Improving trans and gender diverse health care

Trans and gender diverse (TGD) people have a gender identity that varies from that usually associated with their sex assigned at birth. Many seek to transition socially and or medically to another gender position. They experience significant levels of social isolation and stigma, with major impacts on physical and mental health, including very high levels of depression, anxiety and suicidality. Engagement with health practitioners by TGD people has been problematic historically – often avoiding treatment due to stigma, mis-gendering and pathologisation. Gender variance is no longer viewed as a disorder by relevant clinicians, but social or medical issues often need to be considered in approving treatments. Until recently, a mental health diagnosis of "Gender Dysphoria" was required for surgical treatment in Australia. Mental health professionals have thus been seen as “gate-keepers” for hormonal and surgical treatments sought by TGD people. However this has rapidly changed, including a shift from secondary to primary care. The Victorian government has greatly increased funding for specialist clinics, community-based primary care services, health professional training and peer support. Assessment for hormones is shifting from psychiatrists to clinical psychologists; and to GPs under “Informed Consent" models. The Monash Health Gender Clinic (MHGC) shifted to diagnostic criteria for "Gender Incongruence" in the WHO International Classification of Diseases, which is not in a mental health category. However, most GPs and other primary care health practitioners lack training or experience with TGD clients. New resources are available for GPs, including online training modules and webinars, Health Pathways guidelines, and social media support groups, but lack widespread take-up. Given this background there a wide range of possible research projects at undergraduate, honours, master or doctoral levels. These could focus on primary or secondary care, or their interaction. Research possibilities Collaboration with MHGC, Royal Children’s Hospital Gender Service and TGD experienced GP clinics can be organised. Dr Lane is a Project/Research Worker at MHGC, and active in Australian Professional Association for Trans Health Research and Education sub-committees. The following outlines some past or potential projects as a guide. The research candidate is expected to shape their project in consultation with the researcher. When participating with external organizations, such as MHGC, they would consult with their leadership and researchers to receive endorsement of the project. Past or ongoing projects Client Satisfaction at the MHGC: Experiences and Barriers to Care (BMedSc Hons 2023) Outcomes for TGD clients under different models of care. Current PhD student, and a relevant MRFF grant awarded in 2024. (Hons, Masters, PhD) How does co-occurring ASD/Neurodiversity impact TGD people's clinical care (SIP, Honours) Potential projects Conduct a literature review, e.g. on access to affirmative care in a migrant community (Short project/Honours) Conduct interviews with experts, e.g. on coordinating secondary and primary services (Short project/Honours) Assessing “informed consent” models of TGD health care: what makes a “complex case”? - Interviews with primary and secondary clinicians. (Hons) Assess how specific services are utilised at Monash Health, e.g. the endocrinology clinic. (Hons) Mapping growth in TGD health care (and social representations of TGD people). (Hons, part 1 or 2; Masters or PhD, both part 1&2) Part 1 Collect and analyse referral data from MHGC, private psychiatrists and psychologists, GPs, and surgeons. Identify changing patterns of presentations, referral, prescriptions of hormones, and rates of gender-affirming surgeries Part 2 Map changes in media representations and legal settings around TGD people, and how these influence GP and other health professionals’ attitudes and practices. Our research environment Department of General Practice supervisors have an outstanding track record across a breadth of topic areas, including asylum seeker and refugee health, early detection of cancer and cancer survivorship, prevention and management of chronic disease, mental health, family violence, and women's health. Our supervisors are very experienced, highly trained and accredited with Monash Graduate Education to supervise a range of research candidates. The Department has access to a biostatistician, and social scientists trained in qualitative methods. All are based at the 553 St Kilda Rd campus, and can provide assistance regarding data collection, analysis and interpretation. Early career research support groups and training are available. The Department of General Practice provides a supportive environment for researchers, with supervision and mentorship of a designated academic supervisor, regular team meetings, and excellent study facilities..