FAQs Gender Affirmation (AKA Transition) Pathways

For people younger than 18:

People aged under 18 in Australia can commence puberty blockers or gender affirming hormone treatment with agreement between themselves, their prescribing medical practitioner, and their parents (or those with legal parental responsibility). Young people under 16 may be able to commence puberty blockers, and those 16 and older may be able to commence GAHT after assessment at the clinic.

The first step is consulting with your GP and gaining a referral to an appropriate service, such as the Women’s and Children’s Hospital (WCH) Gender Diversity Clinic. To find a GP who is known to the TGD community, consult the Trans Health SA Practitioner’s List.
While awaiting an appointment with the WCH Gender Diversity Clinic, young people (12 and over) may seek supportive counselling or peer support through mental health services, or through SHINE SA services such as the Sexual Health Counselling Service and the Gender Wellbeing Service.

Please note that these SHINE SA mental health services do not provide access to transition related medical care – rather, they provide counselling, psychological therapies, and peer support to young people while they await assessment with the WCH Gender Diversity Clinic.

If there is disagreement regarding the young person’s treatment between any person involved, for example if one custodial parent does not provide consent, this can be resolved through an application to the Family Court of Australia. For more information, see Trans Health SA.

For people 18 and older:

The first step to accessing GAHT is to see your GP. To find a GP who is known to the TGD community, consult the Trans Health SA Practitioner’s List.
To support you to access GAHT, your GP will refer you to an endocrinologist or sexual health physician.

Sometimes, your GP will also refer you to a psychologist or psychiatrist to assess you for a ‘gender dysphoria’ diagnosis. This is not strictly necessary for all people seeking GAHT – however, some GPs and specialists may prefer this.

One alternative option is consulting a GP or specialist who uses the Informed Consent Model of care, which means you will be given clear information about GAHT so that you can make the right choice for your health. You may still need future appointments with an endocrinologist or sexual health physician to monitor your care.

To access gender affirming surgeries, first familiarise yourself with available surgeons and surgical procedures in South Australia. For a list of surgeons who perform gender affirming surgeries such as chest reconstructive (top) surgery, breast augmentation surgery, and facial feminisation and masculinisation surgeries in South Australia, see the Trans Health SA Practitioner’s List. There are no genital reconstructive surgeons in South Australia to our knowledge.

Next, consult your GP for a referral to the surgeon of your choice. Schedule a consult with the surgeon, and discuss your wants and needs for your surgery to ensure the surgeon is an appropriate fit for you.

You will also require “letters of readiness” for gender affirming surgery. Therapists with a Masters qualification and experience assessing for readiness and capacity can provide these letters. You will often require a referral letter from your GP to access these therapists. Consult the Trans Health SA Practitioner’s List for appropriate clinicians available in South Australia; or if you have a mental health clinician/psychologist/psychiatrist you see regularly, ask if they’d be willing to provide such a letter. Letters must be dated within 12 months of your consult with your surgeon.

• For breast/chest surgery one letter of readiness is required.
• For facial surgery one letter of readiness is recommended.
• For genital related surgery two letters of readiness from two separate mental health professionals who have independently assessed the patient are needed. If one letter is from your usual therapist, the second needs to be from someone who has only played an evaluative role.

Resources related to accessing surgery include TransMascSA’s ‘Questions to Ask your Top Surgeon’ and ‘Planning for Chest Reconstructive Surgery’. While these focus on chest reconstruction, many questions can be slightly adjusted to be applicable for other kinds of affirming surgery.

To our knowledge, there is not an equivalent local resource regarding surgeries for transfeminine people. Community groups such as TransFemme SHINE SA may be able to provide information from a peer perspective, and direct community members to up-to-date information online.

Unfortunately, we cannot provide letters of readiness for gender affirming medical care. There are several practitioners on the Trans Health SA Practitioner’s List who provide support letters to people seeking transition related care. Some practitioners will provide once-off assessments, which can reduce the time and financial burden of obtaining a support letter.

You do not need to be diagnosed with gender dysphoria to access transition related health care in South Australia. While this used to be the case, many practitioners now use the Informed Consent Model of care, in which a gender dysphoria diagnosis is not required.

The informed consent model is a framework for medical practitioners to commence and manage gender affirming hormonal treatment (GAHT) for TGD patients without the involvement of a medical specialist, psychologist, or psychiatrist.

An Informed Consent approach ensures that you (the patient) have enough information to make an informed decision about your own care. The practitioner will inform you about the short- and long-term risks and benefits of GAHT, with your personal medical and mental health history in mind.

The Informed Consent Model is appropriate for most people seeking GAHT. For people with select health conditions/concerns, the GP may advise that you see a medical specialist before commencing GAHT. For people with complex mental health concerns, the GP may advise that you obtain a letter of support from a mental health professional.

