Frequently asked questions

Read through Monash Health Gender Clinic’s frequently asked questions for more information about the clinic and general gender information.

On this page

• General
• Referrals into the Gender Clinic
• Gender Clinic Services
• Assessments
• Starting at the Gender Clinic
• Hormones
• Surgery
• Supports
• Documents

General Information about the Gender Clinic

What is the Gender Clinic?

The Gender Clinic is part of the Monash Health network in Melbourne, Victoria, Australia. It also has links with the Monash University Department of Psychological Medicine. The largest government-funded clinic of its kind in Australia, we provide services for trans, gender diverse and non-binary people.

These include:

• assisting with exploring gender identity, informing about diverse way that gender is identified and expressed;
• assessing if a person is experiencing gender dysphoria;
• exploring how a person’s gender dysphoria may be lessened, through various medical and social interventions;
• assessing if hormonal and surgical treatments are suitable;
• providing psychological support with issues that relate to transition.

For more information, please visit our About the Monash Health Gender Clinic page.

Who can access the Gender Clinic?

We provide services to residents of the Victoria or Tasmania, who are

• trans, gender diverse and non-binary people of 16 years of age or older,
• their family members, and
• their partners.

We are also a resource for health care providers and community and advocacy groups.

Clients are referred for many reasons:

• they may want to just explore and achieve a better sense of their gender identity
• others who identify with a gender other than their birth-assigned gender may seek assistance to make their body as congruent as possible with their affirmed gender.

If attending the clinic in person, there are on-street parking options on Jackson St and other nearby streets. Please check parking signs for restrictions, time limits and fees. The most convenient public transport access are the 16 and 96 trams.

The main entrance and lifts are suitable for people using wheelchairs. Please advise about your needs when you confirm your appointment.

Clients may also be eligible for transport assistance. For further information, please see the Victorian Patient Transport Assistance Scheme (VPTAS) website.

Clients can have sessions conducted via teleconference, using HealthDirect. This is the preferred option since the start of the COVID-19 pandemic.

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Referrals into the Gender Clinic

How do I arrange an appointment to be seen at the clinic?

You will need to get a referral from a medical practitioner, such as a GP or medical specialist. They can submit this through eReferral by HealthLink, which is now our required method of referral; we no longer accept referrals by fax, email or post. Find up-to-date information about how to send a referral to Monash Health Specialist Consulting Clinics on the eReferrals page on our website. You can provide your health care provider with this information: information for health care professionals

If you are worried that your GP will not refer you, ask for a second opinion from another GP – click here for a list of GPs experienced with trans gender diverse and non-binary clients.

Gender Incongruence and Gender Dysphoria are internationally recognised medical conditions, for which patients are entitled to seek treatment. Please be aware that your GP may not have had experience of the trans and gender diverse community and may not be aware of procedures, but they can find guidance from HealthPathways.

A month before your first appointment, please provide the following:

• A report or psychiatric assessment from any previous or current mental health clinician (if applicable)
• A brief (1-2 pages) autobiographical statement explaining how gender dysphoria or gender variance has developed in your life, including information regarding schooling, friends, family and occupation.

This can give us an understanding of your background before we meet with you and provides an opportunity for you to consider your thoughts and feelings in your own written words.

Is there a waiting time for an initial appointment?

Waiting times vary throughout the year, check with our administrative staff when you submit your General Information Form and referral letter, or later via email to genderclinic@monashhealth.org with: surname, date of birth and Medicare number.

There are a range of private practitioners who provide similar services. Please feel free to discuss options with our Administrative staff.

If you have a referral for endocrinology at Monash health, you will not require additional assessment at the Gender Clinic.

Are there private practitioners who provide similar services?

Specialist gender-related mental health assessments are also provided by psychiatrists and clinical psychologists who work in the private sector. A list of these private providers are found (links below) in

• the service providers section of the Australian Professional Association for Trans Health main page.

Please note: you can remain on the Gender Clinic waiting list whilst seeing private providers.

These assessments are best done by specialist providers. If you are already seeing a counsellor, psychologist or psychiatrist; we suggest you still make sure that your assessment is done by mental health professional who specialises in gender dysphoria.

