Frequently asked questions
Important information
The Gender clinic is unable to accept referrals for 3-6 months from March 27 2020 due to the Covid-19 pandemic. You can contact private providers as listed on our information for clients page.
General
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 clinic is the largest government-funded clinic of its kind in Australia, and provides services for trans, gender diverse and non-binary people. These include:
- assisting a client to explore their gender identity and providing information about the diversity of gender identities and expressions;
- assessing whether a person is experiencing gender dysphoria and exploring various medical and social interventions which may assist in alleviating that dysphoria;
- assessing suitability for hormonal and surgical treatments;
- 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 are available for trans, gender diverse and non-binary people of 17 years of age or older, their family members, and partners, who are residents of the States of Victoria and Tasmania. We are also a resource for health care providers and community and advocacy groups.
Clients can be referred for various reasons. Some people may want to just explore and achieve a better sense of their gender identity while others who identify with a gender other than their birth-assigned gender, may seek assistance in starting the process to make their body as congruent as possible with their affirmed gender.
When accessing the clinic, there are on-street parking options on South Rd and nearby side streets. Please check parking signs for restrictions, time limits and fees. The most convenient public transport access is usually via Moorabbin railway station on the Frankston line.
There is a ramp at the main entrance suitable for people using wheelchairs. We can allocate an easy access office on the ground floor. Please advise about your needs when you confirm your appointment.
Clients travelling from regional or remote areas may be eligible for session conducted via teleconference. The clinic uses BlueJeans software. Clients may also be eligible for transport assistance. For further information please see the Victorian Patient Transport Assistance Scheme (VPTAS) website.
Referrals into the Gender Clinic
How do I arrange an appointment to be seen at the clinic?
You will need to complete a General Information Form, and get a referral form a medical practitioner, such as a GP or medical specialist. Click on GIF online portal
You will need a referral from your GP or a medical specialist. You can provide your health care provider with this information: # link to G:\genderclinic\Website\health care professionals Referral information for GP’s.pdf
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 wo provide similar services?
There are both psychiatrists and clinical psychologists working in the private sector who are able to complete specialist gender-related mental health assessments (please see attached list). If you are already seeing a mental health clinician, for example, psychologist, counsellor or psychiatrist, we suggest choosing to see a private mental health professional who specialises in gender dysphoria for your assessment.
Clinicians working in the private system usually have significantly shorter waiting lists than the Gender Clinic. There are, however, 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 be advised that clients who have undergone a mental health assessment by a private clinician and are then referred back to the clinic for other services e.g., hormone therapy, will still be subject to the usual waiting time to see a mental health clinician. Given that they have already had a mental assessment by a private clinician, it is likely that their assessment by one of our clinicians will be much briefer.
What can I do while I wait for an appointment?
Everybody’s situation is different and personal to them. The best advice we can give you is to keep yourself fit and well, both physically and mentally. We also encourage clients to engage with local peer support groups.
You may wish to also consider the following which can be undertaken while on the waiting list:
- Taking some steps to change your identity documents.
- Seeing a speech therapist.
- Seeking private counselling.
- Commencing hair removal treatment such as laser therapy or electrolysis, which is available at Monash health while you are awaiting assessment
Gender Clinic Services
What services are available for TGD people and their loved ones through the Gender Clinic?
The Gender Clinic provides mental health assessment and treatment for gender identity, gender expression and/or gender transition related concerns, and social work and psychological support for issues related to transition.
We refer internally at 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
We refer externally for other services, including:
- Most surgeries: breast reduction or enhancement, genital surgeries (vaginoplasty)
- Peer support
- Advice on presentation: make-up etc.
- Fertility preservation
- Speech therapy
Are there any services I can use while on the waiting list for assessment?
Yes. There are options to see private mental health professionals or experienced GPs for assessment.
It is also possible to begin speech therapy at La Trobe and get a referral for laser hair removal at Monash Health, whilst on the waiting list.
You can start at the La Trobe Communication Clinic while on the waiting list. They will accept a referral from the gender clinic, from: yourself, health or social work professionals or the Gender Clinic.
If there are any issues that can complicate assessment – for example mental health conditions such as psychosis or dissociative identity disorder, it is a good idea to seek treatment for these whilst on the waiting list.
