Last week was a big week for young trans people in Australia.
On Thursday the Family Court of Australia handed down their decision in an appeal that sought to have hormone treatment taken out of the court’s jurisdiction. The case has been referred to as “Re: Kelvin”. The court decided in favour of the appellants, and there is now no longer a requirement for the court to approve stage 2 (hormone) treatment. Actually Australia was the only country in the world where this strange situation existed, but now finally the decision regarding if and when to start hormones can be made by the treating doctors, without the lengthy and expensive court process to get there.
For the full story click here
As many readers of this blog will know, I dedicate a large proportion of my working day in Brisbane to seeing transgender people, and often young trans teens, for whom the ramifications of this decision will mean celebrations and a profound sigh of relief. However I also work intermittently at a clinic in Darwin, where the celebrations started the very next day, with my colleague Dr Stuart Aitken starting hormone therapy for a young man who had been waiting a very long time. See Brody’s story here.
Darwin is the capital of the Northern Territory, in what is affectionately known as the Top End of Australia. Darwin is a fascinating place, a real melting pot of people. There is the local indigenous people, the immigrants from Asia, a variety of colourful characters from all over the world, and loads of people who have moved from other parts of Australia, drawn by the allure of a much more laid back and casual tropical lifestyle, a place where life moves more slowly, and the climate is basically hot or very hot, with occasional cyclones in the wet season. It was through coming up regularly to work at the clinic that I discovered what a fabulous place Darwin is. If you’ve never been I recommend you go immediately (unless there’s a cyclone) and have a look. Actually we are coming into the wet season now where there’s every chance of monsoonal downpours and impassable roads due to rivers rising – the dry from April to September is the best time to visit when it’s drier and (slightly) cooler.
The clinic I work at, Northside Health NT, was founded by local GP Dr Dani Stewart (a finalist for 2017 Darwin GP of the year incidentally), who realized there were no services for LGBT patients in Darwin, and especially no dedicated clinicians working with the transgender population. So Dani made a few calls and put together a team of doctors who were willing to fly up regularly to see patients. It was through the hard work of Dani and her partner Sam that this specialist clinic came about.
I was privileged to be involved with the clinic from early on, and immediately realized that it filled a vacuum in services for trans people in the Top End. It started as a single day, and soon grew to two completely booked out days once a month. It’s clear there’s a great need being met here.
Working at this Darwin clinic brings me face to face with the challenges for trans people living in the Top End – it’s bad enough in Darwin where the monthly clinic is all they have, but people living remotely have no services in their towns, and travel long distances to access treatment. I have seen patients who have driven from the far corners of the country. One young trans woman came in from Kununurra (that’s a 7 hour drive folks – her lovely grandmother did the driving!) and others regularly drive 4 hours from Katherine.
There is an abundance of evidence that the lives of transgender people are overwhelmingly improved by having access to hormone therapy and surgical options, with supportive psychological services as they may be required along the way.
Recent guidelines on the management of trans and gender diverse children and adolescents have been published by the Royal Children’s Hospital Melbourne, thanks largely to the hard work and dedication of Associate Professor Michelle Telfer. Statistics provided by Dr Telfer about the RCH’s cohort of patients suggests that the rate of desistance of young trans people by the time they reach late adolescence (ie the percentage whose dysphoria simply goes away and they no longer identify as trans) is only 4%, which is much less than the figure of 85% quoted in the literature. It should be noted that gender affirming surgery (also known as stage 3 treatment) is very rarely performed in anyone under the age of 18, and the recent court decision does not cover this area.
There is still a long way to go to establish reliable funding to ensure the long-term viability of the Darwin clinic. Ultimately it would be great to have a stand-alone or fully supported clinic that ran every week. We like to think big!
And as for the Family Court decision, it’s wonderful to finally be free of the restriction of having to go to court to begin stage 2 treatment, but there is so much more work to be done to improve access to treatment. I’m so very proud to be part of these efforts, along with my wonderful colleagues Dr Ruth McNair, Dr Jeff Wilcox, Dr Stuart Aitken, Dr Pauline Cundill, and of course Dr Dani!