Clinicians working in the private system usually have significantly shorter waiting lists than the Gender Clinic. However, there are costs to see a private clinician, even after a Medicare rebate has been claimed. These extra costs can range from $20 to $120 per session. For up-to-date information regarding waiting times and consultation fees, please contact the clinicians directly. Contact details are provided in the attached list of private clinicians. You will also need to contact them directly to organize an appointment.

Please note: if you have a gender-related mental health assessment done by a private provider, this will not shorten your waiting time on the Gender Clinic waiting list. You will still see a Gender Clinic mental health clinician, with the usual waiting times involved. If you have a mental assessment previously done by a private clinician, your assessment with one of our clinicians is likely to be much briefer.

Informed consent primary care options

We encourage clients who only wish to commence hormone therapy to be referred to a clinic that provides care under the informed consent protocol. An exception is when a client has complex needs or is seeking more comprehensive mental health assessment and support, particularly if this is beyond a GP’s usual scope.

For more information about our intake criteria and a list of relevant clinics, see our Information for health professionals page.

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About the services at the Gender Clinic

What services are available for trans, gender diverse and non-binary people and their loved ones through the Gender Clinic?

The Gender Clinic itself provides mental health assessment and treatment, related to gender transition, for:

• gender identity, gender expression and/or gender transition related concerns
• social work and psychological support.

Gender Clinic clients can be referred to other departments in Monash Health for:

• Endocrinology for hormone assessment and prescription.
• Surgeries including hysterectomy (removal of womb), oophorectomy (removal of ovaries), tubal ligation (surgical contraception), and initial assessment for fertility preservation at Obstetrics and Gynaecology.
• Orchidectomy (removal of testicles) at Andrology
• Laser hair removal

Our clients can be referred to private service providers outside of Monash Health for:

• Most surgeries: breast reduction or enhancement and genital surgeries (vaginoplasty)
• Peer support
• Advice on presentation (make-up, etc)
• Fertility preservation
• Speech therapy

What services can I use while on the waiting list for assessment?

A range of needs can be helped while our clients are on our waiting list:

• Private mental health professionals or experienced GPs can conduct an assessment.
• Speech therapy (voice and communication training) at La Trobe Communication Clinic can begin. They accept referrals from health professionals, social workers, the Gender Clinic; or a self-referral.
• A referral can be arranged for laser hair removal at Monash Health.

Some mental health conditions can complicate the results of a mental health assessment (eg, psychosis or dissociative identity disorder). It is a good idea to seek treatment for these while on the waiting list.

Intake Call/Peer workers 
About 6-8 weeks after we receive your referral, our intake team will reach out to you for an initial phone assessment. This is to introduce you to our clinic’s services and help the clinic understand your gender affirmation objectives. The intake call should take no more than 30 minutes, during which we’ll explore your goals for attending the clinic and to ensure that the gender clinic is the most appropriate service for you. We may suggest alternative services that you can consider.

The clinic provides peer support by peer workers with lived experience. They can provide mutual support, information and practical assistance to Gender Clinic clients and carers/family as appropriate. They can also provide referral and liaison support to assist clients in accessing other LGBTIQ+ services. Individual and group peer support is available to clients referred to the clinic, including those on the waitlist.

Who is able to access the laser service? 

Free laser treatment is available for current Gender Clinic patients. This includes those on our waiting list. Referrals are accepted from your treating clinician or our intake worker.

What areas can be treated?

The Monash Health laser service is approved to treat any areas that a medical officer indicates has excess hair. That is not the same as all unwanted hair. For Gender patients, it means laser treatment is available to those areas of your body that are relevant to having your gender affirmed. The Gender Clinic will write these areas on the referral. This means the laser service may not be able to treat all of the body areas you wish.

The Monash Health laser service performs this service one referral at a time. If a client has new areas of excess hair, the first referral must be completed first. Then a new referral may be written for the new area. Please note: the maximum number of treatments offered per area is between 8 to 12 sessions. The exact number is determined by the dermal therapist, at their discretion.

How can I access Speech Therapy?

For many people, it is felt that the gender they were assigned at birth is reflected in their voice and the way they communicate. A gender transition can include modifying the voice.

