Transgender health outcomes

Improving health outcomes for transgender children and young people

As the need for gender services grows globally, wait times of up to two years are becoming the norm. But here in Melbourne, an innovative clinical model is reducing the wait and improving wellbeing for young people.

The Royal Children’s Hospital Gender Service’s (RCHGS) First Assessment Single-Session Triage (FASST) clinic is reducing wait times by up to 10 months, research led by the Murdoch Children’s Research Institute (MCRI) has found.

FASST: A timely intervention

Introduced in 2016, the FASST model invites transgender and gender diverse young people and their families to a 90-minute face-to-face session with a clinical nurse consultant or RCHGS Adolescent Medicine fellow.

“For young people, coming to the clinic helps to validate their experience, improve their confidence, and have a greater sense of empowerment moving forward,” says Royal Children’s Hospital paediatrician and corresponding author of the study, Associate Professor Ken Pang (BMedSc 1995, MBBS (Hons) 1998, PhD 2007).

The one-off session provides initial assessment and triage while delivering information, education and support to patients and their families.

This might involve discussions about how to socially affirm one’s gender by using preferred names and pronouns at home or at school or emphasising the importance of looking after one’s general mental health and accessing relevant community-based services.

Associate Professor Pang says that for young people who attend the clinic, learning what they can do while they wait for a more definitive, multidisciplinary assessment at the RCHGS is empowering.

“Young people described a greater sense of agency afterwards and we were really pleased to see significant improvements in mental health and quality of life following attendance,” he says.

Meeting a critical need

The RCHGS is one of the world’s largest multidisciplinary clinics providing care to transgender children and adolescents.

A recent community-based survey of almost 900 Australian trans youth found a staggering 80 per cent had self-harmed and 48 per cent had attempted suicide. Three quarters had been diagnosed with depression and 72 per cent with anxiety.

Associate Professor Pang points out that most trans youth surveyed lacked family support and had experienced bullying and discrimination, which are likely to be important drivers of mental ill-health along with gender dysphoria.

“At a service like ours, there's a lot of work that goes on to support transgender young people and their families,” says Associate Professor Pang, who is also a Team Leader within MCRI’s Clinical Sciences Theme.

“There is sometimes a misconception that young people come into our service and walk away with a script for hormones after one or two sessions. In reality, young people and their families are typically supported by a multidisciplinary team over many years. In a lot of instances, young people and their parents tell us how lifesaving the service has been.”

Trans20: Taking a longitudinal view

The FASST clinic is just one of a range of recent RCHGS innovations and research projects. Requests and referrals to specialist gender services are on the rise globally, with around one per cent of adolescents and adults now identifying as transgender.

Associate Professor Pang says more research is needed into the clinical care provided to transgender young people, especially hormonal interventions.

The MCRI’s Trans20 project is the first longitudinal study to evaluate the health outcomes of young transgender people attending the RCHGS. Intended to last 20 years, it will use annual questionnaires to provide critical information on the benefits and risks associated with current clinical practices and guide future clinical pathways.

The study’s longitudinal nature will provide useful data to help address key questions regarding gender dysphoria, mental and physical health and overall wellbeing in transgender children and adolescents.

“Our research covers many different aspects of transgender health, but Trans20 is our flagship project and has been made possible through the generous support of the Royal Children’s Hospital Foundation, the Hugh Williamson Foundation and the NHMRC,” says Associate Professor Pang.

The Trans20 team published a study in The Lancet Child & Adolescent Health that found most existing tools, primarily created pre-2000 to measure gender identity, expression, or dysphoria in transgender youth, are limited.

This further highlights the important work of the Royal Children’s Hospital and MCRI team, particularly considering that healthcare for transgender and gender diverse children and adolescents has only emerged over the past few decades.

How Melbourne alumni are driving better care

Associate Professor Pang has a long history with the University of Melbourne, having completed his medical degree and a PhD in immunology and genomics here. He also attended Harvard University as a Fulbright Scholar and NHMRC Menzies Fellow before returning to Melbourne in 2012 to work at the WEHI.

Working with transgender and gender diverse youth at the RCHGS was a big shift from this lab-based research but enabled him to build upon his previous clinical training.

“Although I formally qualified as a paediatrician, half of my postgraduate clinical training was actually in psychiatry. Working with trans and gender diverse children and their families represents a convergence of these dual clinical interests and has been very rewarding,” he says.

Mentoring emerging health professionals is also an important part of Associate Professor Pang’s work. He supervised Dr Sarah Dahlgren Allen (BCom, BSc 2011, MD 2018), who led the FASST study as part of her Doctor of Medicine MD Research Project.

“One of the really gratifying aspects of research is being able to mentor students and to see them grow and flourish,” he says. “This was certainly the case with Sarah, who did an outstanding job and whose paper was published in Pediatrics.”

Associate Professor Pang also encouraged Dr Dahlgren Allen to present her research at the 2019 Australian Professional Association for Trans Health Conference, for which she was awarded a travel scholarship.

“The whole team at the Gender Service was incredibly supportive and encouraging. I thoroughly enjoyed working with Associate Professor Pang, whose supervision struck the perfect balance between providing guidance and autonomy, allowing me to really maximise what I got out of the research project,” says Dr Dahlgren Allen, who is completing a Master of Public Health at the University of Melbourne.

As part of her research, Dr Dahlgren Allen interviewed FASST clinic patients who described improvements in their sense of self, confidence, and hope for the future.

She was heartened to hear about their positive clinic experiences, growing confidence and feelings of validation. “I think that was probably my favorite experience, because it also validated for me how I felt about the work that the Gender Service was doing.”