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 relating to gender and title is
- 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 .
- 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
- Some TGD people have specific medical issues associated with gender
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
Specialised 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
- Advice and referral may be needed for chest reconstruction
- 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
- 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
- Age-appropriate prostate screening is required.
- Age-appropriate breast screening is recommended for trans women
- 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.
Young People (under 18):
Royal Children’s Hospital
Monash Gender Clinic
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Couch, M., and Barrett, A., 2012, Private Lives 2: The second national
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GLBTI Health and Wellbeing Ministerial Advisory Committee, 2014.
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Pitts, M. K., Couch, M., Mulcare, H., Croy, S., and Mitchell, A., 2009,
Transgender people in Australia and New Zealand: Health,well-being and
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