Published Research.

Research for the Betterment of All.

We conduct research with one goal: to provide robust evidence to better the health and well-being of the trans including gender diverse and non-binary community. This is our community. Every question we ask, every project that we do, every collaboration that we start must be aligned with our goal and translate to better health. Findings guide health and well-being programs, treatment guidelines and health policy to enable trans people to live a life without barriers.

 

We hope you find our list of research below informative. All have been peer-reviewed and published in academic journals. Due to journal copyright restrictions, we can't link to the full texts of some publications. If you find the full text isn't available in the link, just send us a request to gender-research@unimelb.edu.au and we will gladly email you a copy.

Peer-Reviewed Journal Publications.

Efficacy of micronised progesterone for sleep: a systematic review and meta-analysis of randomised controlled trial data.

Nolan BJ, Liang B, Cheung AS. Efficacy of micronised progesterone for sleep: a systematic review and meta-analysis of randomised controlled trial data. Journal of Clinical Endocrinology and Metabolism 2021 Apr.

Factors associated with suicide attempts among Australian transgender adults.

Zwickl S, Wong AFQ, Dowers E, Leemaqz SY, Bretherton I, Cook T, Zajac JD, Yip PSF, Cheung AS. Factors associated with suicide attempts among Australian transgender adults. BMC Psychiatry 2021 Feb.

Sexual dimorphism in innate immunity: The role of sex hormones and epigenetics.

Shepherd R, Cheung AS, Pang KC, Saffery R, Novakovic B. Sexual dimorphism in innate immunity: The role of sex hormones and epigenetics. Frontiers in Immunology 2021 Jan.

A systematic review of anti-androgens and feminisation in transgender women.

Angus LM, Nolan BJ, Zajac JD, Cheung AS. A systematic review of anti-androgens and feminisation in transgender women. Clinical Endocrinology (Oxf) 2020 Sep.

Estradiol therapy in the perioperative period: implications for transfeminine individuals.

Nolan BJ and Cheung AS. Estradiol therapy in the perioperative period: implications for transfeminine individuals. Yale Journal of Biology and Medicine. 2020 [accepted 23rd May 2020].

Click Here

Non-Binary and Binary Gender Identity in Australian Trans and Gender Diverse Individuals.

Cheung AS, Leemaqz SY, Wong JP, Chew D, Ooi O, Zwickl S, Cundill P, Silberstein N, Locke P, Grayson R, Zajac JD, Pang KC. Non-Binary and Binary Gender Identity in Australian Trans and Gender Diverse Individuals. Archives of Sexual Behavior. 2020 Apr 13.

Australian endocrinologists need more training in transgender health: A national survey.

Bretherton I, Grossmann M, Leemaqz SY, Zajac JD, Cheung AS. Australian endocrinologists need more training in transgender health: A national survey. Clinical Endocrinology (Oxf). 2020 Mar;92(3):247-257.

Cross-sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare.

Bretherton I, Thrower E, Grossmann M, Zajac JD, Cheung AS. Cross-sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare. Internal Medicine Journal 2019 Feb;49(2):182-188.

Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals – a systematic review.

McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals – a systematic review. Clinical Endocrinology (Oxf) 2018 Dec;89(6):700-711.

The impact of the first three months of the COVID-19 pandemic on the Australian trans community.

Zwickl S, Angus LM, Wong AFQ, Ginger A, Eshin K, Cook T, Leemaqz SY, Dowers E, Zajac JD, Cheung AS. The impact of the first three months of the COVID-19 pandemic on the Australian trans community. International Journal of Transgender Health 2021 Mar.

The Informed Consent Model of care for accessing gender-affirming hormone therapy is associated with high patient satisfaction.

Spanos C, Grace JA, Leemaqz SY, Brownhill A, Cundill P, Locke P, Wong P, Zajac JD, Cheung AS. The Informed Consent Model of care for accessing gender-affirming hormone therapy is associated with high patient satisfaction. Journal of Sexual Medicine 2021 Jan.

Insulin resistance in transgender individuals correlates with android fat mass.

Bretherton I, Spanos C, Leemaqz SY, Premaratne G, Grossmann M, Zajac JD, Cheung AS. Insulin resistance in transgender individuals correlates with android fat mass. Therapeutic Advances in Endocrinology & Metabolism January 2021.

Testosterone therapy considerations in estrogen, progesterone and androgen receptor positive breast cancer in a transgender male.

Light M, McFarlane T, Ives A, Shah B, Lim E, Grossmann M, Zajac JD, Cheung AS. Testosterone therapy considerations in estrogen, progesterone and androgen receptor positive breast cancer in a transgender male. Clinical Endocrinology (Oxf). 2020 Jun 10.

Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile.

Chew D, Tollit MA, Poulakis Z, Zwickl S, Cheung AS, Pang KC. Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. Lancet Child & Adolescent Health 2020 Apr;4(4):322-330.

Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: a systematic review.

Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: a systematic review. Journal of Autism and Developmental Disorders 2020 Mar;50(3):695-706.

Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy.

Nolan BJ, Brownhill A, et al. Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy. Therapeutic Advances in Endocrinology and Metabolism 2020;11:1-7.

Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey.

Zwickl S, Wong A, Bretherton I, Rainier M, Chetcuti D, Zajac JD, Cheung AS. Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey. International Journal of Environmental Research and Public Health 2019 16(24):5088.

Sociodemographic and Clinical Characteristics of Transgender Adults in Australia.

Cheung AS, Ooi O, Leemaqz S, Cundill P, Silberstein N, Bretherton I, Thrower E, Locke P, Grossmann M, Zajac JD. Sociodemographic and Clinical Characteristics of Transgender Adults in Australia. Transgender Health 2018; 3(1), 229-238.

Approach to interpreting common laboratory pathology tests in transgender individuals.

Cheung AS, Lim HY, Cook T, Zwickl S, Ginger A, Chiang C, Zajac JD. Approach to interpreting common laboratory pathology tests in transgender individuals. Journal of Clinical Endocrinology and Metabolism 2021 Mar.

The health and well-being of transgender Australians: a national community survey.

Bretherton I, Thrower E, Zwickl S, Wong A, Chetcuti D, Grossmann M, Zajac JD, Cheung AS. The health and well-being of transgender Australians: a national community survey. LGBT Health 2021 Jan.

Relationship between serum estradiol concentrations and clinical outcomes in transgender individuals undergoing feminising hormone therapy: a narrative review.

Nolan BJ and Cheung AS. Relationship between serum estradiol concentrations and clinical outcomes in transgender individuals undergoing feminising hormone therapy: a narrative review. Transgender Health 2020 Sep.

Global coagulation assays in transgender women on oral and transdermal estradiol therapy.

Lim HY, Leemaqz SY, Torkamani N, Grossmann M, Zajac JD, Nandurkar H, Ho P, Cheung AS. Global coagulation assays in transgender women on oral and transdermal estradiol therapy. Journal of Clinical Endocrinology and Metabolism. 2020 May 15. pii: dgaa262.

Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals.

Nolan BJ, Leemaqz SY, Ooi O, Cundill P, Silberstein N, Locke P, Grossmann M, Zajac JD, Cheung AS. Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Internal Medicine Journal. 2020 Apr 1.

Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review.

Spanos C, Bretherton I, Zajac JD, Cheung AS. Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review. World Journal of Diabetes 2020 Mar 15;11(3):66-77.

Position statement on the hormonal management of transgender and gender diverse individuals in Australia.

Cheung AS, Wynne K, Murray S, Erasmus J, Zajac JD. Position statement on the hormonal management of transgender and gender diverse individuals in Australia. Medical Journal of Australia 2019 Aug;211(3):127-133.

Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving estradiol therapy.

Angus L, Leemaqz S, Ooi O, Cundill P, Silberstein N, Locke P, Zajac JD, Cheung AS. Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving estradiol therapy. Endocrine Connections 2019; 8(7):935-940.

 
Trans Adults

Data taken from the 2018 study, Sociodemographic and Clinical Characteristics of Transgender Adults in Australia. Cheung et al. Transgender Health 2018.

 

10x number of referrals for trans health services in 2016 compared to 2011. Rising demand for trans care, socioeconomic disadvantage, and high burden of mental health conditions warrants a multidisciplinary approach to provide optimal care. Psychosocial interventions may assist individuals in navigating health care needs and social transitions. Further studies are required to understand links between ASD, ADHD, and gender identity and to evaluate optimal models of health service provision for transgender individuals.

A vector illustration displaying the demographics who responded to the Trans Adults survey. The graphic shows that 540 trans adults were involved, aged 16 to 74, with a median age of 27. 44% were trans men, 36% were trans women, and 18% were non-binary people.

Some people identify as transsexual, which is defined as “a person who experiences a persistent need to physically/socially transition into the opposite sex”, or "a person who transitions their physical sex using medical treatments".

 

Data referencing binary men and women is therefore inclusive of transsexuals as well as transgender-identifying people.

 

This data is also inclusive of all kinds of non-binary transgender people. Non-binary identities include genderqueer, genderfluid, agender, and others.

