Trans Health Research

Research Overview

Trans Health Research conducts research with one goal: to provide robust evidence to improve the health and wellbeing of the trans and gender-diverse (TGD) community. Every question we ask, every project that we do, every collaboration that we start, is aligned with our goal and must translate to better health and advocating for our community. Our research covers three main themes; health care delivery, gender affirming hormone therapy and mental health and wellbeing. Findings guide health and wellbeing programs, treatment guidelines, and health policy, to enable trans people to live a life without barriers and discrimination.

We are nurses, endocrinologists, and TGD researchers with community experience. While gender research is our core focus, as a leading trans health research group in Australia and authors of national gender-affirming hormone therapy guidelines, we are also advocates and passionate speakers, and share gender education with health professionals nationwide.

Our research findings have been translated into policy, and have contributed to government investment in two new multidisciplinary gender clinics in Victoria, and a state-wide training program for health professionals in trans health. However, there is much more work to do, and we invite you to join us in shaping the future for health equity and a life without barriers for the TGD community. Want to know more about being TGD or would like to get involved? Visit our website www.transresearch.org.au for a range of resources and information.

Staff

  • A/Prof Ada Cheung (she/her), Principal Research Fellow
  • Dr Sav Zwickl (they/them), Postdoctoral Research Fellow
  • Dr Ingrid Bretherton (she/her), Postdoctoral Research Fellow
  • Dr Brendan Nolan (he/him), Clinician Scientist, PhD Student
  • Dr Lachlan Angus (he/him), Clinician Scientist, PhD Sttudent
  • Ms Kylie King (she/her), Research Nurse
  • Dr Alex Wong (he/him), Research Assistant
  • Ms Ariel Ginger (she/her), Research Assistant
  • Mx Leo Rhodanthe (they/them), Research Assistant
  • Dr Clare Headland (she/her), Speaker and Educator

Collaborators

We are proud to work in close partnership with TGD community groups and TGD-focussed health services throughout Australia.

Funding

  • NHMRC Investigator Grant Research Support Package
  • Dame Kate Campbell Fellowship, The University of Melbourne
  • Strategic Grants for Outstanding Women, The University of Melbourne
  • Royal Australasian College of Physicians Research Establishment Fellowship
  • Endocrine Society of Australia Research Seed Grant
  • Austin Medical Research Foundation Grant
  • Viertel Charitable Foundation Clinical Investigator Award

