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Gender research

Research project

Referrals of young transgender individuals to specialist gender services have risen dramatically across the western world in recent years. Consistent with this, recent population-based estimates suggest that the prevalence of young people identifying as transgender is around 1%, which is much higher than previously thought.

Providing optimal clinical care for transgender young people is critical. A recent community-based survey of 859 Australian trans youth found a significant proportion had been diagnosed with depression (75%) and anxiety (72%), with 80% of respondents reported having self-harmed and 48% having attempted suicide (Strauss et al, 2017). Many of these young people lacked access to gender-affirming health care, and there is increasing evidence that providing supportive clinical care to transgender youth significantly improves mental health and wellbeing.

The Royal Children’s Hospital Gender Service (RCHGS) provides care to transgender children and adolescents, and is one of the largest multidisciplinary clinics of its kind in the world. While our team recently released the first ever clinical guidelines specific for transgender children and adolescents (Telfer et al, 2018) – as highlighted by a recent editorial in The Lancet - there is a need for more robust empirical data to inform clinical practice in this nascent field.

The overall objective of our team is therefore to produce high quality research evidence related to child and adolescent transgender health. By doing so, we aim to improve the care of transgender young people and ultimately enhance the health and wellbeing of transgender and gender diverse children and adolescents.

Research

The research activities of our team are motivated by a desire to improve clinical practice and health outcomes of transgender children and adolescents. These activities have been developed in consultation with our community advisory group, which consists of trans, gender diverse and non-binary young people and their parents, and include:

Area 1: Trans20

The Trans20 project is a longitudinal cohort study that began in 2017 and has been made possible via the generous support of the Royal Children’s Hospital Foundation, Hugh Williamson Foundation Trust and NHMRC. The broad objective of this project is to determine the long-term biopsychosocial outcomes for transgender individuals attending the RCHGS. Data are collected prospectively as part of routine clinical care and include information not only on gender identity, transition, dysphoria, and gender-related health care, but also mental health, physical health, education, quality of life and family functioning.

Using Trans20 data collected so far, we have started asking clinically relevant questions related to demographic factors, risk and resilience factors, and how different subpopulations (e.g. those with a non-binary gender identity or autism spectrum disorder) vary in their presentation and needs. In time, using longitudinal data, we will be able to address other important questions, such as the evolution of gender identity and dysphoria over time, and the role and safety of different interventions, both medical and psychosocial.

Related publications:

  1. Tollit MA, Pace CC, Telfer MM, Hoq M, Bryson J, Cooper C, Fulkoski N, Pang KC. (2019) What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study. BMJ Open. 9:e032151.

Area 2: Fertility counselling and preservation

Various treatment options provided as part of transgender health care can affect fertility. As a result, current clinical guidelines recommend fertility counselling prior to the commencement of such treatments and the use of fertility preservation measures, where appropriate. The provision of such counselling and fertility preservation to transgender children and adolescents is an area that deserves further exploration, and we are currently undertaking a series of studies in this area.

Related publications:

  1. Lai TC, Davies C, Robinson K, Feldman D, Elder CV, Cooper C, Pang KC, McDougall R. (2021) Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices. BMJ Open. 11(5):e043237.
  2. Lai TC, McDougall R, Feldman D, Elder CV, Pang KC. (2020) Fertility Counselling for Transgender Adolescents: a review. Journal of Adolescent Health. 66(6): 658-665
  3. Pang KC, Peri AJS, Chung HE, Telfer M, Elder CV, Grover S, Jayasinghe Y. (2020) Rates of Fertility Preservation Use Among Transgender Adolescents. JAMA Pediatrics. e200264.

Area 3: Non-binary young people

Despite the growing awareness that significant numbers of children and adolescents identify as transgender or gender diverse, it is often not appreciated that many of these young people do not conform to traditional binary notions of male and female and instead have a ‘non-binary’ gender identity. The health of non-binary individuals is under-represented in research, and we are conducted a range of studies to help fill this gap.

