Criteria

The criteria for initiating (starting) hormones will differ depending upon your age, where you live, your health and medical history.  

For more information about the differences between the feeling and diagnosis of gender dysphoria, refer to our pages on gender dysphoria and gender diagnoses.  

Hormone Treatment for Adults

Australian SoC-8 criteria

  1. Gender incongruence is marked and sustained;  
  1. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;  
  1. Demonstrates capacity to consent for the specific gender-affirming surgical intervention; 
  1. Other possible causes of apparent gender incongruence have been identified and excluded; 
  1. Mental health and physical conditions that could negatively impact the outcome of treatment have been assessed, with risks and benefits discussed; 
  1. Understands the effect of gender-affirming hormone treatment on reproduction and they have explored reproductive options 

Standards of Care for the Health of Transgender and Gender Diverse People, Version 81

Hormone Treatment using oestrogen or testosterone for Adolescents

Australian SoC-8 criteria

  1. Gender diversity/incongruence is marked and sustained over time; 
  1. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;  
  1. Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment; 
  1. Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally. 
  1. Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility; 
  1. Reached Tanner stage 2; 

Standards of Care for the Health of Transgender and Gender Diverse People, Version 81 

Puberty suppression for Adolescents

Australian SoC-8 criteria

  1. Gender diversity/incongruence is marked and sustained over time; 
  1. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;  
  1. Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment; 
  1. Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally. 
  1. Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility; 
  1. Reached Tanner stage 2; 

 
Standards of Care for the Health of Transgender and Gender Diverse People, Version 81

Under 18s

A Family Court of Australia ruling (Re Kelvin, 2017)2 overturned an existing law that required all young people and their parents or guardians to go to Court to commence gender affirming hormones prior to age 18, this ruling was further clarified in the judgement of Re Imogen 20203.  

This means that treatment can be commenced in Australia with people under 18 when there is no dispute between parents (or those with parental responsibility), the medical practitioner and the young person themselves with regard to:   

  • The Gillick competence of an adolescent; or  
  • A diagnosis of gender dysphoria; or  
  • Proposed treatment for gender dysphoria  

 
Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re Imogen 2020.  

Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a child’s carers or legal guardians consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers (“Stage 1”), hormones (“Stage 2”) or surgical intervention (“Stage 3”) without court authorisation.  

For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court must be involved. Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones or seeking to access them outside of medical care and oversight.  

Should you want to take legal action, you may want to find professional support in your state or territory to assist you. For other support services, you can explore QLife’s National LGBTQI+ Services Directory. 

AusPATH endorses local and international Standards of Care that offer guidance on puberty suppression for trans young people and adolescents. 

1  Standards of Care V8 [PDF]  – WPATH 
2   Re: Kelvin FamCAFC 258 (2017) – Family Court of Australia 

3 Re: Imogen (No. 6) (2020) FamCA 761 (10 September 2020). - Family Court of Australia judgement 
Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents v1.4 [PDF] - The Royal Children’s Hospital Melbourne 

Position statement on the hormonal management of adult TGD individuals - Ada S Cheung, Katie Wynne, Jaco Erasmus, Sally Murray and Jeffrey D Zajac 

Trans children and medical treatment: the law [PDF] - Inner City Legal Centre (NSW)

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