Research Publications

  • Nolan BJ, Frydman AS, Leemaqz SY, Carroll M, Grossmann M, Zajac JD, Cheung AS. Effects of low-dose oral micronised progesterone on sleep, psychological distress, and breast development in transgender individuals undergoing feminising hormone therapy: a prospective controlled study. Endocr Connect. 2022;11(5):e220170 https://doi.org/10.1530/EC-22-0170
  • Jones P, Voisin S, Nolan BJ, Landen S, Jacques M, Newell B, Zwickl S, Cook T, Wong A, Ginger A, Palmer A, Garnham A, Alvarez-Romero J, Mohandas N, Seale K, Cheung AS & Eynon N. (co-senior author). Uncovering the effects of gender affirming hormone therapy on skeletal muscle and epigenetics: protocol for a prospective matched cohort study in transgender individuals (The GAME Study). BMJ Open 2022 Apr https://doi.org/10.1136/bmjopen-2022-060869
  • Nolan BJ, Zwickl S, Wong AFQ, Locke P, Simpson S, Li L, Zajac JD, Cheung AS. Testosterone concentrations and prescription patterns of 1% testosterone gel in transgender and gender diverse individuals. Ther Adv Endocrinol Metab 2022 Feb. https://doi.org/10.1177/20420188221083512
  • Nolan BJ, Zwickl S, Locke P, Simpson S, Li L, Zajac JD, Cheung AS. Prescription patterns and testosterone concentrations achieved with AndroForte 5% testosterone cream in transgender and gender diverse individuals. J Sex Med 2022 Feb https://doi.org/10.1016/j.jsxm.2022.02.020
  • Shepherd R, Bretherton I, Pang K, Mansell T, Czajko A, Kim B, Vlahos A, Zajac JD, Saffery R, Cheung AS, Novakovic B. (co-senior author). Gender-affirming hormone therapy induces specific DNA methylation changes in blood. Clin Epigenet 2022; 14:24. https://doi.org/10.1186/s13148-022-01236-4
  • Bretherton I, Ghasem-Zadeh A, Leemaqz S, Seeman E, Wang X, McFarlane T, Spanos C, Grossmann M, Zajac JD, Cheung AS. Bone microarchitecture in transgender adults: a cross-sectional study. J Bone Miner Res 2022 Jan. https://doi.org/10.1002/jbmr.4497
  • Solanki P, Colon Cabrera D, Barton C, Locke P, Cheung AS, Grace J, Erasmus J, Lane R. Gender-Affirming Hormone Therapy for the Trans, Gender Diverse and Non-Binary community: coordinating WPATH and Informed Consent models of care. Transgend Health 2022 Feb https://doi.org/10.1089/trgh.2021.0069
  • Foster Skewis L, Bretherton I, Leemaqz SY, Zajac JD, Cheung AS. Short-term effects of gender-affirming hormone therapy on dysphoria and quality of life in transgender individuals: a prospective controlled study. Front Endocrinol 2021 Jul https://doi.org/10.3389/fendo.2021.717766
  • Balcerek MI, Nolan BJ, Brownhill A, Wong P, Locke P, Zajac JD, Cheung AS. Feminizing hormone therapy prescription patterns and cardiovascular risk factors in older transgender individuals in Australia. Front Endocrinol 2021 Jun. https://doi.org/10.3389/fendo.2021.667403
  • Zwickl S, Angus LM, Wong AFQ, Ginger A, Eshin K, Cook T, Leemaqz SY, Dowers E, Zajac JD, Cheung AS. The impact of the first three months of the COVID-19 pandemic on the Australian trans community. Int J Transgend Health 2021 Mar https://doi.org/10.1080/26895269.2021.1890659
  • Zwickl S, Wong AFQ, Dowers E, Leemaqz SY, Bretherton I, Cook T, Zajac JD, Yip PSF, Cheung AS. Factors associated with suicide attempts among Australian transgender adults. BMC Psychiatry 2021;21:18. https://doi.org/10.1186/s12888-021-03084-7
  • Bretherton I, Spanos C, Leemaqz SY, Premaratne G, Grossmann M, Zajac JD, Cheung AS. Insulin resistance in transgender individuals correlates with android fat mass. Ther Adv Endocrinol Metab 2021;12:1-12. https://doi.org/10.1177/2042018820985681
  • Bretherton I, Thrower E, Zwickl S, Wong A, Chetcuti D, Grossmann M, Zajac JD, Cheung AS. The health and well-being of transgender Australians: a national community survey. LGBT Health 2021; 8(1):42-49. DOI: 10.1089/lgbt.2020.0178
  • Spanos C, Grace JA, Leemaqz SY, Brownhill A, Cundill P, Locke P, Wong P, Zajac JD, Cheung AS. The Informed Consent Model of care for accessing gender-affirming hormone therapy is associated with high patient satisfaction. J Sex Med 2021;18(1):201-208. https://doi.org/10.1016/j.jsxm.2020.10.020
  • Lim HY, Leemaqz SY, Torkamani N, Grossmann M, Zajac JD, Nandurkar H, Ho P, Cheung AS. Global coagulation assays in transgender women on oral and transdermal estradiol therapy. J Clin Endocrinol Metab. 2020 Jul 1;105(7):dgaa262. doi: 10.1210/clinem/dgaa262.
  • Nolan BJ, Brownhill A, Bretherton I, Wong P, Fox S, Locke P, Russell N, Grossmann M, Zajac JD, Cheung AS. Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy. Ther Adv Endocrinol Metab 2020;11:1-7. https://doi.org/10.1177/2042018820924543
  • Nolan BJ, Leemaqz SY, Ooi O, Cundill P, Silberstein N, Locke P, Grossmann M, Zajac JD, Cheung AS. Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Intern Med J. 2020 Apr 1. https://doi.org/10.1111/imj.14839. [Epub ahead of print]
  • Cheung AS, Leemaqz SY, Wong JP, Chew D, Ooi O, Zwickl S, Cundill P, Silberstein N, Locke P, Grayson R, Zajac JD, Pang KC.  Non-Binary and Binary Gender Identity in Australian Trans and Gender Diverse Individuals. Arch Sex Behav. 2020 Oct;49(7):2673-2681. https://doi.org/10.1007/s10508-020-01689-9.
