Transgender community calls for fast-tracked mental health services to avoid lengthy wait for hormones

Updated November 21, 2016 21:38:54

Victoria's growing transgender community is demanding greater action to tackle long public waiting lists to access hormone therapy.

Melbourne has two publicly-funded facilities specialising in transgender health — the Monash Gender Dysphoria Clinic and the Royal Children's Hospital Gender Service.

But transgender specialist Dr Pauline Cundill said some patients faced delays of between 12 and 18 months to see psychiatrists and clinical psychologists through the two services.

"The last few years in particular, we've seen exponential increases in the number of trans and gender-diverse clients accessing medical care, and as a result the public clinics have become overwhelmed," she said.

She said part of the reason for the long delays was a requirement for general practitioners to seek psychological approval before prescribing sex-change hormones.

Jeremy Wiggins, the Victorian AIDS Council's spokesman on transgender health, said the delays could be reduced if patients saw a private specialist, although most could not afford to pay up to $200 a session.

"There's a huge increase in the number of trans, gender-diverse people wanting to affirm their gender and wanting to go through a process of medical transition," he said.

"This is why we're seeing these services being completely inundated and the current service model cannot keep up with the number of people requiring support."

Youths call for quicker access to hormones

Jasper, 18, has been receiving sex-change hormones for about five months.

He said he started seeing a psychologist a year ago to make sure he was ready to start taking hormones "as soon as I possibly could".

"It has made me feel incredible," he said.

"I got all of the changes quite quickly, my voice dropped heaps in the early days … I still don't have facial hair, but one day."

He said it should be easier and quicker to access hormone therapy because transgender people could not wait months or even years for treatment.

"I'm lucky in that I did plan so well ahead that I got it as easy as possible," he said.

"I had to work so much harder without them to make myself seem male socially."

Bianca, 20, started self-medicating with hormones purchased online while undergoing psychological assessment.

"I already knew what I wanted, I knew exactly who I was and I can understand if other people needed to see someone but I just didn't need to really," she said.

Dr Cundill has experienced the demand first hand — she helps to operate the Equinox Gender Diverse Health Service at Fitzroy in Melbourne's inner-north.

The bulk-billing general practice has seen more than 200 patients since opening in February this year and takes on about four new patients every day.

Call for GPs to be given greater role

Dr Cundill recommended a new government-backed approach to treatment and further state funding to reduce the waiting times.

She said a model of "informed consent" was being successfully used overseas, where GPs with appropriate training carry out their own psychological assessments.

"Where we ask ourselves, do all clients require a mental health review prior to initiating hormone therapy? The answer is no, not all clients do," she said.

"Mental health support is recommended for everyone … but it's not a compulsory requirement prior to initiating hormones."

Jeremy Wiggins believes allowing GPs to take on a greater role would ease the burden on the two public facilities and provide better access for people in regional areas.

"Instead of referring people to these services that are clearly inundated ... we could be providing GPs with some support to actually do the initial assessments," he said.

"We're not talking about people being able to access hormones and walking away in the first session. We're talking about developing a relationship with their primary health care provider."

He also suggested forming an organisation to provide specialist training and ongoing advice to doctors working in the field.

Victoria's Mental Health Minister Martin Foley said additional funding for both services had recently seen waiting times fall.

"To the point that where for young people those services are turned around very quickly and for adults at Monash I'm advised the waiting list is down to about nine months," he said.

He said the Government would continue working with transgender groups to reduce waiting times for the growing population.

Topics: lgbt, community-and-society, sexual-health, health, sexuality, doctors-and-medical-professionals, health-administration, government-and-politics, state-parliament, vic, melbourne-3000

First posted November 21, 2016 18:37:54