Trans and gender diverse health

Gender identity describes a person’s internal experience of gender. For cisgender (cis) individuals, this identity is aligned with the gender that is presumed or assigned at birth. Trans and gender diverse (trans) individuals, have a different gender identity to that presumed or assigned at birth. It is estimated that up to 2% of the population is trans.

Binary gender identities are:

  • male or man
  • female or woman.

Nonbinary genders are not exclusively male or female; terms used include (but are not limited to):

  • nonbinary
  • genderqueer
  • agender (genderless or gender neutral)
  • genderfluid (fluctuates)
  • trans masculine
  • trans feminine.

Cis individuals have a binary gender identity; trans individuals may have a binary or nonbinary gender identity.

To capture the spectrum of gender identities that should be considered in a clinical situation, the following terms may be used:

  • ‘presumed female at birth’, referring to cis women, trans men, and some nonbinary individuals
  • ‘presumed male at birth’, referring to cis men, trans women, and some nonbinary individuals.

Health care providers are encouraged to use a sensitive approach that does not make assumptions about an individual’s’ gender identity, sexual orientation or practices. While many aspects of care for trans individuals are the same as for cis individuals, some needs are more specific. The approach to trans healthcare is evolving; healthcare practitioners have a growing requirement for treatment guidelines, care pathways and resources.

In conjunction with training and ongoing support from experienced providers, the following resources can be used, to help clinicians offer gender-affirming therapy and inclusive primary care:

  • The Australian Professional Association for Trans Health website provides detailed information about trans health, including:
    • standards of care and treatment guidelines. Links are included for the Australian Standards of Care and Treatment Guidelines for Transgender and Gender Diverse Children and Adolescents, the Australian Position statement on the hormonal management of adult transgender and gender diverse individuals, international standards of care for adults, and guidelines on the informed consent pathway to facilitate gender-affirming care in general practice
    • an online training module for general practitioners. This includes education about the spectrum of gender identity and language used, guidance on creating a supportive environment, options for gender-affirmation care (including hormone prescribing and monitoring) and referral, and resources for psychosocial support, peer support and access to other services
    • an online training module for mental health professionals to become familiar with and sensitive to the diverse terminology, experiences, issues, standards, and referral pathways for trans individuals.
  • The TransHub website provides extensive information for trans individuals and healthcare providers, with information on:
    • creating a welcoming clinical environment, including template intake forms
    • the informed consent care pathway with links to patient information sheets and consent forms, the Australian Position statement on the hormonal management of adult transgender and gender diverse individuals, Australian Standards of Care and Treatment Guidelines for Transgender and Gender Diverse Children and Adolescents and international standards of care for adults
    • medical and surgical aspects of gender affirmation, including clinical protocols, templates for GP management plans, and information on assessment of readiness for surgery
    • sexual health, including history taking, sexual health testing and sexual function
    • mental health, including an outline of the role of mental health professionals in assessing surgical readiness
    • fertility and reproductive health, including information on fertility preservation.

See also Hormone Replacement Therapy Prescribing Guide for General Practitioners outlining the use of and monitoring requirements for gender-affirming hormone management.