< All about hormones

Endocrinology

This page provides guidance on when to engage specialist endocrinology for gender affirming hormonal care.

Specialist endocrinology has traditionally been viewed as an essential part of hormonal affirmation for all trans and gender diverse people, with Endocrinologists being the key to access and provision of hormones. This has meant skilled Endocrinologists have been required to see a lot of very healthy trans people.

Using the Informed Consent Model - also known as ‘affirmation enablement’ - Endocrinologists might be one part of a larger multidisciplinary network of health professionals facilitated by a GP who work in partnership with trans patients to manage their hormonal and medical needs.

With the majority of hormonal affirmation managed through primary care, Endocrinologists can manage the care of trans people with more complex needs, contraindications, and endocrine issues.

When is specialist endocrinology necessary?

Working with an Endocrinologist can be helpful for trans patients when:

  • A hormonal profile at baseline or once commenced is atypical

  • Complex physical health co-morbidities are present

  • Complications arise if initiating hormones

  • Pubescent adolescents are making decisions about hormone use

  • Trans people are in their 50s and above

  • For assistance with lactation induction in trans women

  • A patient wants to see an Endocrinologist

Testosterone and the PBS

Accessing PBS-listed testosterone does currently require an additional step where a doctor (or the patient) will need to consult with an Endocrinologist, Sexual Health Doctor or Urologist. This only needs to happen once.

A prescribing doctor can use the PBS authority indication “androgen deficiency due to an established testicular disorder”, which is accurate since your patient doesn’t naturally produce enough testosterone on their own. The patient doesn’t need to be listed with Medicare as male in order to access PBS-listed testosterone.

The patient must be treated by or in consultation (including teleconsult, phone or email) with a paediatrician, endocrinologist, urologist or sexual health physician. The specialist’s name must be given in the authority application.

Authority Indication, Pharmaceutical Benefits Scheme

Paediatric endocrinology

For children up to 16-17 years, working with a Paediatric Endocrinologist is recommended as per the Australian Standards of Care and Treatment Guidelines For Trans and Gender Diverse Children and Adolescents. It is recommended that an Endocrinologist is one member of a multidisciplinary team of health professionals working to support and affirm the patient.

The roles of the Paediatrician, Adolescent Physician or Endocrinologist in the assessment and ongoing care of trans adolescents include include:

  • Provision of information and education to the adolescent and their parents/carers regarding options for medical [affirmation] including risks and benefits of puberty suppression, and gender affirming hormones.
  • Education, advice and provision of medical intervention when appropriate for the management of menstrual suppression, contraception and pregnancy related issues.
  • Provision of developmentally appropriate education regarding the impact of medical intervention on sexuality, sexual pleasure, fertility potential and the options available for fertility preservation.
  • Referral for fertility preservation as required.
  • Assessment of the adolescent’s ability to consent to medical intervention. This should be done in collaboration with the mental health clinician.
  • Prescription of medication for initiation and maintenance of pubertal suppression and gender affirming hormone treatment.
  • Monitoring of physical and mental health during medical [affirmation]. This includes identification and monitoring for … desired physical and psychological changes and adverse effects from treatment.

Australian Standards of Care and Treatment Guidelines For Trans and Gender Diverse Children and Adolescents