  1. Xu JY, O’Connell MA, Notini L, Cheung AS, Zwickl S, Pang KC. (2021) Selective estrogen receptor modulators (SERMs): a potential option for non-binary gender-affirming hormonal care? Frontiers in Endocrinology. 12: 742.
  2. Notini, L, Pang KC, Telfer M, McDougall RJ. (2021) “No one stays just on blockers forever”: Clinicians’ divergent views and practices regarding puberty suppression for non-binary young people. Journal of Adolescent Health. 68(6):1189-1196.
  3. Cheung AS, Leemaqz S, Wong JWP, Chew D, Ooi O, Cundill P, Silberstein N, Locke P, Grayson R, Zajac JD, Pang KC. (2020) Non-Binary and Binary Gender Identity in Australian Trans and Gender Diverse Individuals. Archives Sexual Behavior. 49: 2673–2681.
  4. Chew D, Tollit MA Poulakis Z, Zwickl S, Cheung AS, Pang KC. (2020) Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. Lancet Child and Adolescent Health. 4(4):322-330
  5. Pang KC, Notini L, McDougall R, Gillam L, Savulescu J, Wilkinson D, Clark BA, Olson-Kennedy J, Telfer MM, Lantos JD. (2020) Ethics Rounds: Long-term puberty suppression for a non-binary teen. Pediatrics. 145(2):e20191606.
  6. Notini, L, Earp, B.D, Gillam L, McDougall RJ, Savulescu J, Telfer M, Pang KC. (2020) Identity, wellbeing and autonomy in ongoing puberty suppression for non-binary adults: a response to the commentaries. Journal of Medical Ethics. 46(11):761-762.
  7. Notini, L, Earp, B.D, Gillam L, McDougall RJ, Savulescu J, Telfer M, Pang KC. (2020) Forever young? The ethics of ongoing puberty suppression for non-binary adults. Journal of Medical Ethics. 46(11):743-752.

Area 4: Autism and gender dysphoria

A significant minority of young people attending the RCHGS have previously been diagnosed with autism. Similar observations have been made around the world, but there is little known about why this overlap occurs so much more frequently than would be expected by chance. We are therefore working to better understand the relationship between gender dysphoria and autism in the hope that doing so can provide more tailored advice and treatment for such young people.

Related publications:

  1. McPhate L, Williams K, Winther J, Vance A, Pang KC, May T (2020). Gender Variance in Children and Adolescents with Neurodevelopmental and Psychiatric Conditions from Australia. Archives of Sexual Behaviour. 2021 Apr;50(3):863-871.
  2. Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. (2020) Prevalence of autism spectrum disorder and attention-deficit hyperactivity disorder amongst individuals with gender dysphoria: a systematic review. J Autism Dev Disord. 50(3):695-706. 
  3. May T, Pang K, Williams KJ. (2017). Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research. Int J Transgenderism. 18:1, 7-15.

Area 5: Bioethics

Transgender health care for children and adolescents is in its relatively early stages as a clinical discipline, and determining the best course of action for an individual can be complex. We are therefore exploring a range of ethical issues related to transgender health care in collaboration with bioethics colleagues at the University of Melbourne and in the UK.  

Related publications:

  1. Notini, L, Pang KC, Telfer M, McDougall RJ. (2021) “No one stays just on blockers forever”: Clinicians’ divergent views and practices regarding puberty suppression for non-binary young people. Journal of Adolescent Health. Jun;68(6):1189-1196.
  2. Notini, L, Earp, B.D, Gillam L, McDougall RJ, Savulescu J, Telfer M, Pang KC. (2020) Identity, wellbeing and autonomy in ongoing puberty suppression for non-binary adults: a response to the commentaries. Journal of Medical Ethics. 46(11):761-762.
  3. Notini, L, Earp, B.D, Gillam L, McDougall RJ, Savulescu J, Telfer M, Pang KC. (2020) Forever young? The ethics of ongoing puberty suppression for non-binary adults. Journal of Medical Ethics. Med Ethics. 2020 Nov;46(11):743-752.
  4. Pang KC, Notini L, McDougall R, Gillam L, Savulescu J, Wilkinson D, Clark BA, Olson-Kennedy J, Telfer MM, Lantos JD. (2020) Ethics Rounds: Long-term puberty suppression for a non-binary teen. Pediatrics. 145(2):e20191606.
  5. Notini L, McDougall R, Pang KC.  (2019) Should parental refusal of puberty-blocking treatment be overridden? The role of the harm principle. American Journal of Bioethics. 19(2):69-72. 
  6. Notini L, Gillam, Pang KC. (2018) Facial feminization surgery: Personal identity, compensatory justice and resource allocation. American Journal of Bioethics. 18(12): 12-5.

Publications

We have also performed research across a range of other topics, and relevant publications are listed below.

