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Gender Service

  • Overview


    The Royal Children's Hospital (RCH) Gender Service aims to improve the physical and mental health outcomes of children and adolescents who are trans or gender diverse. Being trans or gender diverse is seen as part of the natural spectrum of human diversity.

    Some trans or gender diverse children and adolescents experience gender dysphoria. Gender dysphoria is a medical term that refers to the distress that a person may experience when there is an incongruence between their gender identity and their gender assigned at birth. Trans and gender diverse children and adolescents have considerably higher rates of depression, anxiety, self-harm and attempted suicide compared to their cis-gender peers. This is due to their experiences of stigma, discrimination, social exclusion, bullying and harassment. Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.

    • The Gender Service is a Victorian statewide service. Unfortunately the Service is unable to accept referrals from interstate or overseas.

      • The RCH Gender Service is not a crisis service. Should you have immediate or urgent concerns for 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 

        Victoria's Mental Health Services


        If you or someone you know needs someone to talk to urgently:

        Referrals

        Children and adolescents up to 16 years

        We accept new referrals from across Victoria for any child or adolescent up to the age of 16 years with concerns regarding their gender identity. A referral from a General Practitioner (GP) to the Gender Service is required.

        To facilitate the processing of new referrals we request referring General Practitioner’s please ensure that referrals to the Gender Service:

        • Provide relevant clinical information including whether the young person is pre-pubertal or post-pubertal. Blood tests are not required.
        • Include information regarding sociocultural vulnerability to assist with triage processes. This includes Aboriginal and Torres Strait Islander young people, and families with involvement of child protective services. 
        • Ensure community based mental health support is in place.
        • Adolescents who are 16 years or under require a parent to be aware of the appointment and to attend with them.

        Once a referral has been received by the hospital a phone SMS from the hospital is sent to confirm the referral has been accepted. All new referrals will receive an appointment in the mail outlining the details of the first appointment. There is a wait time for this.

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

        Adolescents 16 years and over

        The RCH Gender Service see children and adolescents for a new assessment up to their 16th birthday. Adolescents who are 16 years or over may be eligible to access adult services:

        Monash Medical Centre Gender Clinic
        Referrals accepted from age 16 years 
        Phone: 03 9556 5216 
        Fax: 03 9556 5256

        There are also a number of community adult services including Northside ClinicEquinox Gender Diverse Health Centre, Prahran Market Clinic, TG Health Clinic, Eleanor Clinic and Trans and Gender Diverse Community Health Services in Preston (PANCH) and Ballarat.

        Contact information

        To change or cancel a booked appointment

        Please contact the RCH Gender Service on (03) 9345 6175, please leave a message with your patient UR number, reason for cancellation and confirm if you would like to be rebooked or discharged from the service.  For appointments that are rebooked a new appointment letter will be sent out in the mail.                 

        The Service

        Once a referral has been received by the Gender Service it will be triaged and placed on the waitlist.  When an appointment is available you will be sent out an appointment confirmation letter 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 offered.

        Assessment

        When an appointment for your assessment becomes available you will be contacted by our Administration Coordinator to confirm details. 

        Children under 8 years

        The initial consultation for children 8 years and under will entail a review by a psychologist or child psychiatrist. They may be referred later to a paediatrician who specialises in adolescent medicine and gender diversity if required.

        Children and Adolescents 8-16 years

        Assessment and Support

        The initial consultation is the entry point into service for children 8 years and adolescents up to their 16th birthday. This is a one off consultation with the Gender Service clinical nurse consultant or one of our adolescent medicine doctors.

        This initial consultation will involve an assessment that will allow the Gender Service team to provide you and your child or adolescent with information regarding the service. As an outcome of this assessment you will be provided recommendations to the relevant supports that are available within the Royal Children’s Hospital and external community organisations. 

        Treatment

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

        Following your initial assessment you will be offered four appointments with a child and adolescent clinical psychologist or psychiatrist and then a paediatrician both of whom specialise in gender identity.

        For pre-pubertal gender diverse children, assistance is provided to develop gender affirming environments both at home and at school. Once puberty starts, options for medical treatment include:

        1. Puberty suppression

        Puberty blockers – prescribed by a paediatrician or paediatric endocrinologist.

        Puberty blockers suppress the development of secondary sex characteristics and are used for adolescents in the early stages of pubertal development. As they are reversible in their effects, should an adolescent wish to stop taking them at any time, their biological puberty will resume.

        2. Gender Affirming Hormone Treatment

        Gender affirming hormones  (oestrogen or testosterone) – prescribed by paediatrician or paediatric endocrinologist.

        Gender affirming hormone treatment initiates pubertal changes consistent with the young person's affirmed gender. The timing of hormone treatment is individualised based on the young person's circumstances. Trans feminine young people can be offered oestrogen treatment and trans masculine young people can be offered testosterone. These hormones are only partially reversible in their effects. 

        Guidelines

        The RCH Gender Service provides care that is consistent with the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (Version 1.3, 2020).

        Resources

        Australian Standards of Care and Treatment Guidelines

        Australian Gender Standards of Care

        Parent support groups

        Support groups for young people

        Community information and support services

        Education, sport and other information links

        Research and evaluation

        Research into trans and gender diverse children and young people 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. For more information, please see visit Transgender Health and Transgender Youth Health 

        Professional affiliations

        More about the RCH Gender Service