Premium
Cross‐sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare
Author(s) -
Bretherton Ingrid,
Thrower Emily,
Grossmann Mathis,
Zajac Jeffrey D.,
Cheung Ada S.
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14035
Subject(s) - medicine , transgender , hormone therapy , family medicine , medical prescription , health care , psychiatry , nursing , psychology , cancer , breast cancer , psychoanalysis , economics , economic growth
Background Despite increasing demand for transgender healthcare, guidelines for cross‐sex hormone therapy are based on low‐level evidence only. As most data are based on international expert opinions, interpretations and practices vary significantly. Aims To aid the development of Australian clinical guidelines, we aimed to identify cross‐sex hormone therapy prescribing patterns among medical practitioners experienced in adult transgender healthcare. Methods We conducted an anonymous online survey of experienced hormone prescribers who were members of the Australian and New Zealand Professional Association for Transgender Health (ANZPATH). Results We received 35 responses from 43 individuals listed with ANZPATH. Mental health assessments prior to commencement of hormonal therapy were recommended by 80% of prescribers. The preferred first‐line masculinising hormone therapy was intramuscular testosterone undecanoate (46% of respondents). The most commonly prescribed feminising agents were oral estradiol valerate (first line in 71.4%), with either spironolactone or cyproterone acetate. Most respondents (>90%) targeted sex steroid reference ranges of the affirmed gender, and 71.4% reviewed individuals every 2–3 months in the first year. Better training for doctors was seen as the most pressing priority for government funding, and 79.3% supported the development of local Australian‐based guidelines. Conclusions Experienced hormone prescribers in Australia largely use medication regimens and monitor sex steroid levels and potential adverse effects of sex hormone therapy in accordance with broad, subjective recommendations listed in international guidelines. Additional practitioner training is necessary, and local Australian‐based guidelines would offer specific, relevant guidance to clinicians in the initiation and monitoring of cross‐sex hormone therapy for adult transgender individuals.