Uni Degree:

A vector illustration displaying rates of university education. The graphic shows that 53.4% of trans people have uni degrees, compared with 38.5% of cis Australians. TRANS CIS 38.5% 53.4%

Unemployment:

A vector illustration displaying rates of unemployment. The graphic shows that 21.3% of trans people struggle with unemployment, compared with 5.4% of cis people. TRANS CIS 5.4% 21.3%

Depression:

A vector illustration displaying rates of depression. The graphic shows that 55.7% of trans people struggle with depression, compared with 7.9% of cis people. TRANS CIS 7.9% 55.7%

Anxiety:

A vector illustration displaying rates of anxiety. The graphic shows that 40.4% of trans people struggle with anxiety, compared with 16.3% of cis people. TRANS CIS 16.3% 40.4%

ADHD:

A vector illustration displaying rates of ADHD. The graphic shows that 4.3% of trans people have ADHD, compared with 1.1% of cis people. TRANS CIS 1.1% 4.3%

Psychiatric or psychological assessment before hormone therapy:

A vector illustration displaying the number of people who undergo psychiatric or psychological assessment before commencing hormone therapy. 88.3% of trans people did, 11.7% of people did not.

Mastectomy: Trans Men

A vector illustration showing that 40% of trans men have a mastectomy, whereas 60% do not. 60% 40% YES NO

Phalloplasty: Trans Men

A vector illustration showing that 0.4% of trans men undergo Phalloplasty, whereas 99.6% do not. 99.6% 0.4% YES NO

Hysterectomy: Trans Men

A vector illustration showing that 5.9% of trans men have a hysterectomy performed, whereas 94.1% do not. 94.1% 5.9% YES NO

Vaginoplasty/orchidectomy: Trans women

A vector illustration showing that 18.4% of trans women have vaginoplasty, whereas 81.6% do not. 81.6% 18.4% YES NO

Facial feminisation: Trans women

A vector illustration showing that 2.6% of trans women have facial feminisation surgery, whereas 97.4% do not. 97.4% 2.6% YES NO

Breast augmentation: Trans women

A vector illustration showing that 3.1% of trans women have breast augmentation surgery, whereas 96.9% do not. 96.9% 3.1% YES NO

Orchidectomy: Non-binary

A vector illustration showing that 1% of non-binary people have an orchidectomy performed, whereas 99% do not. 99% 1% YES NO

Laryngeal shave: Non-binary

A vector illustration showing that 1% of non-binary people have a laryngeal shave performed, whereas 99% do not. 99% 1% YES NO

Mastectomy: Non-binary

A vector illustration showing that 12.1% of non-binary people have a mastectomy performed, whereas 87.9% do not. 87.9% 12.1% YES NO
 
 
Health Needs

Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey. Zwickl et al. International Journal of Environmental Research and Public Health, 2019. Led by two trans researchers Sav Zwickl and Alex Wong.

EXPERIENCES INCLUDE:

  • Incorrect pronouns being used by healthcare providers and receptionists.

  • Inappropriate and irrelevant questions about patients’ transgender experiences.

  • Incorrect focus on patients’ transgender status as a cause of any presenting mental and medical health issues.

  • Transgender people being unable to dictate their own hormonal transitions.

  • Inability to afford medically-necessary operations.

Overall findings highlight a pressing need for better training for healthcare professionals in trans healthcare, to improve access to care for the community.

928 trans respondents aged 18+

Vector art of a female figure.

37%

TRANS FEMALE

Vector art of a male figure.

36%

TRANS MALE

Vector art of the non-binary symbol.

27%

NON-BINARY

Vector art of the intersex symbol.

1%

INTERSEX

45%

 

Trans people who have experienced severely lacking knowledge among healthcare providers

Vector art to illustrate 45% of interviewees.

80%

 

Trans people with a regular primary care doctor

Vector art to illustrate 80% of interviewees.

15.3%

 

Trans people who want further research in mental health and neurological indicators

Vector art to illustrate 15.3% of interviewees.
Vector art showing two people in conversation.

Training for all kinds of healthcare professionals, including doctors, therapists, and specialists

Vector art showing a doctor and a first aid kit.

Medical advances including surgical techniques, hormone effects, risks and alternative treatments

Vector art showing a heart monitor.

Medical interventions and ongoing support for trans people who are years into their medical transitions

Mentioned issues and suggestions include:

Vector art showing a child holding hands with their parent.

Further research into hormone blockers to reduce the stigma around their use, and increase their safety

Vector art showing a person’s face and brain.

Further understanding of the correlation between Autism disorders and transgender identities

Vector art showing male, female, and androgynous figures.

