Key messages

  • Trans and gender diverse (TGD) people do not identify with the gender they were assigned based on their body at birth.
  • In general, the health and wellbeing of TGD people is markedly worse than that of other LGB people and the general population due to discrimination.
  • TGD people often experience social isolation, exclusion from their family and discrimination. As a result of this discrimination, many TGD people experience high levels of anxiety, depression, self-harm and/or suicide. 
  • Assisting with mental health and wellbeing issues, as well as acceptance of TGD people, should be a major priority for service providers.

Some people do not identify with the gender they are assigned based on their body at birth and some do not fit into the binary concept of male and female. Gender may be male, female or somewhere in-between. These people are often referred to as trans and gender diverse (TGD).

Key issues for services

Key issues for services working with TGD people include:

  • Using the preferred names and pronoun for TGD people and ensuring that documentation relating to gender and title is correct.
  • Understanding that gender identity can be fluid over time.
  • Gender identity should be differentiated from sexual orientation and intersex. TGD people have the same possibilities for sexual orientation as the general population and some TGD people might also have a LGB sexual orientation.
  • Health and wellbeing needs are not always associated with gender identity. Only ask questions about a person’s gender identity or physical transition if it is clinically relevant.
  • Many young trans children transition to their preferred gender at school and might need assistance within the school environment.
  • TGD people may avoid or delay seeking care at health services due to actual or perceived transphobia and/or lack of knowledge about transgender health and wellbeing.
  • Confidentiality about a TGD person’s gender is very important.
  • Some TGD people have specific medical issues associated with gender affirmation treatments.

Services for adults

Referral to the Monash Gender Clinic can allow adults to consider options such as permanent transition through surgery and hormone treatment. For some, personal expression of gender may not include surgical or medical treatment but may be achieved through options such as clothing choices or name change.

Services for children

Children and family services may work with children showing signs of conflict between their gender identity and their gender of upbringing. Early assessment is recommended so that support needs can be identified. Depending on age, supports may include reversible hormonal treatment to delay puberty until the child can make a mature and informed decision about their gender. 

Specialised genderservices at the Royal Children’s Hospital work with young people under 18 years and their families.

Health and wellbeing

In general, the health and wellbeing of TGD people is markedly worse than that of other LGB people and the general population.

TGD people often experience social isolation, exclusion from their family and discrimination due to ignorance around gender diversity. As a result of this discrimination, many TGD people experience high levels of anxiety, depression, self-harm and/or suicide.

Assisting with mental health and wellbeing issues, as well as acceptance of TGD people, should be a major priority for service providers.

Health issues for trans men

  • Some trans women may have a lifelong need for oestrogen therapy (at lower levels if they have had an oophorectomy).
  • Regular cervical screening is needed if the cervix has not been removed.
  • Advice and referral may be needed for chest reconstruction (bilateral mastectomy).
  • Breast screening may be required in transgender men who choose not to have chest reconstruction or if significant amounts of breast tissue remain following surgery.
  • Bone density screening should be considered for those over 50 years of age who have had testosterone therapy for more than five years.
  • Trans men may have different sexual identities and socialise in different social groups. Their health risks may be the same as the risks of the group they associate with, for example gay transgendered men may have the same risks of STI and substance misuse as gay men.
  • Speech therapy may be required.

Health issues for trans women

  • Some trans women may have a lifelong need for oestrogen therapy, at lower levels if they have had oophorectomy.
  • Many trans women opt for genital gender reassignment surgery.
  • Speech therapy may be required to increase the pitch of the voice.
  • Age-appropriate prostate screening is required.
  • Age-appropriate breast screening is recommended for trans women taking oestrogen.
  • Regular cholesterol and blood pressure monitoring is recommended for those taking oestrogen therapy.

For gender diverse people that identify as neither male or female, it will be important to consider the health issues (above) that are associated with their biological sex at birth and any hormones they may be taking.

Support services

Young People (under 18):
Royal Children’s Hospital Gender Clinic

Adults:

Monash Gender Clinic 

General practitioners:

Northside Clinic

Prahran Market Clinic

Counselling:
Drummond Street Services

Schools:
Safe School Coalition Victoria

Voice clinic:
La Trobe University Voice Clinic

Community groups:
Genda
Genderqueer Australia
Seahorse Vic support group
TransFamily
Transgender Victoria
YGender (young people)
Gender Centre

References

Leonard, W., Pitts, M., Mitchell, A., Lyons, A., Smith, A., Patel, S., Couch, M., and Barrett, A., 2012, Private Lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians, in: MonographSeries Number 86 (H. S. Australian Research Centre in Sex, ed.), La Trobe University, Melbourne.

GLBTI Health and Wellbeing Ministerial Advisory Committee, 2014.  paperTransgender and gender diverse health and wellbeing background . Victorian Department of Health.

Pitts, M. K., Couch, M., Mulcare, H., Croy, S., and Mitchell, A., 2009, Transgender people in Australia and New Zealand: Health,well-being and access to health services,  Feminism & Psychology 19(4):475-495.

Williams, M. E., and Freeman, P. A., 2007, Transgender health: Implications for aging and caregiving., Journal of Gay and Lesbian Social Services 18:93-108.