People who wish to modify their voice or communication style as part of their gender transition can be referred to the La Trobe University’s Voice Clinic. Clients will usually see a speech therapy student who is in their final year of training. If so, that student will be supervised by a qualified speech therapist.

Speech therapy can be arranged at any time during your transition process. The service can range from:

• one or two sessions for voice analysis and advice, to
• regular weekly sessions for focused voice modification.

The needs of every speech therapy client is different. This therapy targets a person’s individual needs. It is not possible to say how many sessions are required to meet those needs.

You may wish to see a a private speech therapist. If so, you can discuss how to get a referral with your clinician.

How much do appointments at Monash Health cost?

There are currently no costs for attending appointments at Monash Health.

How much do gender affirming hormones cost?

Hormones are available on the PBS, and so usually cost between $6 and $40 per month. This depends on the hormone prescribed and if you have a health care card.

What does gender affirming surgery cost?

There are significant costs associated with surgery.

Costs of Reproductive organ surgery

Some surgeries are provided to trans masculine people by Monash Health at no cost to the client and no need for private insurance, including:

• removal of internal reproductive organs (hysterectomy and oophorectomy)
• tubal ligation for contraception.

For private hysterectomy and oophorectomy, out of pocket costs will vary between surgeons and hospitals.

Costs of Genital surgery (vaginoplasty)

To perform vaginoplasty, Monash Health requires that their clients take out private health insurance. Medicare only covers a small proportion of the procedures involved. The clinic is unable to assist with the cost of private health insurance.

The out-of-pocket cost of vaginoplasty, with top level private health insurance, is around $18-30,000. Please contact the surgeon directly for an up-to-date estimate of costs.

Costs of Chest reconstruction surgery

Medicare only covers a small proportion of the procedures involved in chest reconstruction surgery. For chest reconstruction surgery, the out-of-pocket cost is $6,000 to $18,000, depending on whether you have private health insurance. Please contact the surgeon directly for an up-to-date estimate of costs.

Limited financial support for Gender Clinic surgery patients

The Gender Clinic provides some financial support to a limited number of clients each year. This assists with out-of-pocket costs of vaginoplasty, vulvoplasty and chest reconstruction (mastectomy). This support is intended for those who cannot afford to pay for private surgery.

We do not reimburse costs for surgery that a client has already paid for. The surgeons charge us directly, and our clients wait in turn for the available funding. Please speak to your clinician for further information.

Private health insurance is recommended for surgery

For most gender transition surgeries, we strongly recommend private health with the highest level of hospital cover. This is needed to cover some of the costs of the surgery.

Please note: even with the highest level of private health insurance cover, there are still significant out of pocket fees. All health insurance companies have waiting periods (usually 12 months) before a claim can be made.

PrivateHealth.gov.au is an unbiased way to find private health insurance options  How much cost the private health insurance will cover depends on the type of insurance you have and the cost of the surgery. You can speak to your private health fund to ask them about the amount you will get back.

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About Mental Health Assessments

What are the WPATH Standards of Care and does the Gender Clinic follow these guidelines?

Standards of Care is a document published to communicate worldwide professional opinions about the treatment and management of gender dysphoria. Gender Clinic staff follow these guidelines when providing gender transition-related care.

WPATH is the shortened name for the World Professional Association for Transgender Health. WPATH is a non-profit, interdisciplinary, professional and educational organization devoted to transgender health. Its mission is to promote evidence-based health care, education, research, advocacy, public policy and respect in transgender health.

These guidelines can sometimes appear restrictive. However, it is important the Gender Clinic and its clients are cautious in how we deliver gender affirming care. Together, we must be sure it is highly unlikely that a client will regret having that treatment. However, the clinic applies the guidelines in a way that recognizes a person’s unique anatomical, social or psychological situation. This flexible approach aims to achieve positive outcomes for clients in a safe manner.

The Standards of Care are available at www.wpath.org. The Standards of Care were updated from version 7 to 8 in September 2022.

Why do you require a mental health assessment?

Having a gender identity that differs from the gender assigned at birth is not considered a psychiatric disorder. However, some mental health conditions that are not related to gender identity can present with gender variance. It is very important to rule out those conditions before we provide gender-affirming care. As a result, the clinic takes great care to ensure a comprehensive assessment is conducted first.