Further understanding of non-binary identities and social transitions, including the use of pronouns

Vector art of a phone.

The use of Telehealth to support trans people in remote and rural areas, who suffer from lack of access

Hormone Therapy

Cross-Sex Hormone Therapy in Australia: the Prescription Patterns of Clinicians Experienced in Adult Transgender Healthcare. Bretherton et al. Internal Medicine Journal 2018.

 

Anecdotally, both in clinics and on online forums, there was wide discrepancy in trans hormone prescription. We conducted this study to try to document how doctors were prescribing hormone therapy in Australia. We targeted AusPATH members as we thought they would be the most experienced in trans health. The responses were pretty homogenous so the people who actually prescribe differently (like people who give estrogen implants or those that aim for very high estrogen levels), may have not responded to our survey. This is a limitation.

35 AusPATH members experienced in hormone prescription.

AusPATH formerly known as ANZPATH.

Vector art of a female figure.

54.3%

FEMALE

Vector art of a male figure.

40%

MALE

Vector art of the transgender symbol.

5.7%

TRANS

Vector art of a clipboard next to the 79% statistic.

79% supported development of Australian guidelines, later created by THR

Vector art of a needle next to the 46% statistic.

Testosterone Undecanoate injections (Reandron) used by 46%

Vector art of a pill next to the 71.4% statistic.

Oral Estradiol Valerate (Progynova) used by 71.4%

Vector art of a stethoscope next to the 90% statistic.

>90% targeted hormone reference ranges of the affirmed gender

Patients were monitored during the first year of hormone therapy, every;

Vector art displaying that 17.1% of trans people were monitored every 4-6 months during their first year of hormone therapy, whereas 71.4% were monitored every 2-3 months. 17.1% 71.4% 2-3 Months 4-6 Months

Testing throughout masculinising hormone treatment:

Vector art displaying testing throughout masculinising hormone treatment. 76% had their Testosterone levels tested. 61% had their estradiol levels tested. 61% had their full bloods, electrolytes, and renal function tested. 73% had their liver function tested.

Feminising hormone treatment methods:

Vector art displaying feminising hormone treatment methods. Oral estradiol valerate is 71.4%, and transdermal estradiol patch is 8.6%. 17.1% did not respond, whereas 2.9% employed other methods.

Masculinising hormone treatment methods:

Vector art displaying masculinising hormone treatment methods. Intramuscular Testosterone undecanoate is 48.6%, intramuscular Testosterone enantate is 31.4%, Testosterone gel/cream is 14.3%, and 5.7% gave no response.

Funding priorities, as dictated by the AusPATH members when asked to select their top priority for government funding:

Vector art displaying funding priorities, as dictated by the AusPATH members when asked to select their top priority for government funding. 44.8% said, better training for doctors. 24.1% said gender clinics. 17.2% said psychology and psychiatry services. 10.3% said medical research. 0% 12.5% 25% 37.5% 50% BETTER TRAINING FOR DOCTORS GENDER CLINICS PSYCHOLOGY AND PSYCHIATRY SERVICES MEDICAL RESEARCH 10.3% 17.2% 24.1% 44.8%

Approach before hormone therapy:

Vector art displaying that 80% of respondents recommended a mental health assessment before hormone therapy. 20% recommended a mental health assessment or informed consent. 20% 80% Mental Health Assessment Assessment or Informed Consent
 
 
Trans Healthcare

Australian Endocrinologists Need More Training in Transgender Health: A National Survey. Bretherton et al. Clinical Endocrinology 2020.

 

Recommended: Incorporation of trans health into medical school and endocrine training curricula. Training or lectures delivered should be designed by experienced clinicians in collaboration with trans community members. Inclusion of community voices allows an understanding of health issues and barriers faced by the community.

147 Clinical Endocrine Society of Australia members.

34%

FEMALE

66%

MALE

0%

OTHER

Number of trans individuals under the care of interviewed Australian endocrinologists:

Desire for more training in treating trans individuals among endocrinologists:

25.2%

 

Endocrinologists who feel comfortable commencing gender-affirming hormone therapy

90.5%

 

Endocrinologists who want more training in trans medicine

1.4%

 

Medical students who have training in trans medicine

29.3%

 

Endocrinologists who have training in trans medicine

67.4%

 

Endocrinologists who have low confidence in performing a trans consultation

49.6%

 

Endocrinologists who have seen 1-4 trans patients in their career

14.3%

 

Endocrinologists who have never seen a trans patient throughout their career

19.1%

 

Endocrinologists who feel comfortable treating trans patients

Trans Health Research logo.