Transgender Health

Our vision is to improve the healthcare, wellbeing and overall outcomes for transgender and gender diverse young people and their families.

It is estimated that 2-3 per cent of young Australians identify as transgender or gender diverse (collectively referred to as trans), which is around 100,000 people between the ages of 10 and 24 years. There has been an ongoing rise in referrals of trans young people to specialist gender services in Australia and internationally, therefore providing optimal and accessible clinical care for trans young people is critical.  

A recent community-based survey of 859 Australian trans youth found that three-quarters had been diagnosed with depression and/or anxiety, and nearly half having attempted suicide. Poor mental health can be linked to gender dysphoria as well as experiences of social rejection and discrimination. There is increasing evidence that supportive clinical care significantly improves mental health and wellbeing among trans youth, yet many of these young people lack access to gender-affirming healthcare. 

Previously, our team released the first-ever clinical guidelines specific for transgender children and adolescents. Still, there is a need for more robust, co-designed research to inform clinical practice in this field. We are therefore conducting a range of research projects, including studies exploring: 

• Health and wellbeing outcomes over time for trans young people attending The Royal Children’s Hospital (RCH) Gender Service

• Different models of gender-affirming care between services

• Group mental health interventions for trans young people 

• Common and unique experiences of gender diversity among trans young people. 

The overall aim of our program is to produce high-quality evidence to improve the healthcare, wellbeing, and overall outcomes of trans young people and their families. Our research activities are actively developed in consultation with our community advisory groups, which includes young trans people and their families. 

Image: Charlotte and Associate Professsor Ken Pang

More information

• A-Z: Transgender youth health
• Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents (Clinical Guidelines) - AusPath
• Podcast episode - Understanding gender diversity - RCH Kids Health
• The Royal Children’s Hospital Gender Service

Our projects

Trans20

The Trans20 project is a longitudinal cohort study that began in 2017.

The broad objective of Trans20 is to determine the long-term biopsychosocial outcomes for transgender individuals attending the RCH’s Gender Service. Data is collected prospectively as part of routine clinical care and includes information on gender identity, transition, dysphoria, gender-related health care and mental health, physical health, education, quality of life and family functioning. Using this data, we are examining the evolution of gender identity and dysphoria over time, and the role and safety of different interventions, both medical and psychological.

Australian Research Consortium for Trans Youth and Children (ARCTYC)

The Australian Research Consortium for Trans Youth and Children (ARCTYC) was launched in 2022 and will co-design and co-deliver research with consumers that provides a stronger evidence base to inform the care of transgender and gender diverse children, adolescents and young adults. As part of ARCTYC, MCRI is leading a project comparing the effectiveness, acceptability and equity of different models of clinical care for trans young people, including those with intersectional identities and experiences.

Trans Adolescent Group ThErapy for Alleviating Minority stress (TAG TEAM)

The Trans Adolescent Group ThErapy for Alleviating Minority stress (TAG TEAM) is a co-designed group cognitive-behavioural therapy (CBT) intervention for trans young people. It is based on the needs and preferences of trans young people, centring on themes related to minority stress and CBT principles.

We have conducted a feasibility trial, which also compares in-person and online delivery. A subsequent pilot randomised control trial compares the intervention and waitlist at baseline, post-treatment, and 3-month follow-up. In both studies, participants complete a series of quantitative and qualitative measures (e.g. mental health, wellbeing, and quality of life), which will be analysed.

Gender euphoria

Gender euphoria encompasses a range of positive emotions associated with one’s gender identity, expression, or affirmation. Despite its significance to many trans people, gender euphoria has never been reliably measured as a construct and has rarely been formally studied. Accordingly, we have developed the Gender Euphoria Scale (GES) to assess gender euphoria and to build an understanding of when and how gender euphoria arises. The GES will also facilitate research into the relationship between gender euphoria and mental health outcomes and enable continued examination into the efficacy of gender affirming interventions.

Autism and gender diversity

There is an elevated co-occurrence of autism in trans individuals, with recent meta-analyses suggesting that 11% of trans individuals are autistic. While many trans young people display traits of autism, how these traits relate to the nature and experience of gender diversity is unclear. We are conducting research exploring the experience of autistic trans young people and seeking to understand how gender-affirming care can be made more responsive to their needs. 

Deciding About Hormones

When a trans adolescent wants to start hormones, their clinicians talk to them over many sessions about their goals, options, and the effects of the treatment. In the process, their clinicians consider many different factors (e.g. cognitive development) that might affect whether the young person has the maturity to decide about starting hormones. Our research will help improve our understanding of the factors involved in the capacity to decide about hormones for trans young people. As part of this, we aim to make the clinical assessment process more structured, efficient, and accessible for families and clinicians.

