Medical Transitioning: Where to Start

by | Jul 10, 2021 | LGBTQI+ Health | 49 comments

🕓 Reading time: 7 minutes

Due to the immense demand for gender-affirming care, Tasha isn’t seeing any new patients at the moment.

She needs to ensure existing patients receive the highest standard of care.

We apologise and appreciate this may be disappointing for many people.


If you feel you were assigned the wrong gender at birth, you might consider asserting your true identity with medical assistance, commonly 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’.


ON THIS PAGE

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 in guiding your choices. The medical options available to you range from speech pathology 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 came out to family and friends, while others simply chose to dress more masculine or feminine.

By the same token, many have undergone surgery.

People need to 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.

non binary

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.

Hormone Replacement Therapy

Hormone therapy aims to help people increase or decrease gender-specific characteristics.

Male-Female Affirmation

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.

For people who wish to continue oestrogen therapy yet require a less frequent delivery method or aren’t suited to tablets, patches, and gels, I also offer oestrogen implants.

The implant is a small, slow-release pellet containing the hormone oestradiol, a type of oestrogen.

I insert the pellet into the fatty tissue under the skin (subdermally), preferably in the upper buttocks or lower abdomen. The procedure is relatively quick and simple.

Implants aren’t recommended for starting oestrogen therapy as they can’t be removed in the rare event of adverse side effects.

Testosterone blockers, or anti-androgens, are another complementary option, and they work by reducing your body’s testosterone production and minimising its masculinising effects.

Female-Male Affirmation

Masculinising hormone therapy typically involves 3-monthly testosterone injections. I also prescribe gels and creams.

The effects of testosterone include increased muscle bulk, more facial hair, a deeper voice, and body fat distribution changes.

Partial Effect Options

MTN and FTN people may prefer lower hormonal replacement doses to achieve partial effects. We can discuss this together.

Prescribing Approach

I offer advice and prescribe most hormone therapies at the clinic, though testosterone requires a specialist endocrinologist’s review before starting.

A referral to such a specialist (or a 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.

Speech Pathology

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.

Speech pathologists can use voice training and exercises to help you change your vocal tones, inflections, and word styling specifically for your needs.

A great starting point is to consider the voices of people to whom 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.

You may consider re-defining your jaw and making your brow line more prominent to achieve this.

Surgery

Surgical transitioning options are plentiful, though procedures generally require high out-of-pocket costs.

Cosmetic facial procedures and top surgery (operations on the chest and upper torso) are among the most commonly performed procedures.

cosmetic face surgery

Facial cosmetic surgery includes:

Examples of top surgery are:

As the name suggests, bottom surgery focuses on surgically altering the shape and function of your genitals. Many people instantly think of genital reconfiguration surgery (GRS), which includes:

However, only a handful of surgeons in Australia currently offer GRS, and waitlists are relatively long. Fingers crossed, more will soon offer these procedures.

Surgical options such as labiaplasties (modifying your labia) and orchiectomies (removing one or both testicles) are generally more accessible.

Other surgical options include:

Before you decide on any surgery, it is 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 Visit

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 and is 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 include 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 history 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 questions concerning:

  • What to expect
  • Risks vs benefits
  • Costs
  • 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 for a chat and check-up a few times a year.

These regular consults are an excellent opportunity to see how you’re feeling about your transition and to support your mental health.

Caring for Your Mental Health Is Essential

Being at peace with your gender identity is a highly positive and affirming part of your general health and well-being.

happy transgender girl

Towards this goal, it’s important to recognise that 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 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.

pronouns

Kids typically find social inclusion, self-acceptance, and family relationships harder to navigate than 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.


Dr Tasha Patel blog

Dr Tasha Patel is a local 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.


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 multi-faith backgrounds.
  • Minus18: Online portal that aims to improve the health and well-being 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.
  • 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.

49 Comments

  1. Christine

    Is Dr. Tasha providing HRT to the client?

    Reply
    • Doctors of South Melbourne

      Hi Christine,

      Yes, Dr Tasha can prescribe Hormone Replacement Therapy (HRT) for people over 18 years old. However, this can only happen following a thorough assessment and discussion.

      King regards,
      Doctors of South Melbourne

      Reply
  2. Tim

    I think the practice needs another option in the new patient form under ‘Title’. At present it contains no titles for people who do not identify with binary terms.

    Reply
    • Doctors of South Melbourne

      Hi Tim,

      Thanks so much for your feedback. We’ve previously requested this change from the software provider and are pushing them to expand the ‘Title’ field options to reflect all people in the community.