  1. Bloom T, Nguyen TP, Lami F, Pace C, Poulakis Z, Telfer M, Taylor A, Pang KC, Tollit MA. (2021) Measurement tools for gender identity, gender expression and gender dysphoria in transgender and gender diverse children and adolescents: a systematic review. Lancet Child and Adolescent Health. S2352-4642(21)00098-5.
  2. Pang KC, de Graaf NM, Chew D, Hoq M, Keith DR, Carmichael P & Steensma TD. (2020) Association of media coverage of transgender and gender diverse issues with rates of referral of transgender children and adolescents to specialist gender clinics in the UK and Australia. JAMA Network Open. 3(7):e2011161.
  3. Ferguson G, Simm P, O’Connell M, Pang KC. (2019) Use of puberty blockers in trans and gender diverse adolescents frequently results in loss of bone mineral density. BMJ. 367:l6471.
  4. Pang KC, Telfer MM, Tollit MA, Pace CC. (2019). Everyone agrees transgender children require more science. Medical Journal of Australia. 211 (3). 
  5. Telfer MM, Tollit MA, Pace CC, Pang KC. (2018) Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents. Medical Journal of Australia. 209(3):132-136.
  6. Chew D, Anderson J, Williams K, May T, Pang KC. (2018) Hormonal Treatment in Young People with Gender Dysphoria: a systematic review. Pediatrics. 141(4): pii: e20173742. 
  7. Pace CC, Pang KC, Tollit M. (2018). Transgender kids get their own health-care guidelines. The Conversation. 
  8. Eade DM, Telfer MM, Tollit, MA. (2018) Implementing a Single-Session Nurse-Led Assessment Clinic into a Gender Service. Transgender Health. 3(1): 43–46.  
  9. Tollit MA, Feldman D, McKie G, Telfer MM. (2018) Patient and Parent Experiences of Care at a Pediatric Gender Service. Transgender Health. 3(1):251-256. 
  10. Telfer M, Kelly F, Feldman D, Stone G, Robertson R, Poulakis Z. (2018) Transgender adolescents and legal reform: How improved access to healthcare was achieved through medical, legal and community collaboration. Journal of Paediatrics and Child Health. 54: 1096-9.  
  11. Pang KC, Feldman D, Oertel R, Telfer M. (2018) Molecular karyotyping in children and adolescents with gender dysphoria. Transgender Health. 3(1): 147–153. 

Positions available

We are currently recruiting high quality students with a background in medicine/psychology/neuroscience who wish to undertake postgraduate research in transgender health. Interested applicants should send a statement of research interests, CV, and two references by email to ken.pang@mcri.edu.au

Contact

Ken Pang
Email: ken.pang@mcri.edu.au
50 Flemington Road, Royal Children’s Hospital, Level 2 East. 

Team Members:

  • Associate Professor Ken Pang, Team Leader, MCRI; Paediatrician, RCH Gender Service
  • Dr Michelle Tollit, Postdoctoral Fellow, MCRI; Clinical Evaluation Coordinator, RCH Gender Service
  • Associate Professor Michelle Telfer, Paediatrician and Head of RCH Gender Service
  • Dr Carmen Pace, Postdoctoral Fellow, MCRI; Senior Clinical Psychologist, RCH Gender Service
  • Dr Monsurul Hoq, Biostatistician and Postdoctoral Fellow, MCRI
  • Dr Francesca Lami, Research Assistant
  • Mx Casey McGlasson, Project Assistant 
  • Ms Katie Murfitt, Clinical Psychology Masters student and Project Assistant
  • Ms Charlotte Blacklock, Clinical Psychology Masters/PhD student
  • Mr Douglas Russell, PhD student
  • Shantelle Hendy, Administration Coordinator 
  • Corinne Meunier, Administration Assistant 
  • Ms Donna Eade, Clinical Nurse Consultant, RCH Gender Service
  • Mr Tim Cronin, Clinical Psychologist, RCH Gender Service
  • Dr Zeffie Poulakis, Senior Clinical Psychologist, RCH Gender Service
  • Dr Charlotte Elder, Gynaecologist, RCH Gender Service
  • Dr Michele O'Connell, Paediatric Endocrinologist, RCH Gender Service
  • Dr Tiba Maloof, Psychiatrist, RCH Gender Service
  • Dr Debi Feldman, Paediatrician, RCH Gender Service
  • Dr Freya Kahn, Paediatric Advanced Trainee
  • Dr Jessica Paine, Paediatric Advanced Trainee