Program leader: Ken Pang
Referrals of young transgender individuals to clinical services are rising exponentially across the western world. 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 still a lack of good research data to inform clinical practice in this nascent field.
The goal of our team is therefore to improve the care of transgender young people and ultimately enhance the health and wellbeing of transgender and gender diverse children and adolescents via a range of research activities that are summarised below.
The research activities of our team are motivated by a desire to improve clinical practice, and have been developed in consultation with our community advisory group, which consists of trans and gender diverse young people and their parents. These activities include:
Project 1: Trans20
The Trans20 project is a longitudinal cohort study that began in 2017 with the generous support of the Royal Children’s Hospital Foundation. The broad objective of this project is to determine the 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 baseline Trans20 data, 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.
Project 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 to better understand the rates of fertility preservation utilisation, the experiences of young people who receive fertility counselling/preservation, and the experiences of clinicians who provide fertility counselling/preservation.
Project 3: Bioethics
Transgender health care for children and adolescents is in its early stages as a clinical discipline, and determining the best course of action for an individual can sometimes raise important ethical issues. We are therefore exploring a range of ethical issues related to transgender health care in collaboration with members of the bioethics team at the University of Melbourne and within MCRI.
Project 4: Autism and gender dysphoria
We have observed that 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.
Project 5: Genetics
Previous twin studies have indicated that gender dysphoria has – at least in part – a genetic basis. This is important, since it suggests that gender identity may have a fundamental biological origin. Using an unbiased genome-wide approach, we recently identified a small chromosomal variation that occurs at 10x the frequency in transgender males compared to the general population (Pang et al, 2018). This work reinforces the likely biological origins of gender identity, and we are continuing to actively explore this area.
Pang KC, Feldman D, Oertel R, Telfer M. (2018) Molecular karyotyping in children and adolescents with gender dysphoria. Transgender Health. 3(1): 147–153. Link.
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. doi: 10.5694/mja17.01044. Link.
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. Link.
Pace CC, Pang KC, Tollit M. (2018). Transgender kids get their own health-care guidelines. The Conversation. Link.
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. Link.
Notini L, Gillam, Pang KC. (2018) Facial feminization surgery: Personal identity, compensatory justice and resource allocation. American Journal of Bioethics. DOI:10.1080/15265161.2018.1531168
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. Link.
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 email@example.com
50 Flemington Road, Royal Children’s Hospital, Level 2 East.
- Dr Ken Pang, Team Leader and Clinician Scientist Fellow, MCRI; Consultant Paediatrician, RCH Gender Service
- Dr Michelle Tollit, Postdoctoral Fellow, MCRI; Clinical Evaluation Coordinator, RCH Gender Service
- Associate Professor Michelle Telfer, Consultant Paediatrician and Head of RCH Gender Service
- Dr Carmen Pace, Postdoctoral Fellow, MCRI; Clinical Psychologist, RCH Gender Service
- Ms Janet Bryson, Project Assistant
- Mr Charlie Cooper, Project Assistant
- Mr Monsurul Hoq, Biostatistician
- Ms Donna Eade, Clinical Nurse Consultant, RCH Gender Service
- Dr Zeffie Poulakis, Clinical Psychologist, RCH Gender Service
- Dr Debi Feldman, Consultant Paediatrician, RCH Gender Service
- Associate Professor Campbell Paul, Consultant Psychiatrist, RCH Gender Service
- Dr Lauren Notini, Postdoctoral Fellow, Biomedical Ethics, MCRI