      We’ll pass your comment on to the provider to bolster our request.

      Kind regards,
      Doctors of South Melbourne

      Reply
  3. Ray

    Is this for Australian citizens only or any international transgender who is also interested?

    Reply
    • Doctors of South Melbourne

      Hi Ray,

      Though we can’t offer appointments to non-Australian citizens while they’re overseas, you’re most welcome to see Dr Tasha if you’re ever in Melbourne for an extended period.

      However, we must stress that the costs would be pretty high without government Medicare subsidies. This is compounded by the fact that medically transitioning often involves numerous GP appointments and potentially with psychologists and endocrinologists.

      Kind regards,
      Doctors of South Melbourne

      Reply
  4. Kiki

    Can the doctor provide a medical certificate for the change gender?

    Reply
    • Doctors of South Melbourne

      Hi Kiki,

      There are specific requirements depending on exactly the type of documentation you need. However, your GP should be able to issue most medical certificates.

      Kind regards,
      Doctors of South Melbourne

      Reply
  5. Astra

    Does Dr Tasha Patel offer hormone implants for trans women? Thanks.

    Reply
    • Doctors of South Melbourne

      Hi Astra,

      Dr Tasha doesn’t currently offer hormone implants for trans women. However, she’d be very happy to help you with any other aspects of care.

      Kind regards,
      Doctors of South Melbourne

      Reply
  6. JayElle

    Can your clinic recommend any clinics down in south east melbourne near Frankston? can people from all over Melbourne visit your clinic?

    Reply
    • Doctors of South Melbourne

      Hi JayElle,

      We’re not aware of any GP clinics in the general Frankston area that offer LGBTQI+ health services. However, allies such as Peninsula Pride and Peninsula Health may have more local knowledge.

      And yes, we warmly welcome people from all over Melbourne visiting our clinic.

      Kind regards,
      Doctors of South Melbourne

      Reply
  7. Flynn

    Hi, does dr Tasha Patel prescribe hrt to people over the age of 16? Cheers

    Reply
    • Flynn

      And can she provide a diagnosis of gender dysphoria aswell?

      Reply
      • Doctors of South Melbourne

        Hi Flynn,

        Dr Tasha only initiates hormone therapy for gender affirmation in people over 18 years old.

        Regarding a gender dysphoria diagnosis, this all depends on what the person needs the diagnosis for. Generally, if you need an ‘official diagnosis’ to access top surgery, for example, this would have to be done with a World Professional Association for Transgender Health (WPATH) psychologist or psychiatrist. Tasha can provide a referral but cannot do that assessment herself.

        Kind regards,
        Doctors of South Melbourne

        Reply
  8. Peter

    do you have a contact in the Wodonga area as it would be a 12 hour return trip to see you. Can this be done via zoom and blood test at local clinic?

    Reply
      • Chris

        Hi I’m Chris from North east Victoria can I see a doctor at your clinic please

        Reply
        • Doctors of South Melbourne

          Hi Chris,

          You sure can. Feel free to call us on (03) 8579 6838 or click the ‘Book Online’ button at the top of this page.

          Kind regards,
          Doctors of South Melbourne

          Reply
          • Mikayla

            Hi what is the cost for the male to female one testi removal orchiectomy please?.

          • Doctors of South Melbourne

            Hi Mikayla,

            Thanks for reaching out.

            It’s very difficult to know the cost of an orchiectomy for several reasons. These include your personal circumstances, medical history, Medicare and insurance particulars, and the surgeon and technique used.

            Being a GP practice, we don’t perform gender reassignment surgery at the clinic. This process would start with a potential referral to a urologist.

            However, you’re more than welcome to make an appointment with Dr Tasha for an initial consultation to discuss your options and help answer any questions.

            Kind regards,
            Doctors of South Melbourne

  9. Hannah

    Hi does Dr Patel offer HRT to international students in Melbourne as well? I am in the process of getting enrolled in UniMelb and will probably be getting an OHSC cover pretty soon. The university has recommended some providers but I would like to know which ones would be the best for trans health covers.

    I am also not out to my parents yet to to scepticism and plan to come out hopefully after getting on hormones though I am over 18 years of age, so it would be crucial for me to get covered by insurance.

    Thank you

    Reply
    • Doctors of South Melbourne

      Hi Hannah,

      All doctors at the clinic, including Dr Tasha, can treat international patients. However, appointments can be relatively expensive without Medicare.

      We can’t recommend health insurance for trans health cover. It’s best you do your own research while considering your specific needs for an insurance policy.

