Position Statement on the Hormonal Management of Adult Transgender and Gender Diverse Individuals

Introduction

Rising demand for gender-affirming hormone therapy mandates a need for more formalised care of transgender and gender diverse (TGD) individuals in Australia. Estimates suggest that 0.1–2.0% of the population are TGD, yet medical education in transgender health is lacking. We aim to provide general practitioners, physicians and other medical professionals with specific Australian recommendations for the hormonal and related management of adult TGD individuals.

Main recommendations

  • Hormonal therapy is effective at aligning physical characteristics with gender identity and in addition to respectful care, may im-prove mental health symptoms.
  • Masculinising hormone therapy options include transdermal or intramuscular testosterone at standard doses.
  • Feminising hormone therapy options include transdermal or oral estradiol. Additional anti-androgen therapy with cyproterone ac-etate or spironolactone is typically required.
  • Treatment should be adjusted to clinical response. For biochemical monitoring, target estradiol and testosterone levels in the refer-ence range of the affirmed gender.
  • Monitoring is suggested for adverse effects of hormone therapy.
  • Preferred names in use and pronouns should be used during con-sultations and reflected in medical records.
  • While being TGD is not a mental health disorder, individualised mental health support to monitor mood during medical transition is recommended.

Changes in management as result of this position statement

Gender-affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring. Further research is needed to guide clinical care and understand long term effects of hormonal therapies. We provide the first guidelines for medical practitioners to aid the provision of gender-affirming care for Australian adult TGD individuals.

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