Medical Transition
Please note that some of the language on this page may cause gender dysphoria, as anatomical terms are used.
Hormone Therapy
Gender-Affirming Hormone Therapy
For many trans people, gender-affirming hormone therapy (masculinising or feminising), is a very important step during their transition. Gender-affirming hormone therapy is different for everybody, so it is important to go through the right avenues to obtain and use hormone therapy.
Where to find a doctor:
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Victorian Trans and Gender Diverse Health Community Health Services - complete a quick online form and a trained peer navigator will help you coordinate healthcare.
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In Victoria (where we are based), Northside Clinic, Prahran Market Clinic, Equinox Gender Diverse Health Centre, Eleanor Clinic, Ballarat Community Health, Your Community Health (based at PANCH with Austin Health) and Monash Gender Clinic are specialised clinics designed to help trans, gender diverse and non-binary people seek hormone therapy.
Traditional Pathway to Accessing Hormones:
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This pathway to hormones involves obtaining an approval letter to start hormones after a detailed assessment and support (usually 3–6 appointments) with a specialised mental health professional experienced in gender transition. Whilst there is criticism that this process is ‘gate-keeping’, many find this process beneficial and valuable to support them through gender transition, and prepare them for starting hormones.
Informed Consent Pathway:
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Under an ‘Informed Consent’ model of care, General Practitionersperform the initial assessment, play a key role in mental health and risk assessments for trans clients, and organise referral for secondary consultation where required. This process was designed to reduce unnecessary barriers.
Hormone therapies can make trans people infertile. Feminising hormones with oestrogen can block sperm production, and if biological children are desired in the future, sperm storage is recommended before starting hormones. This can be done at some hospital andrology clinics and some specialised pathology clinics (ask your GP) and there is a cost involved (usually a few hundred dollars) for collection and then annual storage costs (a few hundred dollars).
Feminising Hormones
Feminising hormone therapy, for transgender people who are assigned male at birth, typically increases the feminising hormone estradiol, and lowers the masculinising hormone testosterone. Estradiol is the mainstay, but often testosterone blockers are needed too.
Masculinising Hormones
Masculinising hormone therapy consists of a testosterone formulation which increases a person’s blood testosterone concentrations, typically to the male reference range. Some people, particularly non-binary people, may choose to use a lower dose of testosterone to achieve partial masculinisation.
Surgery
For many trans people, surgery is an important step. Many do not have surgery. Our research has found that many more desire surgery than have had surgery. Cost is the biggest barrier as surgery in Australia is only performed in the private sector. There are many different types of surgeries available.
Feminising surgery includes:
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Facial Feminisation Surgery: FFS is a combination of facial reconstructive procedures thats aim is to change the effects testosterone has had on the person’s face and to create a more typically feminine face.
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Voice surgery: The effects testosterone has on someone’s voice permanently deepens their voice and for some voice training (more information in Social Transitioning) isn’t enough to help feminise the voice so voice surgery can help raise the pitch of your voice and create a more feminine sounding voice.
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Laryngeal shave: This reduces the appearance of the Adam's apple in the neck.
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Bottom surgery/gender confirmation surgery: bottom surgery for trans women is when a surgeon surgically constructs a vagina from the existing genitals the person was born with at birth.
Masculinising surgery includes:
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Chest reconstructive surgery: chest reconstructive surgery or top surgery removes breast tissue to create a more flat, masculine chest. There are many methods to do this but some of the popular methods include keyhole surgery and the inverted “T” method.
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Reproductive surgery: Reproductive surgery involves removing the reproductive system including the uterus and fallopian tube with either a hysterectomy and or bilateral oophorectomy.
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Bottom surgery/gender confirmation surgery: For trans men there are multiple options for having bottom surgery. The most common types include metoidioplasty and phalloplasty and are usually done over multiple stages.
You can find a list of Australian Professional Association of Trans Health member surgeons here.
Videos About Surgery
Here are some videos, featuring trans people reflecting on their experiences with surgery, and surgeons talking about their professional involvement with trans communities.
FTM Transgender Getting Bottom Surgery