Gender Service

  • Overview

    The Royal Children's Hospital Gender Service aims to improve the physical and mental wellbeing outcomes of children and adolescents who experience gender dysphoria.

    Gender dysphoria refers to the distress that a person may experience when there is an incongruence between their biological gender and their expressed gender. Transgender and gender diverse young people have considerably higher rates of self-harm, attempted suicide, depression and anxiety compared to their cis-gender peers. Outcomes for these young people can be significantly improved through medical support.

    • The Gender Service is a Victorian statewide service. Unfortunately the Service is unable to accept referrals from interstate.
    • The RCH Gender Service is not a crisis service. Should you have immediate or urgent concerns for your or your child's mental wellbeing please contact your regional mental health service.

    The mental health service State Government website provides contact details for Victoria's regionalised mental health services and the suburbs and regions they cover.

    Referrals

    Children and adolescents up to 17 years

    We accept new referrals for any child or adolescent up to the age of 17, who resides in Victoria, with concerns regarding gender diversity or gender dysphoria can be referred by a General Medical Practitioner (GP) to the Gender Service for assessment and support with ongoing treatment and care.

    Referrals can be made to the Gender Service using the interactive Referral form  which should then be faxed to (03) 9345 5034.

    Once a referral has been received by the hospital you will get a phone SMS from the hospital confirming this.

    We have recently implemented a new pathway of care into the Gender Service. Commencing 1st of May 2016, all new referrals will receive an appointment in the mail outlining the details of their first appointment.

    Adolescents 17 years and over

    The RCH Gender Service see children and adolescents for a new assessment up to their 17thbirthday. Adolescents who are 17 years or over may be eligible to access adult services:

    Monash Medical Centre Gender Clinic
    For people aged 17+
    Phone: 03 9556 5216 
    Fax: 03 9556 5256

    Contact information pre-referral

    The Gender Service Clinical Nurse Consultant can be contacted on (03) 9345 4719.

    Contact information regarding changing new appointments

    The Gender Service administration coordinator can be contacted on (03) 9345 5890

    Contact information regarding changing review or follow up appointments

    Specialist clinics can be contacted via switchboard on (03) 9345 6180 - specifically ask for Desk D

    The Service

    Once a referral has been received by the Gender Service you will be sent an appointment in the mail.

    Families who access the Royal Children's Hospital Gender Service with their child or adolescent will be provided with a family centred approach to care. This will entail a multidisciplinary assessment of their child or adolescent regarding gender diversity or gender dysphoria. As an outcome of the assessment, support and treatment pathways will be proposed.

    Assessment

    When an appointment for your assessment becomes available you will be contacted by our Administration Coordinator to confirm details. There is currently a long wait list to access the service.

    Children under 8 years

    The initial consultation for children 8 years and under will entail a review by a psychologist and then your child may be referred to paediatrician who specialises in adolescent medicine if needed.

    Children and Adolescents 8-16 years

    Assessment and Support

    Families may need considerable support in understanding and responding to their child or adolescent's needs. The initial consultation for children over 8 and adolescents up to their 17thbirthday will involve an assessment with the Gender Service clinical nurse consultant or one of our adolescent medical fellows.

    This initial assessment will allow the Gender Service team to provide you and your child or adolescent with information regarding relevant supports that are available both within the Royal Children’s Hospital and through external groups and community organisations.

    Diagnosis and Treatment

    Following your initial assessment you will be offered an appointment with a child and adolescent psychiatrist and a paediatrician who specialise in gender identity.

    Treatment provided by the Gender Service therefore involves diagnosis and then development of a comprehensive management plan in collaboration with the child or adolescent and their family.

    For prepubescent children treatment may be gender affirmation with assistance and support in home and schooling environments. Once puberty starts two psychiatric opinions are required and options for medical treatment are divided into two stages:

    Stage 1

    Puberty blockers – prescribed by a paediatrician or paediatric endocrinologist.

    Puberty blockers suspend the development of secondary sex characteristics whilst providing time for cognitive and social development. They are reversible, therefore if an adolescent stops taking them puberty will resume in the biological sex.

    Stage 2

    Cross hormones – prescribed by paediatrician or paediatric endocrinologist.

    Cross hormones initiate puberty in the affirmed gender and may be commenced around the age of 16 years. A transgender female would be initiated on oestrogen and a transgender male would start testosterone. They are only partially reversible. In Australia, this stage requires court approval for adolescents under the age of 18 years.

    Guidelines

    RCH Gender Service treatment guideline follows the Endocrine Society Clinical Practice Guidelines and The World Professional Association of Transgender Health (WPATH) Standards of Care (Version 7 Published 2011) which highlight that "being transgender… is a matter of diversity, not pathology".

    Resources

    Parent support groups

    Support groups for young people

    • Minus 18
      youth led organisation for GLBTI
    • YGender
    • YAK
      GLBTI or not sure social group for young people 12-25 years
    • Free 2 Be Me Knox & Emerge; Same Sex Attracted & Gender Diverse (SSAGD) Knox
    • Rainbow Connections is a Youth Group for GLBTIQ/ Gender Diverse children
      Under 12 years of age - Mornington Peninsula
      Contact: Wayne 0451 631805 or Celeste 0419 249727  
    • Rainbow Kids : Gender diverse children under 13 and their families in the Geelong area
      Contact Tory Wood 0421 737 323    https://www.facebook.com/rainbowkidsgeelong
    • Kaleidoscope Banyule child and Family Support group for gender diverse and questioning children under 12 years and their families Kaleidoscopebanyule@gmail.com


    Community information and support services

    Education, sport and other information links

    Research and evaluation

    Research into gender dysphoria has been increasing over the past 10 years however, further evaluation and research is required to maximise treatment outcomes. To provide great care to children and adolescents with gender diverse or experience gender dysphoria, the RCH Gender Service is undertaking research and evaluation to better understand gender concerns in children and adolescents. There are currently three research and evaluation projects underway:

    Patient and parent experiences at the RCH Gender Service

    This project explores the way that patients and parents experience the service. We will then use this feedback to improve our service for patients and their families.

    Evaluating the RCH Gender Service

    We are undertaking an evaluation of the service to explore whether it is having a positive impact. This evaluation will involve collecting information about the health and wellbeing of patients (and parents) when they are first seen at the service and then at regular follow up periods. This information will help us understand the health care needs of children and adolescents with gender dysphoria. We will then be able to see how these needs change over time.

    Parental experiences of raising a child with gender dysphoria

    We are also interested in how gender dysphoria affects parents. This project explores how raising a child with gender dysphoria is related to parent wellbeing, and the types of support that parents may want to access.

    These three projects will help to improve our care for RCH patients and their families. We hope that these projects will improve our understanding of gender dysphoria and gender diversity in children and adolescents. We plan to build our research and evaluation activities in the future to expand our knowledge of gender in children and young people.

    Professional affiliations

    More about the RCH Gender Service