This page provides guidance on the Informed Consent Model (also known as ‘Affirmation Enablement’) to help you support your trans patients if they seek to medically affirm their gender using this model. The informed consent model¹,² offers a framework and protocol that supports GPs to commence and manage gender affirming hormonal treatment.
“Ultimately, access to transition-related health care should be based on providing adequate information and obtaining informed consent from the individual.” – Protocols for the Provision of Hormone Therapy3
Informed consent involves a GP providing adequate and accurate information to enable a person to make an informed decision regarding potential medical treatment to affirm their gender. For an intervention such as gender affirming hormone treatment, the individual must understand the short and long term risks and benefits of the intervention, and how this may affect any existing medical or mental health care needs.
The model has been around for a long time, and was formalised at the Callen Lorde Community Health Centre in New York. They write in their Protocols for the Provision of Hormone Therapy³ that hormonal affirmation is “a cooperative effort between patient and provider. We strive to establish relationships with patients in which they are the primary decision makers about their care, and we serve as their partners in promoting health.”
Thorne Harbour Health’s Equinox Gender Diverse Health Centre in Victoria also developed the excellent Protocols for the Initiation of Hormone Therapy for Trans and Gender Diverse Patients, and are endorsed by AusPATH.
They write that “Implementing an ‘Informed Consent’ model of care would reduce waiting times at public mental health services. It would improve access to initiation of [hormones] for trans people, particularly those living in rural and remote areas. It may reduce the use of self medicating (buying hormones online) with the associated medical risks.”
Informed consent recognises the trans person as the experts of their own needs and experience, while respecting that medical professional(s) are able to utilise their expertise to enable effective and safe treatment. Together, they can optimise the health and wellbeing of the person requiring access to gender affirming treatment in a timely manner.
All doctors have the opportunity to be a gender affirming doctor. Gender affirming medicine is a part of general medical care within the primary health care system. Any GP is able to prescribe gender affirming hormonal therapy for most people aged 18 and above, without requiring further consultation from a mental health professional or endocrinologist.
How do I offer gender affirming care using the Informed Consent Model?
Informed consent recognises the trans person as the expert of their own needs and experience, while respecting that medical professional(s) can utilise their expertise to enable effective and safe treatment. Together, they can optimise the health and wellbeing of the person requiring access to gender affirming treatment in a timely manner.
Guidelines
There are guidelines and templates available, including TransHub’s GP Gender Affirming Management Plan. These templates require individualising to remain Medicare compliant but provide all the information required for feminising and masculinising medical affirmation. In NSW, you can also check out the Gender affirming Health Pathways. Outside of NSW, refer to your local Primary Health Network’s Health Pathways, if applicable.
The process may look like:
- A consultation with your patient (aged 18+) across 2-3 appointments. This will include assessing physical health, family history, and previous hormonal or gender affirmation experience.
- Discussion about how they want to affirm their gender medically, and associated goals.
- Discussion of risks factors.
- Assessment of patient’s capacity to make an informed decision and consent to treatment, ensuring that they are making a decision of their own free will.
- Assessment of patient’s medical history to check for contraindications:
- Absolute contraindication – current pregnancy
- Consider relative contraindications to testosterone or estrogen such as polycythaemia, thrombosis, liver disease or cardiac failure
- There is insufficient data regarding the long term effects of hormonal therapy on cardiovascular outcomes⁴ and well controlled cardiovascular conditions are not considered contraindications
- Identify any history of migraines, liver disease, seizures, breast tissue lumps and irregular bleeding, and decide whether these warrant further investigation prior to commencing hormone therapy.
- Consider current medications, allergies, alcohol or tobacco use, and what your patient’s support networks are like at home and at work.
- Discuss fertility goals and reproductive health needs. Provide information on fertility preservation process (many HealthPathways include fertility preservation referral pathways)
- Assess preventative health needs – last cervical screen, STI test, contraception methods, bowel cancer screen etc.
- Conduct blood tests to establish base line levels of FBC, E/LFT, fasting glucose/lipids, estrogen and testosterone, as well as blood pressure and weight.
- Provide patient with informed consent paperwork, that show the patient has been provided with, and understands all the necessary information, and consents to the process
- A sexual history is not required, but can be undertaken in an affirming manner if also providing sexual health care or screening
- A genital exam is not required and is not recommended in any guidelines⁵
Downloads
10 trans questions to ask a doctor - TransHub
10 tips for clinicians working with trans & gender diverse people - TransHub
Gender affirming intake form for doctors - TransHub
Trans-Affirming Clinical Language - TransHub
Informed Consent Graphic – PDF
Testosterone-based gender-affirming hormonal therapy consent form – AusPATH
Estradiol-based gender-affirming hormonal therapy consent form – AusPATH
References & Links
¹Healthdirect Australia. (n.d.). Informed consent.
²Schulz, S. L. (2018). The informed consent model of transgender care: An alternative to the diagnosis of gender dysphoria. Journal of humanistic psychology, 58(1), 72-92.
³Callen Lorde Community Health Center. (2014). Protocols for the Provision of Hormone Therapy.
⁴Cheung, A. S., Wynne, K., Erasmus, J., Murray, S., & Zajac, J. D. (2019). Position statement on the hormonal management of adult transgender and gender diverse individuals. Medical Journal of Australia, 211(3), 127–133.
⁵Coleman, E., et al. (2022). Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health, 23(S1), S1–S260.
Thorne Harbour Health. (2020). Protocol for the initiation of hormone therapy (Version 2).
