Cross-Sex Hormone Therapy in Australia: The Prescription Patterns of Clinicians Experienced in Adult Transgender Healthcare

In a 2017 survey of 35 Australian medical practitioners experienced in adult transgender healthcare, the study found that intramuscular testosterone undecanoate was the preferred masculinising hormone by 46% of respondents, while oral estradiol valerate was the most commonly prescribed feminising hormone by 71.4% of respondents, often combined with spironolactone or cyproterone acetate. Mental health assessments were recommended by 80% of prescribers before starting hormone therapy. The clinicians generally aimed for sex steroid levels within the reference range of the affirmed gender and conducted patient reviews every 2-3 months during the first year. The study revealed a consensus on the need for improved doctor training and the creation of Australian-based guidelines, with 79.3% of respondents in favor. Prescribing patterns were consistent with international guidelines, though based on low-level evidence. The study also noted the potential impact of changes in pharmaceutical availability and benefits scheme listings on future prescribing patterns, and the predominance of primary care settings in hormone therapy delivery, indicating a lack of public gender services and specialized training. Monitoring practices varied, with additional measures for those on spironolactone, and while there was variation in the use of an informed consent model, mental health support was commonly advocated. Despite limitations like a small sample size and possible responder bias, the study provided valuable insights into the prescribing patterns for cross-sex hormone therapy in Australia.