Also, these assessment identify any supports that may help with affirming gender before any medical treatments are commenced. We can then refer clients to appropriate services; such as assistance with housing, employment and social isolation.

Please note: clients who have a mental health condition such as schizophrenia, depression, Borderline Personality Disorder or Autism Spectrum Disorder are still eligible to receive support from our clinic. However, their assessment may be extended, to ensure that adequate supports are in place prior to any gender-related treatments.

A comprehensive mental health assessment is a very important part of the clinic’s work with clients. During the assessment your clinician will gather information about:

• Your experiences of gender at various stages of your life,
• Any gender-related distress,
• Your mental health history and current supports,
• Other relevant life experiences.

The purpose of this is to identify your strengths and what supports are needed as you embark on strategies to reduce your distress.

The assessment process is strictly private and confidential. We will not speak to your family unless there is an immediate risk to your safety or we have you clear consent to do so. We do however encourage meeting with families to provide education and discuss any concerns they may have, in order to help them support you during your transition.

What other mental health assistance is needed during transition?

Gender transition and the “Real Life Experience” of living in the affirmed gender can present a number of social and psychological challenges along the way. This can be helped through ongoing monitoring or counselling. Importantly, this is done with a mental health clinician that the client can form a trusting relationship with, so they can explore their gender identity with confidence. As everyone is unique, there is no standard number of the sessions needed or recommended.

Meeting regularly with a mental health clinician helps clients who are transitioning to achieve stability and satisfaction in their lives. by:

• Helping to find the best set of medical and social options
• Working through difficulties where they arise
• Addressing any expectations of the outcomes of transgender treatments and gender transition.
• Being a source of general support during transition.

What are “gender dysphoria” and “gender incongruence”?

“Gender Dysphoria” is the discomfort and unhappiness a person might experience as a result of the tension between the gender assigned to them at birth and the gender with which they identify (including non-binary gender identities). Not everybody who experiences gender diversity feels this distress.

The term ‘Gender Dysphoria’ is also used for a specific psychiatric diagnosis, found in the American Psychiatric Association’s Diagnostic and Statistical manual (DSM-5). However, the Gender Clinic team strongly reject pathologising gender diversity. We believe that psychiatrically diagnosing aspects of gender identity is damaging for our clients.

The Gender Clinic strongly supports efforts to depathologise gender diversity. This includes adopting the advice of the World Health Organisation’s International Classification of Diseases version 11 (ICD-11). It instead recommends using the term “Gender Incongruence”. When a diagnosis is required, that is the term we will use.

Staff at the clinic seek to work with our clients to individually select the best medical and social options for them. The WPATH Standards of Care notes:

“While many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options and some need neither. …

Health professionals can assist gender dysphoric individuals with affirming their gender identity, exploring different options for expression of that identity, and making decisions about medical treatment options for alleviating gender dysphoria (p9).”

If I have mental health issues or if I am neurodivergent will this impact my assessment?

Receiving care and treatment for mental health issues or neurodiversity issues will not prevent you from accessing our clinic or getting treatment with us. It’s not uncommon for trans and gender diverse people to have or to have had mental health issues or to be neurodivergent.

The Standards of Care do state that mental health conditions must be “reasonably well controlled … these concerns need to be managed prior to or [at the same time as] treatment of gender dysphoria.” Therefore having treatment for mental health conditions may assist in gaining approval for hormonal or surgical treatments.

Many of the clients we support have, or have had, mental health issues or are neurodivergent. Sometimes, their mental health assessment may take longer. This is only to ensure that the right supports can be provided, in preparation for any gender-related treatments.

The Gender Clinic is not a crisis/emergency service. As such, we must be sure that our clients have access to any needed support and treatments for mental health conditions, before we can approve hormonal or surgical treatments.

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Our clinic welcomes neurodivergent clients, including autistic people and people with ADHD. Neurodivergence is not a barrier to accessing hormones or surgery, but may mean the assessment will take more time. This is only to ensure that the right supports can be provided, in preparation for any gender-related treatments.

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Starting at the Gender Clinic

Government assistance with travel costs

Assistance with travel costs can be provided to people with demonstrated needs. You can contact the Clinic genderclinic@monashhealth.org to access a document for guidance on Government provided schemes, or talk to the social worker to discuss options.