  • Bretherton I, Grossmann M, Leemaqz SY, Zajac JD, Cheung AS. Australian endocrinologists need more training in transgender health: A national survey. Clin Endocrinol (Oxf). 2020 Mar;92(3):247-257. https://doi.org/10.1111/cen.14143.
  • Zwickl S, Wong A, Bretherton I, Rainier M, Chetcuti D, Zajac JD, Cheung AS. Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey. Int J Environ Res Public Health 2019 16(24):5088 https://doi.org/10.3390/ijerph16245088.
  • Angus L, Leemaqz S, Ooi O, Cundill P, Silberstein N, Locke P, Zajac JD, Cheung AS. Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving estradiol therapy. Endocr Connect 2019; 8(7):935-940. https://doi.org/10.1530/EC-19-0272
  • Bretherton I, Thrower E, Grossmann M, Zajac JD, Cheung AS. Cross-sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare. Intern Med J 2019 Feb;49(2):182-188. https://doi.org/10.1111/imj.14035.
  • Cheung AS, Ooi O, Leemaqz S, Cundill P, Silberstein N, Bretherton I, Thrower E, Locke P, Grossmann M, Zajac JD. Sociodemographic and Clinical Characteristics of Transgender Adults in Australia. Transgend Health 2018; 3(1), 229-238. https://doi.org/10.1089/trgh.2018.0019
  • Light M, McFarlane T, Ives A, Shah B, Lim E, Grossmann M, Zajac JD, Cheung AS. Testosterone therapy considerations in estrogen, progesterone and androgen receptor positive breast cancer in a transgender male. Clin Endocrinol (Oxf). 2020;93:355-357. https://doi.org/10.1111/cen.14263
  • Cheung AS, Cook T, Ging`er A, Zwickl S. Sex specific reference ranges and transgender care.  BMJ 2022;376:e069874 https://doi.org/10.1136/bmj-2021-069874
  • Xu JY, O'Connell MA, Notini L, Cheung AS, Zwickl S, Pang KC. Selective estrogen receptor modulators (SERMs): a potential option for non-binary gender-affirming hormonal care? Front Endocrinol 2021 https://doi.org/10.3389/fendo.2021.701364
  • Shepherd R, Cheung AS, Pang KC, Saffery R, Novakovic B. Sexual dimorphism in innate immunity: The role of sex hormones and epigenetics. Front Immunol 2021;11:Article604000 https://doi.org/10.3389/fimmu.2020.604000
  • Nolan BJ, Liang B, Cheung AS. Efficacy of micronised progesterone for sleep: a systematic review and meta-analysis of randomised controlled trial data. J Clin Endocrinol Metab 2020 Nov 27;dgaa873. https://doi.org/10.1210/clinem/dgaa873.
  • Nolan BJ and Cheung AS. Relationship between serum estradiol concentrations and clinical outcomes in transgender individuals undergoing feminising hormone therapy: a narrative review. Transgend Health 2020 https://doi.org/10.1089/trgh.2020.0077
  • Angus LM, Nolan BJ, Zajac JD, Cheung AS. A systematic review of anti-androgens and feminisation in transgender women. Clin Endocrinol (Oxf) 2020 https://doi.org/10.1111/cen.14329.
  • Cheung AS, Lim HY, Cook T, Zwickl S, Ginger A, Chiang C, Zajac JD. Approach to interpreting common laboratory pathology tests in transgender individuals. J Clin Endocrinol Metab 2020 https://doi.org/10.1210/clinem/dgaa546
  • Nolan BJ and Cheung AS. Estradiol therapy in the perioperative period: implications for transfeminine individuals. Yale J Biol Med. 2020 Sep 30;93(4):539-548. eCollection 2020 Sep.
  • Spanos C, Bretherton I, Zajac JD, Cheung AS. Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review. World J Diabetes 2020 Mar 15;11(3):66-77. https://doi.org/10.4239/wjd.v11.i3.66.
  • Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: a systematic review. J Autism Dev Disord 2020 Mar;50(3):695-706. https://doi.org/10.1007/s10803-019-04298-1.
  • Chew D, Tollit MA, Poulakis Z, Zwickl S, Cheung AS, Pang KC. Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. Lancet Child Adolesc Health 2020 Apr;4(4):322-330. https://doi.org/10.1016/S2352-4642(19)30403-1
  • Cheung AS, Wynne K, Murray S, Erasmus J, Zajac JD. Position statement on the hormonal management of transgender and gender diverse individuals in Australia. Med J Aust 2019 Aug;211(3):127-133. https://doi.org/10.5694/mja2.50259
  • Liang B, Cheung AS, Nolan BJ. Clinical features and prevalence of Klinefelter syndrome in transgender individuals: A systematic review. Clin Endocrinol (Oxf) 2022;97(1):3-12 https://doi.org/ 10.1111/cen.14734
  • Bensley J, Cheung AS, Grossmann M, Papa N. Testicular Cancer in Trans People Using Feminising Hormone Therapy– A Brief Review. Urology 2021 Nov https://doi.org/10.1016/j.urology.2021.11.014
  • van Leerdam T, Zajac JD, Cheung AS. The effect of gender-affirming hormones on gender dysphoria, quality of life and psychological functioning in transgender individuals: a systematic review. Transgend Health 2021 Published Online: 6 Sep 2021 https://doi.org/10.1089/trgh.2020.0094
  • McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals – a systematic review. Clin Endocrinol (Oxf) 2018 Dec;89(6):700-711. https://doi.org/10.1111/cen.13835

Research Projects

For project inquiries, contact our research group head.


Faculty Research Themes

Neuroscience, Child Health

School Research Themes

Neuroscience & Psychiatry, Child Health in Medicine, Cardiometabolic


Key Contact

For further information about this research, please contact Dr Ada Cheung

Department / Centre

Medicine

Unit / Centre

Trans Health Research

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