How can I access Speech Therapy?
It is important to recognise that a person’s birth-assigned gender is often reflected in their voice and the way they communicate. Therefore, it is possible that you may request voice modification to reflect your affirmed gender. People who wish to modify their voice or communication style in preparation for gender transition can ask for a referral to the La Trobe University’s Voice Clinic.
Clients will usually see a speech therapy student who is in their final year of training and is being supervised by a qualified speech therapist.
Speech therapy can be arranged at any time during your transition process – it may range from one or two sessions for voice analysis and advice to regular weekly sessions for focused voice modification. Because the therapy targets a person’s individual needs, it is not possible to say how many sessions are required to maximise voice potential. Clients may also request to see a private speech therapist. Please discuss how to obtain a referral to a private speech therapist with your clinician.
How much do services cost?
At present there are no costs associated with attending any appointments at Monash Health. There are costs associated with purchasing hormones. Hormones are however available on the PBS and so the costs are usually between $6 and $40 per month depending on what you have been prescribed and whether you have a health care card. There are significant costs associated with surgery.
Some surgeries for trans masculine people are available through Monash Health, including removal of internal reproductive organs (hysterectomy and oophorectomy) and tubal ligation for contraception. Private health insurance is not required for surgery provided by Monash Health, which are at no cost to the client.
For vaginoplasty and chest reconstruction surgery, Medicare only covers a small proportion of the procedures involved. For private hysterectomy and oophorectomy, out of pocket costs will vary between surgeons and hospitals.
For most gender transition surgeries, private health insurance is strongly recommended – with the highest level of hospital cover. This is needed to cover some of the costs of the surgery. 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 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.
For vaginoplasty, with top level private health insurance, the out-of-pocket cost is around $16000. For chest reconstruction surgery, the out-of-pocket cost is $6000 to $12000, depending on whether you have private health insurance. Please contact the surgeon directly for an up-to-date estimate of costs.
The Gender Clinic is able to provide some financial support to a limited number of clients each year. This is to assist with out-of-pocket costs of some surgeries. For vaginoplasty, we require that private health insurance be taken out. The clinic is unable to assist with the cost of private health insurance. Please speak to your clinician for further information.
Assessments
What are the WPATH Standards of Care and does the Gender Clinic follow these guidelines?
WPATH is the World Professional Association for Transgender Health. It 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. WPATH publishes the Standards of Care, which communicate worldwide professional opinions about the treatment and management of gender dysphoria. Gender Clinic staff follow these guidelines in the delivery of gender transition-related care. The Standards of Care are available at www.wpath.org.
Although the guidelines can sometimes appear restrictive, the clinic prefers to adopt a cautious approach in order to reduce the likelihood of regretting 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.
Why do you require a mental health assessment?
While it is not considered a psychiatric disorder to have a gender identity which differs from the gender assigned to you at birth, it is very important to rule out other conditions that could present with gender variance. As a result, the clinic takes great care in ensuring that a comprehensive assessment is conducted.
In addition, the purpose of the assessment is to identify supports that may help prior to commencing any medical treatments leading to gender affirmation. These could include referrals to appropriate services for assistance with housing, employment and social isolation, etc.
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. Their assessment however 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.
In addition, ongoing monitoring or counselling normally occurs alongside the “Real Life Experience” of living in the affirmed gender. This involves forming a trusting relationship with a mental health clinician in order to explore their gender identity.
As everyone is unique, there is no predetermined or recommended number of sessions. Meeting regularly with a mental health clinician is an important means of receiving support, finding the best set of medical and social options for the individual, working through difficulties where they arise and addressing expectations of the outcomes of transgender treatments and gender transition. This process usually covers a broad range of issues in order to consider all the circumstances that will help an individual who is transitioning achieve stability and satisfaction in their lives.
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 are “gender dysphoria” and “gender incongruence”?
“Gender Dysphoria” is a term that describes the discomfort and unhappiness a person experiences 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). We acknowledge that not everybody experiencing gender diversity necessarily experiences distress.