      Please note: Our fees are unlikely to be fully covered by international health cover, and we charge according to the time spent with you.

      For prescribing HRT, each patient is different. Depending on the situation, Tasha might refer you to a specialist such as an endocrinologist.

      Rest assured, we take patient:doctor confidentiality VERY seriously. It’s illegal for any health provider to disclose an adult patient’s information to their parents, spouse, or anyone else.

      Kind regards,
      Doctors of South Melbourne

      Reply
  10. Ella

    Hi, just wanted to check but does this clinic offer HRT using the informed consent model?

    Reply
    • Doctors of South Melbourne

      Hi Ella,

      Yes, Dr Tasha Patel offers patients HRT through the informed consent model.

      During your appointment, she’ll complete a detailed consent form with you while answering any questions along the way.

      Kind regards,
      Doctors of South Melbourne

      Reply
  11. Kate

    Hi, can my 12 year old access hormone blockers via GP or only through RCH?

    Reply
  12. Tempest

    Tasha is incredible. I went into my first appointment a total mess. I was 6’4, muscular and in my 30’s.

    With Tasha’s support, I am now on HRT and have the confidence to present as a female. People laugh, sneer and say mean things but I ignore them and know if it affects me I have Tasha’s support to get through this period of my life.

    Making an appointment with Doctors at South Melbourne has been the single best investment I have made for myself.

    Reply
    • Doctors of South Melbourne

      Hi Tempest,

      Thank you for your lovely feedback. We’re so happy that Dr Tasha was able to offer the support and advice you deserve. She’s one in a million, making a big difference in many people’s lives.

      We look forward to seeing you next time.

      Kind regards,
      Doctors of South Melbourne

      Reply
  13. Zoe

    I understand Dr Patel will only treat over 18s for hormone replacement but would she be willing /able to support a 15 year old with medication just to stop their periods even if this was contraception or similar as opposed to hormone treatment as such?
    RCH is not possible as by the time the referral is progressed they will be too old to attend. Then it is 2 year wait for Monash health meaning 3 years before support can be provided.

    Reply
    • Doctors of South Melbourne

      Hi Zoe,

      Dr Patel is very happy to help out and discuss options for stopping your 15-year-old’s periods and possibly prescribe. You can make an appointment online or by calling us on (03) 8579 6838.

      Sadly, we hear of many kids falling through the gaps in Australia’s healthcare system.

      Kind regards,
      Doctors of South Melbourne

      Reply
  14. Oliveira

    Hi, i’m already transitioning in my home country but i’ll be moving to australia. Can I keep with the treatment? Do i need to translate something from my doctor/endocrinologist (does it helps with something?)?

    Reply
    • Doctors of South Melbourne

      Hi Oliveira,

      Yes, in general, you should be able to continue with treatment in Australia. However, as everyone’s circumstances are unique and different countries permit or exclude various treatments, it’s best to first make an appointment with a GP to discuss your options.

      The more medical history the GP can access in English, the better. 😀

      Kind regards,
      Doctors of South Melbourne

      Reply
  15. Kyle

    Not so much a comment but a question, does it matter if we make an appointment with you if we are in a different state if we make the appointment online?

    Reply
    • Doctors of South Melbourne

      Hi Kyle,

      Unfortunately, we don’t provide medical care via telehealth alone, as in-person consults are necessary for safe and optimal care. However, we’d love to see you if you’re regularly in Melbourne.

      For medical providers in your state, please take a look at the Australian Professional Association for Trans Health directory: https://auspath.org.au/providers/

      Kind regards,
      Doctors of South Melbourne

      Reply
      • Faith

        Hey, we have made an initial appointment for the start of February. Will we be prescribed HRT on the first appointment or on a following one? If it’s a following one how long after the first appointment should that be? I’m asking this as I realise that dr Tasha might not have availability for another appointment for a while if we wait to book after our first appointment. Should I book a second appointment now?

        Reply
        • Doctors of South Melbourne

          Hi Faith,

          The timing of any potential HRT prescription depends on several factors, including a patient’s circumstances, medical history, and whether any blood tests are required – every person is different. So, it’s unlikely that Dr Tasha will prescribe hormone replacement during your first appointment.

          As Dr Tasha is currently booking out in advance due to being on a break, we suggest you book a second appointment for approximately two weeks after your first. She’ll likely want to see you regularly to help guide your transition anyway. You can always cancel an appointment with a couple of days’ notice if necessary. 😀

          Kind regards,
          Doctors of South Melbourne

          Reply
  16. Chai

    is it possible to obtain all of the necessary pre-information before one turns 18, so that they can begin taking their oestrogen prescription on their birthday? or does the patient have to be 18 when coming in for a consutlation?