Funding & collaborations

Thanks to our key partners, funders, and supporters.

Funding

• National Health and Medical Research Council (NHMRC)
• Royal Children’s Hospital Foundation
• Hugh D.T. Williamson Foundation Trust
• Medical Research Future Fund (MRFF)
• Victorian Medical Research Acceleration Fund (VMRAF)
• The University of Melbourne
  
  

Collaborations

• Australian Research Consortium for Trans Youth and Children (ARCTYC)
• Simone Buzwell, Swinburne University
• Grace Mackie, Level Up Psychology
• TAG TEAM Steering Group
• Trans20 Youth Advisory Group
• Youth advisors for the Trans Health Research Group

Featured publications

• Grant, R., Amos, N., Lin, A., Cook, T., Hill, A. O., Pang, K., Skinner, R. S., Carman, M., Bourne, A. (2024). Mental health and wellbeing outcomes associated with social, medical, and legal gender affirmation among trans young people in Australia. International Journal of Transgender Health, 1(13). 

• Chinsen, A., Cronin, T. J., Pace, C. C., Tollit, M. A., & Pang, K. C. (2024). Evaluation of a codesigned group cognitive-behavioural therapy intervention for trans young people (TAG TEAM): protocol for a feasibility trial and a subsequent pilot RCT. BMJ open, 14(1), e076511. 

• Tollit, M. A., Maloof, T., Hoq, M., Haebich, K., Pace, C. C., Rodriguez, Z. M., . . . Pang, K. (2024). A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study. The Lancet Regional Health - Western Pacific, 47, 101084. 

• Skinner, S. R., McLamore, Q., Donaghy, O., Stathis, S., Moore, J. K., Nguyen, T., . . . Pang, K. C. (2024). Recognizing and responding to misleading trans health research. International Journal of Transgender Health, 25(1), 1-9. 

• Kerr, J. A., Paine, J., Thrower, E., Hoq, M., Mollica, C., Sawyer, S. M., . . . Pang, K. C. (2024). Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health, 74(4), 850-853. 
  
  

Other publications

• Grant, R., Amos, N., Lin, A., Cook, T., Hill, A. O., Pang, K., Skinner, R. S., Carman, M., Bourne, A. (2024). Mental health and wellbeing outcomes associated with social, medical, and legal gender affirmation among trans young people in Australia. International Journal of Transgender Health, 1–13. 

• Horton, C., Pearce, R., Veale, J., Oakes-Monger, T. C., Pang, K. C., Pullen Sansfaçon, A., & Quinney, S. (2024). Child rights in trans healthcare – a call to action. International Journal of Transgender Health, 1–8. 

• Daniel Wright, Simona Giordano, Ken C Pang. Further Considerations on Gender-Affirming Care. JAMA Pediatrics. Accepted April 13, 2024.

• Rebecca Shepherd, Lachie Angus, Toby Mansell, Bridget Arman, Bo Won Kim, Ken C Pang, Jeffrey D Zajac, Richard Saffery, Ada Cheung, Boris Novakovic (2024). Impact of Distinct Anti-Androgen Exposures on the Plasma Metabolome in Feminizing Gender-Affirming Hormone Therapy. Journal of Clinical Endocrinology & Metabolism. Accepted April 4, 2024.

• Michelle A. Tollit, Tiba Maloof, Monsurul Hoq, Kristina Haebich, Carmen C. Pace, Zamantha Munoz Rodriguez, Muhammad Sial, Jonathan M. Payne, Ken C Pang (2024). A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study. The Lancet Regional Health - Western Pacific. 47: 101084.

• Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC* (2024). Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health.

• Blacklock CA, Tollit MA, Pace CC, Elphinstone B, Pang KC*, Buzwell S* (2024). The Gender Euphoria Scale (GES): A protocol for developing and validating a tool to measure gender euphoria in transgender and gender diverse individuals. Frontiers in Psychology.

• S. Rachel Skinner, Quinnehtukqut McLamore, Olivia Donaghy, Stephen Stathis, Julia K. Moore, Tram Nguyen, Cate Rayner, Robert Tait, Jemma Anderson and Ken C. Pang (2024). Recognizing and responding to misleading trans health research. International Journal of Transgender Health.

