians.

Ada says that her team wrote the guidelines, as well as a position statement published in today's Medical Journal of Australia, because of feedback from the transgender and gender diverse (TGD) community that there are too many barriers to accessing hormone therapy - particularly the requirement for extensive mental screening from a psychiatrist before treatment can start.

"Estimates suggest that 0.1-2.0% of the population are TGD, yet medical education in transgender health is lacking. We aim to provide general practitioners, physicians and other medical professionals with specific Australian recommendations for the hormonal and related management of adult TGD individuals," says Ada, who also has an appointment at The University of Melbourne.

She says that Austin Health played a leading role in developing the guidelines because of our role in a consortium that is setting up new multidisciplinary health clinics for TGD patients in Preston and Ballarat.

"These guidelines will pave the way for how these clinics function," she said.

"They include that a treating practitioner can go ahead and prescribe hormone therapy without needing a psychiatrist to do an extensive assessment - informed consent is a reasonable approach if the person doesn't have a severe mental health illness."

Other recommendations include that:

  • hormonal therapy is effective at aligning physical characteristics with gender identity and in addition to respectful care, may improve mental health symptoms;
  • masculinising hormone therapy options include transdermal or intramuscular testosterone at standard doses;
  • feminising hormone therapy options include transdermal or oral estradiol; additional anti-androgen therapy with cyproterone acetate or spironolactone is typically required;
  • treatment should be adjusted to clinical response. For biochemical monitoring, target estradiol and testosterone levels in the reference range of the affirmed gender;
  • monitoring is suggested for adverse effects of hormone therapy;
  • preferred names in use and pronouns should be used during consultations and reflected in medical records;
  • while being TGD is not a mental health disorder, individualised mental health support to monitor mood during medical transition is recommended.

"Gender-affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring," the team wrote.

"Further research is needed to guide clinical care and understand long term effects of hormonal therapies."

"We provide the first guidelines for medical practitioners to aid the provision of gender-affirming care for Australian adult TGD individuals."