Medical Information (hormones etc)

If you are a medical practitioner (GP) seeking information about supporting a transgender or gender diverse patient this page may assist you. The Primary Health Network of Western Melbourne has also created a transgender health GP Module that may help GP’s in this field of medicine.

https://nwmphn.org.au/health-systems-capacity-building/trans-gp-module/ 

The Trans Hub website also includes some fantastic information and education resrouces to empower medical providers to better informed about health care provision, including prescribing, for trans and gender diverse patients. It also educates patients on what they may expect on their transition journey.
https://www.transhub.org.au/medical

The following documents can help guide a GP when exploring aspects such as Hormone Replacement Therapy. This includes health assessment and pre-screening (inc blood tests), initiating hormone therapy and monitoring ongoing care:

Hormone Therapy -prescribing-guideline-v3-aug-2020 and
Protocol-for-the-initiation-of-hormone-therapy-v2-aug-2020
written by Thorne Harbour (formerly Victorian AIDS Council) for Equinox and endorsed by AusPATH and Monash Health (Gender Clinic).

These documents can help ensure people have a clearer understanding of hormone therapy and break down some myths:
Testosterone-FAQ – Equinox (Victoria)
Oestrogen-FAQ – Equinox (Victoria)

Informed Consent Forms for medical practitioners prescribing HRT:
Informed Consent Oestrogen
Informed Consent Testosterone

All practitioners should carefully explore the risks and expectations of Hormone Replacement Therapy with a patient/client. Consider these extracts from the WPATH Standards of Care as a starting point for discussion:
Feminising Hormones Risks and Timelines WPATH
Masculinising Hormones Risks and Timelines WPATH

Aotearoa New Zealand also has an in depth document titled Guidelines for Gender Affirming Healthcare which utilizes informed consent models and practitioner information for initial assessment, prescribing, and ongoing care.
Guidelines for Gender Affirming Healthcare Aotearoa New Zealand

UNDER 18’s
The Australian Standards of Care and Treatment Guidelines: for trans and gender diverse children and adolescents (ASOCTG), aim to maximise quality care provision to transgender and gender diverse (TGD) children and adolescents across Australia, while recognising the unique circumstances of providing such care to this population.

Additional resource – Center of Excellence for Transgender Health (Uni of California – San Francisco)
An additional resource providing guidelines of care for gender affirming care of transgender and gender diverse persons. This is a very in-depth resource and highly regarded.

THSA reminds that these are tools for medical practitioners to provide patient informed care with the support of the practitioner. THSA does not endorse nor promote, in any way, self medication.

Extract from Transhub:
“In Australia, trans young people may commence puberty blockers with permission from both carers or guardians, and their doctor. This is usually coordinated through a multi-disciplinary team, when available.

A Family Court ruling (Re Jamie, 20174) overturned existing law that required an adolescent and their family to go to The Family Court of Australia to gain authority to commence puberty blockers prior to 18.

This ruling was further clarified in the judgment of Re Imogen 2020 to mean that treatment can be commenced in Australia with people under 18 when there is no dispute between parents (or those with parental responsibility), the medical practitioner and the young person themselves with regard to:

  • The Gillick competence of an adolescent; or

  • A diagnosis of gender dysphoria; or

  • Proposed treatment for gender dysphoria

Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re Imogen 2020.

Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a child’s parents or legal guardians consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers (“Stage 1”), hormones (“Stage 2”) or surgical intervention (“Stage 3”) without court authorisation.

For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court must be involved. Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones, or seeking to access them outside of medical care and oversight.

Further assistance for trans people is also available at Inner City Legal Centre who offer a NSW-wide free legal service for trans and gender diverse people.

AusPATH endorses local and international Standards of Care that offer guidance on puberty suppression for trans young people and adolescents.”


Testosterone Prescribing

Note – Primoteston injectable 200mg is no longer on PBS and is now written on Private Prescription as of February 1st, 2018. This means any GP can feel confident writing this prescription without requiring a specialist health provider to authorise it.

For trans masculine folk wishing to access hormone therapy (not including Primosteston), it can be a bit muggy knowing how to access anything but hopefully this clears it up. This is taken directly from the PBS federal guidelines under Medicare:

Of importance are the guidelines which are applicable for most (not all) trans masc:
 “Authority Required

  • Androgen deficiency  (THSA note – this is the most applicable to trans masc folk)

Clinical criteria:

  • Patient must have an established pituitary or testicular disorder.

Treatment criteria:

  • Must be treated by a specialist paediatric endocrinologist, specialist urologist, specialist endocrinologist or a Fellow of the Australasian Chapter of Sexual Health Medicine; or in consultation with one of these specialists; OR have an appointment to be assessed by one of these specialists.

The name of the specialist must be included in the authority application.”

This means a General Practitioner CAN prescribe once a referral has been written and an appointment made to a specialist as noted above.
THSA notes that in no way is this an endorsement not to access some health professionals and specialists. THSA values the work of practitioner specialists such as Endocrinologists and Sexual Health Physicians and encourages folk’ access the services they need in collaboration with their General Practitioner. This does however, empower GPs who feel capable and competent to be able to provide a service, to know they are able to do so without the need of a psychologist or psychiatrist if not deemed required for the individual.


Medication Prescribing for Transgender Women / Trans-Feminine Persons

Medications prescribed to those presumed male at birth (PMAB) do not have the same PBS and Medicare restrictions as testosterone. For example, androgen blockers such as Spironolactone or Cyproterone are considered  “General Schedule ” and do not have any “Authority” requirement as are medications containing estrogen/oestrodiol.

Trans Health SA acknowledges this means a suitably educated medical practitioner (GP) can prescribe these medications however it is highly encouraged to do so via a trained and experienced provider in trans and gender diverse health.


Position statement on the hormonal management of adult transgender and gender diverse individuals 

This following resource can help provide support for Medical practitioners when dealing with prescribing hormones and can be used as a guide in doing so.

you can download it HERE. or follow the link below.

https://www.mja.com.au/journal/2019/211/3/position-statement-hormonal-management-adult-transgender-and-gender-diverse