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.
SA Health Launches Statewide Gender Diversity Model of Care
The Statewide Gender Diversity Model of Care (MOC) has been developed to improve timely access to appropriate and evidence-based gender health care and support for South Australians who are trans, gender diverse, non-binary or gender questioning and their families/carers, and establish clear pathways for service access. The MOC describes how health services will be delivered, including who the services are for, how they can be accessed and the types of services available. Launched 25/09/2023.
Statewide Gender Diversity Model of Care | SA Health – weblink
SA Health Statewide Gender Diversity MOC– PDF Download
AusPATH: Australian Informed Consent Standards of Care for Gender Affirming Hormone Therapy.
To mark Trans Day of Visibility on Thursday 31 March 2022, Australia’s peak trans health body AusPATH has launched the Australian Informed Consent Standards of Care for Gender Affirming Hormone Therapy.
These new national Standards of Care are intended to assist and enable clinicians across Australia to better meet the medical gender affirmation needs of their trans women, trans men and non-binary patients. They unapologetically centre the trans person seeking hormonal intervention and empower the clinician to facilitate this access.
These guidelines reflect the consensus of AusPATH’s active membership, and as Australia’s peak body for professionals involved in the health, rights and well-being of all trans people, binary and non-binary, it was entirely appropriate for AusPATH to develop and publish them. The AusPATH Board is proud to have majority trans Directors, with all Sub-Committees inclusive of trans health professionals. AusPATH’s Board and Sub-Committees also include incredible cis allies.
PDF Version – AusPATH_Informed-Consent-SoC_2022
The Trans Hub website includes some fantastic information and education resources 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 Gender Affirming Hormone 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
Testosterone Prescribing
Primoteston injectable 200mg is NOT on PBS and is 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 persons wishing to access masculinising gender affirming 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 an appropriately educated medical practitioner (GP) can prescribe these medications.
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.
ASHM & ACON’s Trans And Gender Diverse Sexual Health Care E-Learning
This ASHM course has been co-designed and developed for clinicians working in a sexual health clinical setting or delivering sexual health care in primary health care settings.
It consists of five modules that should be completed in sequential order. It will take you approximately one-and-a-half hours to complete all five modules. The modules include: trans and gender diverse community, sex and sexual health, trans people and reproductive health, an introduction to gender affirming health care, creating safe and inclusive environments.
AusPATH Endorsed and is a CPD Activity under the RACGP CPD Program. 3 points allocated.
https://ashm.org.au/training_cat/ashm-acons-trans-and-gender-diverse-sexual-health-care-e-learning/
Advanced Gender Affirming Hormone Therapy (GAHT)
This ASHM course has been co-designed and developed for eligible prescribers of gender affirming hormonal therapy, including those working in a sexual health clinical setting or delivering sexual health care in primary health care settings.
By the end of this course, learners will be able to:
- Assess clients holistically in prescribing GAHT, including but not limited to pharmaceutical contraindications, fertility, contraception, sexual function, disease prevention and adverse health outcomes.
- Implement an informed consent model of care in prescribing GAHT.
- Interact with clients respectfully, making them feel comfortable by creating an affirming, safe and inclusive environment beyond the clinical consultation.
- Integrate effective referral pathways to seek expertise and coordinate care for clients, their partners and families.
https://ashm.org.au/training_cat/advanced-gender-affirming-hormone-therapy-gaht/