Telehealth or face to face available

Both face to face and teleconference appointments are available. When booking your appointments the administrative assistant will discuss the use of teleconference. The gender clinic uses HealthDirect software (it’s is similar to Skype or Facetime but offers greater security). Gender Clinic staff are working both offsite and onsite. If you have an upcoming appointment, please contact our admin team to advise them if you would prefer a face to face appointment otherwise we will assume that the appointment is to be held via telehealth. Also advise the admin team if you would like to enter the building via a private side entrance, rather than the main front entrance.

What can I expect when I come to the Gender Clinic?

Gender Clinic clients often feel nervous before their first appointment. The clinic is a safe space for you to explore some very personal issues. Being honest and open with your clinician helps to form a comprehensive understanding of your experiences and needs.

There is no requirement about how you present your appearance at the clinic. We encourage you to dress in a whichever way makes you comfortable.

As a new client, you will be offered appointments at the clinic with a mental health professional. These are for:

• conducting an initial series of interviews for a mental health assessment, under the WPATH Standards of Care guidelines;
• with your consent, a detailed psychological assessment and/or a family assessment;
• discussing the treatment options that are best for you.

The mental health assessment sessions are:

• so that your clinician can gather information about your gender related experiences at various stages of your life and any associated distress;
• identify your strengths;
• assess what supports are needed as you embark on strategies to reduce your distress.

Some aspects of the assessment may be conducted by another member of the team. All assessments are discussed at regular staff meetings.

If clients are approved for gender affirmation therapies and wish to proceed, they can be referred to other clinicians for:

• Hormonal treatment to masculinise the body (partially irreversible) or feminise the body (which is largely reversible); and
• If appropriate and when additional criteria are met, surgical procedures (which are largely irreversible).

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About Hormones

What are the processes for starting on hormone therapy?

Both endocrinologists and GPs can prescribe hormones. Prescribing GPs use the Informed Consent model, and usually have some level of specialisation in gender-affirming care. GPs can independently prescribe feminising hormones, but masculinising hormones require a referral to a named Endocrinologist outside of Monash Health to be eligible for subsidized prescriptions under the PBS (Pharmaceutical Benefits Scheme).

If your GP prefers, we can refer you to a Monash Health Endocrinologist for hormone therapy. The endocrinologist may require you to undergo a full physical examination to ensure that you are physically well enough to be able to have hormone treatments. They will then write to your GP to advise on the type and dosage of hormone treatments and what monitoring will be needed throughout your treatment. If your GP or another service provider begins hormone treatment before or while you are on the waiting list, this will not affect your position on the waiting list.

Anyone assessed as not being appropriate for gender affirmation therapy will be offered support to find non-medical ways of living with their Gender Dysphoria/gender variance. If a client has non-medical interventions, they may then be offered the option of a future re-assessment.

If you consult the Clinic about hormone treatment, we will follow the criteria specified in the WPATH Standards of Care. The criteria to commence hormone therapy as specified in the Standards of Care must be satisfied prior to referral to the hormone prescriber.

If you and your allocated clinician agree that hormones may be helpful, you are referred to an endocrinologist or your GP. Assessment times vary, depending on your individual circumstances. Your clinician will review your progress after the initial set of 3-6 sessions.

Starting hormones could be delayed, If there are significant social or mental health issues that need to be addressed first.

After commencing hormones, individuals are invited to attend follow up sessions for support or other identified needs.

What are the impacts of hormonal treatments?

Hormone treatment plays an important role in the physical and psychological transition process for many clients who attend the clinic.

There can be medical, psychological and social side effects for all people receiving hormonal treatment and it is important to familiarise yourself with these prior to commencing hormones.

Birth-assigned males treated with feminising hormones can expect this treatment to result in:

• breast growth,
• some redistribution of fat,
• decreased body hair,
• slowing or stopping of male pattern balding,
• decreased testicular size,
• reduced fertility and less frequent,
• less firm erections,
• possible loss of libido.