• Chinsen A, Cronin TJ, Pace CC, Tollit MA Pang KC* (2024). Evaluation of a co-designed group cognitive behavioural therapy intervention for trans young people (TAG TEAM): protocol for a feasibility trial and a subsequent pilot RCT. BMJ Open. 14:e076511.

• Moussaoui D, O'Connell MA, Elder CV, Grover SR, Pang KC* (2023) Characteristics of Menstrual Suppression and Its Association With Mental Health in Transgender Adolescents. Obstet Gynecol. doi: 10.1097/AOG.0000000000005317

• Engel L, Majmudar I, Mihalopoulos C, Tollit M, Pang KC* (2023). Assessment of quality of life of transgender and gender diverse children and adolescents in Melbourne, Australia, 2017 to 2020. JAMA Network Open. 6(2):e2254292. doi:10.1001/jamanetworkopen.2022.54292. 

• de Nie I, van Mello NM, Vlahakis E, Cooper C, Peri A, den Heijer M, Meißner A, Huirne J, Pang KC* (2023). Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women Cell Rep Med. 17;4(1):100858. 

• Moussaouia D, Elder CV, O’Connell MA, McLean A, Grover SR, Pang KC* (2022). Pelvic pain in transmasculine adolescents receiving testosterone therapy. International Journal of Transgender Health.

• O'Connell MA and Pang KC* (2022). Cardiometabolic outcomes in transgender youth. Journal of Clinical Endocrinology & Metabolism. 

• Hoq M, Lami F, Tollit MA, Pang KC (2022). Gender Identity Questionnaire for children: An alternative scoring approach reflecting a child’s affirmed gender identity. International Journal of Transgender Health.

• Pang, KC*, Kelly, F, Giordano, S, (2022). Parental consent and the treatment of trans youth: the impact of Re Imogen. Letter. Medical Journal of Australia.

• Russell D, Hoq M, Cogill D, Pang KC* (2022). Prevalence of mental health problems in transgender children aged 9-10 years in the US, 2018. JAMA Network Open.

• Pang KC*, Wiggins J, Telfer M (2022). Gender identity services for children and young people in England. BMJ. FWCI 2.7

• Kelly, F, Telfer, M, Giordano, S, Pang, KC* (2022). Parental consent and the treatment of trans youth: the impact of Re Imogen. Medical Journal of Australia. FWCI 6.1

• Shepherd R, Bretherton I, Pang K, Mansell T, Czajko A, Kim B, Vlahos A, Zajac JD, Saffery R, Cheung A, Novakovic B. (2022) Gender-affirming hormone therapy induces specific DNA methylation changes in blood. Clin Epigenetics. 14(1):24. 

• Pang KC*, Hoq M, Steensma TD (2022). Negative media coverage as a barrier to accessing care for transgender children and adolescents. JAMA Network Open. FWCI 3.2

• Pang KC*, Nguyen TP, Upreti R (2021). Successful use of minoxidil to promote facial hair growth in an adolescent transgender male. Frontiers in Endocrinology. 

• O'Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC* (2021). Approach to the Patient: Pharmacological Management of Trans and Gender Diverse Adolescents. Journal of Clinical Endocrinology & Metabolism. FWCI 7.4 

• Peri A, Ahler A, Gook D, O'Connell MA, Bourne H, Nightingale M, Telfer M, Jayasinghe Y, & Pang KC*. (2021). Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy.Journal of assisted reproduction and genetics.

• Pang KC*, Giordano S, Sood N, Skinner SR (2021).  Regret, informed decision making, and respect for autonomy of transgender young people. The Lancet Child and Adolescent Health.

• 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.

• Tollit MA, May T, Maloof T, Telfer MM, Chew D, Engel M, Pang KC* (2021). The clinical profile of patients attending a large, Australian pediatric gender service: a 10-year review. International Journal of Transgender Health.

• McDougall R, Notini L, Delany C, Telfer M, Pang KC (2021). Should clinicians make chest surgery available to transgender male adolescents? Bioethics.

• 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. 

• Dahlgren Allen S, Tollit MA, McDougall R, Eade D, Hoq M & Pang KC* (2021). A Waitlist Intervention for Transgender Young People and Psychosocial Outcomes. Pediatrics. 

• Bloom TM, Nguyen TP, Lami F, Pace CC, 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. The Lancet Child & Adolescent Health.

• McPhate L, Williams K, Winther J, Vance A, Pang KC*, May T (2021). Gender Variance in Children and Adolescents with Neurodevelopmental and Psychiatric Conditions from Australia. Archives of Sexual Behaviour.

• 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.