The process to update your name and gender legally can vary based on where you were born. If you were born in South Australia or overseas (and have lived in South Australia for 12 months or longer), you can apply to record a change of sex or gender identity with Consumer Business Services. If you were born in Australia but interstate, you must apply in the state or territory where you were born.

If eligible to apply through Consumer Business Services, you can apply to change both your name and gender at the same time, using the Record a change of sex or gender identity form. This may reduce the cost overall, as you will only have to pay one lodgement fee.

Once you have changed your name and/or gender through Consumer Business Services, you will receive an updated birth certificate. Your birth certificate can serve as evidence of your name and gender change, and you can use this to update your details with other organisations, such as Centrelink and Medicare.

For detailed information on how to update your gender on formal documents in South Australia, see Justice Connect’s fact sheet: How to change your gender status on formal documents.

For detailed information on how to update your name in South Australia, see Justice Connect’s fact sheet: How to legally change your name.

Justice Connect has information about how to change your name and gender marker in each state and territory in Australia.

There are many ways to feel more comfortable with your gender and presentation, without medical transition. For example, you might ask people to refer to you by a new name or pronouns, change aspects of your appearance like your hair, clothing, or grooming. For more ideas, see the Gender Connect Country SA resource: Experimenting with with your Gender Expression.

Binders can be purchased online from several retailers. TransMascSA’s: Where to Buy a Binder resource lists a number of community-endorsed sources. Binder costs vary but are usually about $50-$85 AUD. Be wary of cheap binders on websites like Wish or eBay, as they are often not made for safe long-term use. For more in-depth information on binders, see TransHub.

For information on different styles of binders, how to measure your binder size accurately, and how to wear a binder safely and responsibly, see the TransHub website. As a rule of thumb, it’s best to wear your binder for eight hours or less per day, take breaks when possible, avoid binding during exercise and sleep, and take cues from your body – if binding is causing pain or other issues, stop and get advice from a trans-affirming health professional. Binder sizes can vary by brand, retailer, and product, so make sure to check the retailer’s product-specific advice and sizing charts before purchase.

You have the right to use your affirmed (chosen) name and pronouns at school. You also have the right to wear a school uniform that aligns with your gender, to use toilets and other facilities safely, and to have a school environment free from bullying, harassment, and discrimination.

There are some exceptions to this. For example, religious schools may be able to legally treat transgender and gender diverse students in ways that would otherwise be considered discrimination.

If you attend public school, it’s also important to know that the Department of Education has a support procedure for transgender, gender diverse, and intersex young people at school. This is a procedure that schools must follow and can be used to help advocate for support and changes you need at school. If you attend a private school, policies will vary on a school-by-school basis.
For more information on your rights at school, see the Your legal rights at school fact sheet from Justice Connect.

Policies regarding name and gender changes vary from organization to organisation. Some organisations may provide students, staff, and employees the ability to use a preferred name or gender (for example, in the email system, or your name badge) without having changed your name or gender legally. A university or workplace must update your details in their system when you have legally changed your name and/or gender. TransMascSA has created a template that community members may use to notify university staff of a change of name and/or pronouns, available online: TransMascSA template.

Discrimination based on gender identity at university or in the workplace is covered by general anti-discrimination law in South Australia. For more information on what is considered discrimination, and how to report it, see the How to deal with gender discrimination and transphobia factsheet from Justice Connect.

SHINE SA provides safe and affirming sexual health counselling services to TGD people. Sexual Health Counsellors support people experiencing a range of issues.
For more information, see the Sexual Health Counselling page.

The SHINE SA website has information that is trans-inclusive and affirming. A good place to start is the Sexual & Gender Diversity Useful Links and Resources page. The following resource by Gender Connect Country SA dispels common myths about TGD people and sexual health: Myth vs Fact: Transgender and Gender Diverse Sexual Health Information Sheet.

Another reliable source of information is the TransHub website by ACON. You can find out more information at TransHub.

You can transfer your care to a GP in South Australia. Things you might consider bringing, to help your new GP include:

• a copy of your records from your previous GP, including any health or mental health diagnoses, regular medications you take, and treatment you have received
• a copy of any support letters you have received written by a psychologist or psychiatrist, such as for gender affirming hormone therapy (GAHT) or surgeries
• your current prescription medications.

It’s important to note that there may be a wait time for appointments with some GPs. To ensure your access to medication isn’t interrupted, it is a good idea to bring 1-2 months of medication along with you if you’re able.

The Carousel Club is a local support group that welcomes transgender people and crossdressers. Find out more on their Facebook page: Carousel Club S.A