Birth-assigned females treated with masculinising hormones can expect this treatment to result in:

• permanent deepening of the voice,
• permanent clitoral enlargement,
• mild breast shrinkage,
• reduced fertility,
• increased upper body strength,
• weight gain,
• facial and body hair growth,
• increased libido,
• decreased fat on the hips,
• possible male pattern baldness.

What if I have been taking hormones without a doctor’s prescription?

The clinic will see patients who have been begun hormonal treatments without medical supervision. However, reflecting a harm minimisation approach, we will refer you to an endocrinologist or experienced GP to assess the impacts and begin prescribing, so that hormones are taken in a controlled manner.

Obtaining hormones without a prescription is strongly discouraged by the clinic. Our advice is that for your health and safety, you should never take medication sourced through the internet or on the ‘street’. Starting hormonal treatments that are not medically supervised can be dangerous to your long-term health.

The clinic understands the enormous pressures that some people will feel about the need to begin a physical transformation. Despite this, the clinic will always advise that you wait until you have been assessed. The timing of hormone treatments is very specific to the individual and is dependent on a whole series of considerations that need to be made by you and your doctors.

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About Surgery

Why is surgery important for some clients, and what does it involve?

For some people, surgery is an important step in affirming their gender. This involves generally irreversible surgical procedures. It aims to provide a body that is consistent with their gender.

Types of gender affirming surgery
For clients assigned male at birth, surgery can include:

• removal of the testicles and penis,
• creation of a vagina,
• breast enlargement,
• rhinoplasty,
• laryngoplasty (shaving of the “Adam’s apple”),
• vocal cord surgery,
• facial feminisation surgery.

For clients assigned female at birth, surgery can include:

• chest masculinisation,
• removal of the uterus, fallopian tubes and ovaries.

Surgery to create a penis (phalloplasty) or metoidioplasty (clitoral release) is associated with a number of complications that led to the discontinuation of these procedures in Victoria. However, these procedures are still performed elsewhere.

Before surgery, the surgeon will detail to the client the nature of the surgical procedure, its risks and possible complications and the cost.

Providers of gender affirming surgery
At present the only surgical procedures available through Monash Health are:

• removal of the uterus and/or ovaries (hysterectomy and/or oophorectomy);
• removal of testicles (orchidectomy); and
• vocal feminisation.

Other procedures are performed by private surgeons, and your clinician will be able to assist in making referrals as appropriate.

The Gender Clinic itself does not offer other surgical treatments at this stage. However, we are able to provide letters of support to appropriate private surgeons. They can advise you of their fees when you make your appointment with them.

Financial support for surgery

The Gender Clinic is able to provide some financial support to a limited number of clients each year to assist with private surgical costs for:

• chest masculinization for clients assigned female at birth
• genital surgery for clients assigned male at birth.

To qualify for this financial assistance, a client must have been referred to the surgeons after consultations with Monash Gender Clinic clinicians. Please speak to your clinician for further information.

Obtaining gender affirming surgery from overseas providers

Surgery is available in Australia. However, some people may choose to pursue surgery overseas. Please note; the Gender Clinic does not have any official links or affiliations with any overseas surgeons.

Reputable overseas surgeons follow the same Standards of Care as our clinic. Therefore, they often ask our Clinic confirm in writing that we consider those same requirements for gender affirmation surgery have been met.

Complications can arise after gender affirmation surgery. Please note: if this occurs, Australian surgeons are reluctant to perform revision surgeries on work that was done by other surgeons.

When can I have surgery?

If you feel ready for chest masculinization or genital surgery, you will be referred to a surgeon for a medical assessment following your initial assessment. Once you have met with the surgeon you may then book a provisional date for surgery.

Within three months prior to your surgery date your mental health professional need to meet with you and supply a letter of support for surgery, in line with the WPATH Standards of Care. Once this is done, you can contact the surgeon to confirm your surgery date.

The recent Standards of Care guidelines (version 8) requires one opinion/referral for all gender affirming surgeries. However, some surgeons require two opinions for genital surgeries. If a second opinion from a different mental health professional within the team is required, this is usually completed in 2-4 sessions. Please check with your surgeon for their requirements and expectations.

Requirements for surgery set out in the WPATH Standards of Care are as follows:

1. Gender incongruence is marked and sustained;
2. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention;
3. Demonstrates capacity to consent;
4. Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options;
5. Other possible causes of apparent gender incongruence have been identified and excluded;
6. Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed;
7. Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated). [Suggested criteria]

Do I need to be living full-time in my affirmed gender before I have surgery?