Gender Dysphoria is also a psychiatric diagnosis of Gender Dysphoria found in the American Psychiatric Association’s Diagnostic and Statistical manual (DSM-5). The Gender Clinic team strongly reject the pathologising of gender diversity and believe that having a psychiatric diagnosis associated with gender identity is damaging for our clients. We are therefore very supportive of the efforts to depathologise gender diversity in the World Health Organisation’s International Classification of Diseases version 11 (ICD-11) diagnosis of “Gender Incongruence”, and will make reference to it when a diagnosis is required.
Staff at the clinic seek to work with our clients to establish the best medical and social options for each individual. As the WPATH Standards of Care note:
“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 will this impact my assessment?
Many of our clients have, or have had, mental health issues and are still able to receive support from our clinic. Sometimes assessment may take a bit longer to ensure that there are supports and that clients are prepared prior to any gender-related treatments.
If you have had or are receiving care and treatment for mental health issues, this won’t 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.
The Standards of Care requirement is that mental health conditions 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.
As we don’t operate a crisis/emergency service, we will need to be reassured that you have access to adequate support and treatments (if needed) before we can approve hormonal or surgical treatments.
Starting at the Gender Clinic
What can I expect when I come to the Gender Clinic?
It is a common experience to feel nervous before your first appointment. This, however, is a safe space in which you can explore some very personal issues. By being honest and open, your clinician will be able to form a comprehensive understanding of your experiences and needs.
There is no requirement about how you present your appearance at the clinic: dress in a way that allows you to feel comfortable.
As a new client, you will be offered appointments with a mental health professional at the clinic to discuss the best treatment options for your individual situation. An initial series of interviews (approximately 3-6 sessions), will allow assessment under the WPATH SOC guidelines. It may also include, with your consent, a detailed psychological assessment and/or a family assessment. Some aspects of the assessment may be conducted by another member of the team.
During the assessment your clinician will gather information about your experiences in relation to your gender at various stages of your life and any associated distress. The purpose of this is to identify your strengths and to also assess what supports are needed as you embark on strategies to reduce your distress. All assessments are discussed at regular staff meetings.
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.
Teleconference appointments are available. When booking your appointments the administrative assistant will discuss the use of teleconference. The gender clinic uses BlueJeans software (it’s is similar to Skype or Facetime but offers greater security).
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).
Hormones
What are the processes for starting on hormone therapy?
Endocrinologists and General practitioners can prescribe hormones. We can refer you to a Monash Health Endocrinologist, unless your referring GP has indicated a willingness to initiate hormone treatment. 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. The doctor will write to your GP advising 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 medication before or while you are on the waiting list, this will not affect your position on the waiting list.
The Clinic follows the criteria for hormones as specified in the WPATH Standards of Care. If you and your allocated clinician agree that hormones may be helpful your clinician will refer to an endocrinologist or your GP. The assessment time is variable 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 before commencing hormones.
Anyone assessed as not being appropriate for gender affirmation therapy will be offered support to find ways of living with their Gender Dysphoria/gender variance, which do not involve medical treatments. They can also be offered the option to be re-assessed in the future, following other non-medical interventions.
After commencing hormones, individuals are invited to attend follow up sessions for support or other individual 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.
Birth-assigned males treated with feminising hormones can expect 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, with possible loss of libido.
Birth-assigned females treated with masculinising hormones can expect a 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 and possibly male pattern baldness.
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. The criteria to commence hormone therapy as specified in the Standards of Care must be satisfied prior to referral to the hormone prescriber.
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.
Surgery
Why is surgery important for some clients, and what does it involve?
For some people, surgery is an important step in the transition process, and involves generally irreversible surgical procedures aimed at providing anatomical congruence consistent with their affirmed gender.
Surgery for birth-assigned males can include removal of the testicles and penis, and the creation of a vagina. Some individuals may also wish to pursue breast enlargement, rhinoplasty, laryngoplasty (shaving of the “Adam’s apple”), vocal cord surgery, and/or facial feminisation surgery.
Surgery for birth-assigned females can include removal of the breasts, and 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 have led to the discontinuation of these procedures in Victoria. However, these procedures are still performed elsewhere.
The surgeon will provide detailed information to the client prior to the operation, including the nature of the surgical procedure, risks and possible complications and the costs involved. At present the only surgical procedure that is available through Monash Health is removal of the uterus and/or ovaries (hysterectomy and/or oophorectomy). Other procedures are performed by private surgeons, and your clinician will be able to assist in making referrals as appropriate.
