Gender Service

  • Overview

    The Royal Children's Hospital 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 sex assigned at birth. Transgender 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.

      • 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.

        Referrals

        Children and adolescents up to 17 years

        We accept new referrals from across Victoria for any child or adolescent up to the age of 17 years with concerns regarding their gender identity. A referral from a General Practitioner (GP) to the Gender Service is required.

        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. All new referrals will receive an appointment in the mail outlining the details of the 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.

        Changing new appointments

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

        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 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 for children over 8 years and adolescents up to their 17th birthday will involve an assessment with the Gender Service clinical nurse consultant or one of our adolescent medicine fellows.

        This initial assessment will allow the Gender Service team to provide you and your child or adolescent with information regarding the service and relevant supports that are available both within the Royal Children’s Hospital and through external groups and 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 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 are divided into two stages:

        Stage 1

        Puberty blockers – prescribed by a paediatrician or paediatric endocrinologist.

        Puberty blockers suppress the development of secondary sex characteristics whilst providing time for cognitive and emotional development. As they are reversible in their effects, should an adolescent wish to stop taking them at any time, puberty will resume in the biological sex.

        Stage 2

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

        Gender affirming hormones initiate puberty in the affirmed gender and may be commenced around the age of 15 to 16 years. A transgender female would be commenced on oestrogen and a transgender male would start testosterone. These are only partially reversible in their effects. In Australia, this stage of treatment requires Family Court approval for adolescents under the age of 18 years. (See Navigating the stage 2 process in the Education, sport and other information links)

        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 (2017).

        Resources

        Australian Standards of Care and Treatment Guidelines

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        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