Medical

This section currently provides some basic information about various healthcare providers.

In time, this section will expand to include information about:

  • Additional details regarding each listed healthcare provider
  • Hormone therapy
    • Feminising hormones
    • Masculinising hormones
    • Access to hormone therapy
  • Surgeries
    • Feminising surgeries
    • Masculinising surgeries
  • Mental health
  • Sexual and reproductive health
  • Alcohol and other drugs

Finding healthcare providers

Finding healthcare providers that are knowledgeable and experienced in the realm of transgender and gender diverse medicine can be challenging. The vast majority of health practitioners will not have received any formal training in delivering gender affirming care. As a result, they may lack the vocabulary and understanding necessary to adequately address the needs of their transgender and gender diverse patients.

Why is this such an important issue?

Transgender and gender diverse people typically require the input of multiple healthcare providers (see below) to initiate and maintain gender affirming care. Studies show, however, that one in four transgender Australians are denied access to healthcare. Transgender individuals also report high levels of dissatisfaction with the health system.

What are the barriers contributing to substandard healthcare?

There are several barriers that contribute to the substandard healthcare of transgender and gender diverse patients, including: Inadequate education of healthcare providers, insensitive interpersonal communication, difficulty obtaining referrals, or outright refusal of care. In many instances, the patient needs to educate their healthcare provider about how to meet their needs. “Gatekeeping” is another issue, in which a healthcare provider overrides patient autonomy to control and limit access to further gender affirming treatment. Finally, lack of access in regional and rural communities often means that individuals have to travel great distances or move to a major city to receive gender affirming care.

How can I find a healthcare provider that will fulfil my needs?

It is important to engage with healthcare providers that practice in accordance with the World Professional Association for Transgender Health (WPATH) standards of care; most will also be members of the Australian and New Zealand Professional Association for Transgender Health (ANZPATH). Such healthcare providers are most suited to provide gender affirming care.

The following is a list of healthcare providers that transgender and gender diverse patients may encounter:

  1. General Practitioner (GP) – specialist medical doctor involved in all matters of health. Coordinates care by referring patients to other specialists (such as to psychiatrists, endocrinologists, etc.).

  2. Counsellor - A person trained to give guidance on personal or psychological problems.

  3. Clinical Psychologist – provide tools, techniques, and strategies to help improve one’s psychological well-being, including managing gender dysphoria, depression, and anxiety.

  4. Psychiatrist – specialist medical doctor involved in the assessment of gender dysphoria, as well as assessment and treatment of mental health concerns such as depression and anxiety. As per WPATH guidelines, assessment from a psychiatrist is necessary prior to commencing hormone therapy.

  5. Endocrinologist – specialist medical doctor involved in the assessment and treatment of hormonal and metabolic problems. Endocrinologists initiate hormone therapy after assessment by a psychiatrist and monitor its effects.

  6. Surgeon – specialist medical doctor involved in gender affirmation surgeries. Surgeons often become subspecialised to perform specific surgeries/procedures.

  7. Other healthcare providers – Nursing Staff, Sexual Health Physicians, Gynaecologists, Drug and Alcohol Services

A list of healthcare providers that practice in NSW and other Australian states that are members of ANZPATH can be found at http://www.anzpath.org/about/service-providers/

Mental Health

Is being trans or gender diverse a ‘mental illness’?

NO, absolutely not. Just because you do not identify with your assigned sex at birth or comply with socially constructed gender roles does not mean you have a mental illness.

According to a 2017 poll, 1 in 5 people believe that being transgender is a mental illness [1] despite significant changes in the American Psychiatric Association’s (APA) DSM-5 in 2013. ‘Gender Identity Disorder’ has been replaced with ‘Gender Dysphoria’ in an attempt to remove any stigma and the connotation of being ‘disordered’ [2]. Furthermore, the American Psychological Association states that “a psychological state is considered a mental disorder only if it causes significant stress and disability” and “many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder” [3].

The APA feels that gender dysphoria should remain as a diagnostic term to protect access of trans and gender diverse patients to healthcare, but should “not be used against them in social, occupational, or legal areas” [2:1]. Most countries, Australia included, support this notion although countries such as Denmark are beginning to abandon the term in medical practice altogether to prevent stigmatisation and indirect discrimination [4].

Sources


  1. YouGov US 2017 poll: "To what extent do you believe that being transgender is or is not either a choice and/or mental illness?" ↩︎

  2. APA DSM-5: Gender Dysphoria ↩︎ ↩︎

  3. APA What does transgender mean? ↩︎

  4. Scientific American: "Denmark becomes the first country to declassify it as a mental disorder" ↩︎