    Reply
    • Doctors of South Melbourne

      Hi Chai,

      Thanks for your comment.

      If you’re under 18 years old, we can do an initial appointment to gather information, but you cannot formally consent to hormone replacement therapy (HRT) until your 18th birthday.

      If you’re under 16 years old, you may want to explore the option of engaging with the Royal Children’s Hospital (RCH) Gender Service – visit their website for more information: https://www.rch.org.au/adolescent-medicine/gender-service/

      Kind regards,
      Doctors of South Melbourne

      Reply
  17. Theo

    is it compulsory to see an endocrinologist before dr tasha in order for her to prescribe hrt (testosterone) ?

    Reply
    • Doctors of South Melbourne

      Hi Theo,

      No, it’s not compulsory to see an endocrinologist before visiting Dr Tasha – it’s actually the other way around. If Dr Tasha feels hormone replacement therapy (HRT) is the best course of treatment for you, she’ll likely refer you to an endocrinologist. You can only visit an endocrinologist if you have a referral from your GP.

      Dr Tasha can get the ball rolling regarding medication prescribing, but medication is cheaper for you when an endocrinologist is involved.

      Kind regards,
      Doctors of South Melbourne

      Reply
  18. Lucas

    Hi, I’m going to be moving to australia to study next year. How expensive would it be to start HRT for an international patient? I understand that it probably varies from person to person, but a rough estimate would be very helpful

    Reply
    • Doctors of South Melbourne

      Hi Lucas,

      Thanks for getting in touch.

      It’s impossible to say how expensive HRT might be for you, being an international patient without Medicare. Every person’s needs and circumstances are unique.

      However, the entire process might be pretty expensive, maybe in the thousands of dollars, as it would involve appointments with Dr Tasha, possible referrals to a specialist such as an endocrinologist, medications, and periodic reviews. Your international medical insurance may be able to cover some of the costs for you.

      Kind regards,
      Doctors of South Melbourne

      Reply
  19. Felix

    Hey there 🙂
    I was just wondering if having an endocrinologists approval was a necessary part of being able to go on testosterone or if it would be possible to continue the process without seeing an endocrinologist? Thanks!

    Reply
    • Doctors of South Melbourne

      Hi Felix,

      Thanks for reaching out.

      An endocrinologist, urologist, or sexual health physician’s approval is required to access testosterone under the cheaper Pharmaceutical Benefits Scheme (PBS). However, a GP can do ongoing prescribing.

      Kind regards,
      Doctors of South Melbourne

      Reply
  20. Max

    Hi, would it be possible to have an initial appointment to have all the information ready for when i turn 18 to start testosterone, and will i have to have an endocrinologist for a probable hormone imbalance? how much would that cost? Thanks

    Reply
    • Doctors of South Melbourne

      Hi Max,

      Thanks for reaching out.

      You’re most welcome to book an appointment with Dr Tasha to seek her advice and gather information. However, you cannot formally consent to hormone replacement therapy (HRT) until your 18th birthday.

      If Dr Tasha feels HRT is the best course of treatment for you, she’ll likely refer you to an endocrinologist. You can only visit an endocrinologist if you have a referral from your GP.

      An endocrinologist’s (or urologist’s or sexual health physician’s) approval is required to access testosterone to benefit from the cheaper Pharmaceutical Benefits Scheme (PBS). However, your GP can do ongoing prescribing.

      Endocrinologists set their own fees to which we’re not privy. You should anticipate an initial appointment with such a specialist possibly costing a few hundred dollars.

      We hope this information helps. 😀

      Kinds Regards,
      Doctors of South Melbourne

      Reply
  21. Shontal

    Hello, I’ve been doing research on top surgery as this is something I have been wanting for a long time now. I’m interested in booking in for a consultation to start this journey. I was wondering if there is any fees for consultations and how much that is? And how much would top surgery roughly cost (with Medicare)? Thank you so much 😊

    Reply
    • Doctors of South Melbourne

      Hi Shontal,

      Thanks for your questions.

      You’re most welcome to book an appointment with Dr Tasha to seek her advice on the best way to start this journey. We charge standard GP consultations fees at the clinic, which can be found on the Appointments page of our website.

      The cost of top surgery depends on several factors, including your personal circumstances and needs, the surgeon performing the procedure, and the surgical method used. You could be out-of-pocket anywhere from a few thousand dollars to $20,000.

      We hope this information helps.

      Kinds Regards,
      Doctors of South Melbourne

      Reply

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