Background: Transgender health is an understudied area with relatively little evidence to guide clinical practice. Understanding the medical and psychosocial characteristics of transgender individuals accessing cross-sex hormone therapy may be useful in tailoring health services to the needs of the trans-community.
We aimed to document the number of individuals seeking cross-sex hormone therapy and understand their demographics and medical comorbidities.
Methods: We performed a retrospective audit of all initial consultations with gender dysphoria presenting to two endocrinologists at a private practice in Melbourne, Australia between June 2011 and December 2016.
Results: New consultations for gender dysphoria have increased significantly in the last three years (Figure 1) with a total of 283 individuals audited. 17% of patients resided in rural or remote areas across all Australian states. Two-thirds were referred from three LGBTI-friendly GP practices in Melbourne. Median age was 28 years with range (16 – 74). Female-to-male individuals comprised 58% of all referrals, male-to-female 34% and non-binary 8% of trans individuals. Whilst all socio-economic classes were represented, 49% of individuals were either unemployed or students. Medical comorbidities were few with the majority (59%) having a Charlson Comorbidity Index of 0. Conversely psychiatric comorbidities were highly prevalent with 55% being medically diagnosed with depression and 35% diagnosed with anxiety. 24% were currently smoking, higher than the Australian population mean.
Conclusions: There is a rapidly rising demand for endocrinologists to provide cross-sex hormone therapy for trans and gender diverse individuals. Location of patients throughout Australia may reflect a lack of transgender health services. Higher numbers of female-to-male transmen in this specialist endocrinology practice are likely related to current PBS authority guidelines for accessing testosterone therapy. High prevalence of psychiatric comorbidities and relatively social disadvantage support a need for comprehensive multidisciplinary public health services for trans individuals.