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.
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.
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.
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
written by Thorne Harbour (formerly Victorian AIDS Council) for Equinox and endorsed by AusPATH and Monash Health (Gender Clinic).
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
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 Kelvin, 2017) 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.”
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:
- Androgen deficiency (THSA note – this is the most applicable to trans masc folk)
- Patient must have an established pituitary or testicular disorder.
- 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.
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.
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.