There is no requirement in the WPATH Standards of Care 8 for people to live in a role congruent to their gender identity prior to genital surgery. However, it notes that such “social transition can be extremely beneficial to many TGD people.”

Social transition allows the person to develop stability in their affirmed gender, and to build confidence in their ability to live in the affirmed gender role. Gender transition has been known to contribute to employment discrimination, marital problems, divorce, and the restriction or loss of contact with children. Social transition helps raise awareness of these personal and social consequences.

On the other hand, the WPATH Standards of Care 8 also notes: “not all TGD people are able to socially transition or wish to socially transition. Consequently, some TGD people seek gender-affirming interventions after social transition, some before, some during, and some in the absence of social transition. Social transition and gender identity disclosure can improve the mental health of a TGD person seeking gender-affirming interventions. In addition, chest and facial surgeries prior to hormone therapy can facilitate social transition.”

What issues can delay or rule out surgery?

Treatment can be deferred for many different reasons. Your treating clinician will discuss your individual circumstances with you and will explore with you ways in which you can progress.

Having a high body weight increases risk in surgical operations. The surgeons who perform these operations have Body Mass Index (BMI) score requirements for patients who wish to undergo surgery. This BMI score requirement varies between procedures and surgeons. Excess body mass can create problems with breathing under a general anaesthetic, blood loss and causing difficulty with accessing the parts of the body where surgery will be performed. Generally, it is preferred to achieve a weight of under 100kg and BMI less than 30. You need to discuss these requirements with your surgeon.

Your BMI is calculated by dividing your weight in kilograms (kg) by your height in metres (m), then dividing the answer by your height again to get your BMI score. This is a commonly used method by doctors and nurses to approximate whether a person is under or overweight. You calculate your BMI using the BMI calculator. The calculator will also indicate how much over or under your ‘ideal’ weight you are.

Smoking also increases risk in surgical operations. There are already numerous health reasons for quitting smoking. This becomes even more important prior to hormonal treatments and/or surgery. All the hormone and hormone-blocking medicines prescribed to aid with gender affirmation raise the risk of an occurrence of Australia’s biggest killers: heart disease, cancer and cerebrovascular accidents (strokes). The surgeons may not offer treatments until you are able to quit smoking for a period prior to surgery.

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Support

What support is available?

• The Gender Clinic can provide support/explanation for partners, parents and children.
• We can help with support with recovery from surgery.

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Documents

How do I change my name and gender marker on personal documents?

Changing gender markers on ID varies between each State and the Commonwealth Government. A useful summary is can be found at Parents for Gender Diverse Children.

Victoria Drivers’ Licence 

https://www.vicroads.vic.gov.au/licences/renew-replace-or-update/update-your-details/change-of-gender

Medicare

https://www.humanservices.gov.au/individuals/enablers/update-your-personal-details-medicare-card

Centrelink, ATO, other Commonwealth government bodies

https://www.humanservices.gov.au/customer/enablers/updating-your-gender-details-us

Passport

https://www.passports.gov.au/passportsexplained/theapplicationprocess/eligibilityoverview/Pages/changeofsexdoborpob.aspx

Birth Certificate

Birth certificates vary by state, and can depend on a number of factors. Contacting your state Births Deaths and Marriages or equivalent is necessary to obtain the most up to date information.

• Victoria
• New South Wales
• Queensland
• Western Australia
• Tasmania
• South Australia
• Northern Territory
• Australian Capital Territory

Monash Health Records
Monash Health client records will follow the details on your Medicare card. Please advise if your Medicare card name and gender marker change. In the meantime, a preferred name can be registered on the Monash health system. You can also inform Monash Health staff of your preferred title and pronouns. The Gender Clinic will make every effort to respect your choices.

Keypass ID

The Keypass ID is an ID without a gender marker on it. It is available through Australia Post

Relationship Status

If someone change genders, they are still considered to have been in a defacto relationship.

Since the Federal same-sex marriage laws were passed, married people who transition can change identity documents including birth certificates, with nno need to divorce.

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