Dr Tasha Patel is a GP at Doctors of South Melbourne. She previously practised at The Centre Clinic and has a particular interest in LGBTQI+ health, including hormone replacement therapy for gender affirmation.
If you feel you were assigned the wrong gender at birth, you might consider asserting your true identity with medical assistance, known as medical transitioning.
Doctors such as myself prefer the term gender affirmation therapy as your gender identity is more about affirming who you are rather than changing yourself via a transition. However, for the ease of this post, let’s use the term medical transitioning.
Not everyone who’s transgender decides to transition medically. You might choose to socially transition first, a mix of the two, or something in between. Only YOU can decide what best makes you feel comfortable in your own skin.
Discussing your unique circumstances with a GP who specialises in gender diversity can assist guide your choices. The medical options available to you range from speech pathology through to hormone therapy and surgery.
Not All Transgender People Transition
Identifying as gender diverse or non-binary doesn’t mean you must transition.
Some trans people are happy just knowing who they truly are. I’ve consulted with patients who’ve simply come out to family and friends, while others chose to dress more masculine/feminine. By the same token, many have undergone surgery.
People should respect your gender identity regardless of how much or how little you transition. There’s no transgender sliding scale by which others dare judge you.
Let’s take a closer look at:
- Options for medical transitioning
- Why begin with a visit to your GP?
- What to expect from GP appointments
- The importance of mental health support
- Encouraging transgender children
- Links to helpful resources
Medical Transitioning Options to Consider
If you’re considering heading along the medical path, I suggest taking it slow – you can always do more later. Certain procedures aren’t reversible if you change your mind.
Here’s an overview of the options available to you.
Though there’s no such thing as a gendered voice, you may want to alter your voice to a pitch with which you’re more at ease.
Specific to your needs, speech pathologists can help change your vocal tones, inflections, and word styling through voice training and exercises.
A great starting point is to consider the voices of people to which you’d like yours to be similar, both trans and cis. Georgie Stone? Billie Eilish? Morgan Freeman? Your next door neighbour?
Latrobe University offers a trans and gender diverse voice clinic for anyone over the age of 16 years.
Non-Invasive Cosmetic Procedures
Whether you’re affirming your gender from male-female (MTF), male-non binary (MTN), female-male (FTM) or female-non binary (FTN), there are heaps of non-invasive procedures available to help adjust your aesthetics, including:
- Dermal fillers
- Muscle-relaxing injections, such as Botox
- Laser skin resurfacing
- Laser hair removal
Popular procedures to help with MTF and MTN affirmation aim to soften your jawline, make your face appear more heart-shaped and full, and remove facial hair.
With FTM and FTN affirmation, the focus is often more so on making your face appear squarer and more defined. To achieve this, you may consider re-defining your jaw and making your brow line more prominent.
Hormone Replacement Therapy
Hormone therapy aims to help trans people increase or decrease gender-specific characteristics.
For MTF affirmation, oestrogen replacement therapy contributes to feminising effects such as breast growth, a curvier body and softer skin.
I regularly prescribe oestrogen in tablet form, patches and gels. Testosterone blockers, or anti-androgens, are another complementary option. They work by reducing your body’s testosterone production and minimising its masculinising effects.
Masculinising hormone therapy typically involves 3-monthly testosterone injections. I also prescribe gels and creams. Testosterone therapy’s effects include bulking up your muscles, more facial hair, a deeper voice, and body fat distribution changes.
To achieve partial effects, MTN and FTN people may prefer lower hormonal replacement doses. This is something we can chat about together.
I offer advice and prescribe most hormone therapies at the clinic, though testosterone requires a specialist endocrinologist’s review before starting. A referral to a specialist or gender service is also a good idea for people with more complex needs.
It’s important to note that I only initiate hormone therapy for gender affirmation in people over 18 years old.
Surgical transitioning options are plentiful. Cosmetic facial procedures and top surgery (operating on your chest and upper torso) are among the most commonly performed.
As the name suggests, bottom surgery focuses on surgically altering your genitals. Many people instantly think of gender confirmation surgery (a.k.a. gender reassignment surgery) which encompasses:
- converting a penis into a vagina (vaginoplasty, vulvoplasty & orchiectomy);
- constructing a penis using skin from your body (phalloplasty), or
- altering your clitoris to act more like a penis (metoidioplasty).
Though gender confirmation therapy isn’t currently available in Australia, other bottom surgical options are accessible to trans people.