The Gender Clinic does not offer surgical treatment at this stage. However we are able to make referrals to appropriate private surgeons, who will be able to advise you of their fees when you make your appointment with them. The Gender Clinic is able to provide some financial support to a limited number of clients each year to assist with surgical costs. Please speak to your clinician for further information.
Surgery is available in Australia, but some people may choose to pursue surgery overseas; the Gender Clinic does not have any official links or affiliations with any overseas surgeons. It is important to understand that reputable overseas surgeons follow the same Standards of Care as our clinic. Therefore, they often ask for some correspondence from the clinic confirming that all the criteria have been met to undergo gender affirmation surgery.
When can I have surgery?
For chest surgery, you will be referred to a surgeon for a medical assessment once your initial assessment has been completed and you feel ready to proceed with surgery. Once you have met with the surgeon you may then book a provisional date for surgery. Within 3 months prior to your surgery date you will need to meet with your mental health professional again to ensure that you fulfil the criteria to undergo surgery as specified in the WPATH standards of care. Once this has been completed you can contact the surgeon to confirm your surgery date. Please remember that for genital surgery, a second opinion from a different mental health professional within the team must be obtained. This second opinion is usually shorter and last from 2-4 sessions.
At present most surgery is provided by private surgeons in Australia. We are also able to provide referrals to overseas surgeons though we do not have any particular affiliation with any overseas surgeons.
Requirements for surgery set out in the WPATH Standards of Care are as follow.
For Chest surgery:
One opinion/referral required
- Persistent gender dysphoria
- Capacity to give informed consent
- Legal emancipation in given jurisdiction
- Medical /Mental Health concerns well controlled
- For Hysterectomy/BSO & Orchidectomy
Two referrals required
- Persistent gender dysphoria,
- Capacity to give informed consent,
- Legal emancipation in given jurisdiction,
- Medical /Mental Health concerns well controlled
- 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones)
- For Phalloplasty or Vaginoplasty
Two referrals required
- Persistent gender dysphoria
- Capacity to give informed consent, Legal emancipation in given jurisdiction
- Medical /Mental Health concerns well controlled
- 12 continuous months of hormone therapy
- 12 continuous months of living in a gender role that is congruent with gender identity link to next section(“Real Life Experience”)
Do I need to be living full-time in my affirmed gender before I have surgery?
The Real Life Experience is a period of time (usually 12 months) prior to genital surgery where people live in a role congruent to their gender identity. This allows the person to develop stability in their affirmed gender, and to build confidence in their ability to live in the affirmed gender role. It is also intended to raise awareness of the personal and social consequences of transition; this is very important because changing one’s gender expression has been known to contribute to employment discrimination, marital problems and divorce, and the restriction or loss of contact with children.
Many people find that the Real Life Experience allows time for improvement in mental health, and during the Real Life Experience, a mental health professional will help you explore the impact of your transition on family, relationships, finances and legal issues. This process is consistent with the Standards of Care.
Living full time in the gender congruent role is a valuable part of the transition process.
When a person is considered to be living ‘full time in the gender congruent role’ social and occupational changes have to be made.
A person transitions to live in the acquired gender 100% of the time and in all aspects of daily life, i.e. at work, at university, at volunteering, at home, and socially with friends and family members.
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 strict Body Mass Index (BMI) score requirements for patients who wish to undergo surgery. In particular, 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. It is essential to achieve a weight of under 100kg and BMI less than 30.
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 calulator. The calculator will also indicate how much over or under your ‘ideal’ weight you are.
Smoking also increase rick in surgical operations. There are already numerous health reasons for quitting smoking, but 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.
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.
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
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
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 client records will follow the details on your Medicare Card – please advise if your name and gender marker are changed there. Prior to changing your Medicare card, you can register a preferred name on the Monash health system, and inform staff of your preferred title and pronouns. At the Gender Clinic, we will make every effort to respect your choices.
The Keypass ID is an ID without a gender marker on it. Available through Australia Post
If someone change genders, they are still considered to have been in a defacto relationship.
Since the passage of Federal same-sex marriage legislation, married people who transition can change identity documents including birth certificates, without any requirement for divorce.