Generally requiring high out-of-pocket costs, surgeons across Melbourne perform procedures such as:
Facial cosmetic surgery:
- Rhinoplasty, or a nose job
- Chin and cheek augmentation
- Mandibular angle reduction (sculpting your jaw)
- Facelifts, eyelifts, and browlifts
Other surgical options include:
- Tracheal shaving (making your Adam’s Apple smaller)
- Hair transplants
- Buttock augmentation/reduction
Before you decide on any surgery, it’s essential to discuss your options, risks, and alternatives with your GP, specialist, or surgeon. Also talk with trusted family, friends, and others who’ve had similar procedures.
Beginning Your Transition Journey With a GP
Transitioning can be an exciting, confusing, and anxious time. With many options to consider and questions to ask, visiting a GP experienced in gender therapy is golden.
We implicitly understand that gender affirmation encompasses social, emotional, and physical aspects that are different for everyone. Whether you’re unsure about your gender identity, looking for help with medical transitioning, or unsure where to start, we’ll help you navigate through the complex structure of the medical system.
What’s more, we can be the primary source of your general care by advising on all the non-transitioning aspects of your health. These are things like general check-ups, preventive health, and sexual health advice.
What You Can Expect From GP Appointments
During your initial appointments, together we’ll delve into your life and gender journey so far. In the process of doing so, I’ll gain a complete picture of your general health: involving medical conditions, family health history, medications, allergies, smoking, drug & alcohol use, and more.
I’ll listen to your ideas and plans for gender affirmation and answer question concerning:
- What to expect
- Risks vs benefits
- Common side effects
- Fertility preservation options
You’ll need to carefully consider the above and ask a million more questions before we discuss formally consenting to treatment.
Once any treatments have started, I’d initially like to see you every 1-2 months to monitor your progress, then every 3-6 months as things begin to settle. These appointments may involve ordering blood tests, and physical, mental, and social health checks.
Over the longer term, I’d like to see you a few times a year for a chat and check-up. These regular consults are also an excellent opportunity to see how you’re feeling about your transition and to support your mental health.
Caring for Your Mental Health Is Vital
Being at peace with your gender identity is a highly positive and affirming part of your general health and wellbeing.
Towards this goal, it’s important to recognise that your gender diversity doesn’t cause mental health issues. Yet unfortunately, the lives of gender diverse people are often met with family and relationship difficulties, as well as discrimination in the workplace and community.
I’ve cared for many patients by talking over their mental health needs and providing access to practical solutions. I regularly refer people to specialised LGBTQI+ psychologists to discuss the emotional effects of transitioning, usually with success.
Depending on a range of factors, you also may be eligible for a Mental Health Care Plan.
Maintaining a network of friends, support groups, and family is a crucial piece of the well-being puzzle. You may be surprised by the number of people who actually want the best for you.
Do You Have a Transgender Child?
Gender dysphoria can be particularly upsetting and confusing for children, especially with a good dose of puberty thrown in. Kids typically find social inclusion, self-acceptance, and family relationships harder to navigate than for adults with more life experience.
I ask parents of trans kids to have the patience of a saint and be prepared to escape their comfort zones. I recommend they learn as much as possible about gender identity and the options for social and medical transitioning.
Supportive behaviours such as addressing and introducing their children using their preferred names and pronouns, for example, are a great start.
From a clinical point of view, juvenile medical transitioning is a highly specialised area of paediatrics that we can explore together. I can help guide your child’s treatment, including by providing referrals to specialists and the incredible people at the Royal Children’s Hospital (RCH) Gender Service.
Helpful Links and Resources
Here are some excellent resources to which I direct trans people and their families.
- AGMC: National body for LGBTQI+ people and community groups of multicultural and multifaith backgrounds.
- Minus18: Online portal that aims to improve the health and wellbeing of, and provide a safe environment for, young LGBTQI+ Australians.
- Queerspace: LGBTQI+ health and wellbeing support service
- Rainbow Door: Specialist helpline providing information, support, and referral service to all LGBTQIA+ Victorians, their friends and family.
- Rainbow Network: Directory connecting you with LGBTQI+ groups and services across Victoria.
- The Shed: Melbourne based support group for trans masculine people and their allies.
- Switchboard: Peer-driven support services for LGBTQI+ people, their families, allies and communities.
- Trans 101: Gender diversity crash course helping people better understand what it means to be trans.
- Transcend: Parent-led peer support network for the families of transgender children.
- Transgender Victoria: Victoria’s leading body for trans and gender diverse advocacy.
- TransHub: Broad information and resources for all trans and gender diverse people.
- Ygender: Peer-led social support and advocacy group for trans/gender diverse young people.