FREQUENTLY ASKED QUESTIONS
Find answers to common questions about starting Gender Affirming Hormone Therapy with Dr Michelle Dutton at Prism Health, including appointments, informed consent, eligibility, support options, and ongoing care.
Will I need to see a mental health clinician (e.g. psychologist, social worker) as part of accessing hormone therapy?
Not routinely, no.
Dr Michelle Dutton uses an Informed Consent model of care in her approach to providing Gender Affirming Hormone Therapy. This means that where someone is able to understand all of the effects, side effects and risks of treatment and communicate these clearly (referred to as capacity to consent), there is not a need to routinely involve a mental health clinician for assessment.
Mental health clinician input may be required if capacity to consent is not clear. This is more likely for younger patients (under 16, or sometimes 16-18). It is rare to require mental health clinician assessment in people over 18.
Should I be referred a mental health clinician for mental health support if I am planning to start Gender Affirming Hormone Therapy?
Maybe.
This is a very individual decision. Some people do feel that they would benefit from mental health clinician support to help with some of the changes and challenges that can come from starting hormone therapy. Others may feel well supported by friends, peers and family, or may already have a mental health clinician that they feel comfortable with.
If you do want to be referred to a mental health clinician for mental health support, Dr Michelle can provide recommendations for suitable therapist but generally recommends that you obtain the referral and any associated Mental Health Care Plans from your own GP.
How many sessions will I need with Dr Michelle before I can start hormone therapy?
Generally, three sessions, with the option to commence hormone therapy at the third appointment. There are some cases where only two will be required, and occasional cases where more than three will be needed.
Having a detailed referral from your regular GP, although not required to book an appointment with Dr Michelle, can help provide background information and streamline the process.
It is important that you arrive on time for your appointments, as if you arrive significantly late to some of your appointments it is more likely that more than three will be needed to cover the required information.
What will the appointments typically involve?
Appointment 1 (~45min-1 hour)
This appointment involves getting background information such as whether you have any medical conditions (physical or mental health), whether you take any medications, have any allergies etc., the same as you would for any other medical specialist.
At this appointment you will also be invited to share more about your gender experience and decision to start hormone therapy. This often might include things like when you first became aware of your gender, what things you have found affirming so far, when you first started thinking about hormone therapy etc. It is also useful to know what connections with peer supports you have, and how well supported you feel embarking on this step of starting hormones.
Lastly, you will be asked to share your goals of treatment – what you are hoping hormone therapy will do. The idea of these questions is to get an idea of what you already know about hormone therapy, but also to get to know how you feel about particular effects.
Importantly, everyone’s story is different, and not everyone will have the same goals. There are no “correct” or “incorrect” answers to any of the questions you will be asked. It is all about getting to understand your unique experience, and what you want your future to look like.
There may be some effects that are particularly important to you, some that you feel more neutral about, maybe even some that you are not keen on and would prefer didn’t happen! That is all ok, you can choose to start a treatment even if you don’t love all of the effects. What is important is that you are aware of all effects, both positive and negative, as this is part of what makes a decision fully informed.
At the end of this appointment, you will be provided with a form to do blood tests.
Appointment 2 (~30 mins)
This appointment will focus on long term risks of Gender Affirming Hormone Therapy. Discussion of these is to ensure that you know what these risks are, but also what will help keep these risks as low as possible (e.g; avoiding smoking, aiming for regular physical activity etc.) We will also discuss limitations of some of the long term data in this area.
The other part of this appointment is discussing what is known about the effects of hormone therapy on fertility, and what options are available for fertility preservation. Whilst you will always be given the option of undertaking fertility preservation, it is not a mandatory step in accessing hormones, and if you choose to decline this your decision will be respected and supported.
If you have had blood tests done prior to this appointment (recommended) we will go through results at this appointment also.
Appointment 3 (~30 mins)
This appointment will cover side effects of hormone therapy. These tend to be things considered more minor than those classified as risks. An example of a possible side effect would be acne with testosterone treatment, or breast tenderness with estrogen.
This appointment also includes as discussion of the forms that hormone therapy comes in (e.g. estrogen as tablets, patches or gels, testosterone as injections or creams/gel) and shared decision making as to what best would suit your needs.
If blood tests have been done and are normal, and you feel sufficiently informed by the end of this appointment, you will provided with your first prescription, and will be asked to sign and return a consent form.
I am under 18. Do I need my parents’ consent to start hormone therapy?
Generally, yes.
Current case law in most Australian states means that someone under 18 cannot start hormone therapy if one of their parents dissents or disputes treatment. The exception to this is if one parent has a court order granting them full medical decision-making responsibility (if you do have such an order please make sure you have a copy for us to review). In these cases, hormone therapy can be prescribed with just this parent’s consent (as well as yours of course!)
Exceptions may also be made if there is a parent who is estranged and where re-establishing contact would create unacceptable risk (e.g.; history of abuse or family violence), or if a parent is uncontactable (i.e.; there whereabouts is unknown and not able to be ascertained). These would need to be considered by Dr Michelle on a case-by-case basis.
Please note that in these situations where there is complexity around parental consent, it is likely that more appointments than three would be required, and/or it is more likely that mental health clinician input may be required.
Dr Michelle will always strive to centre your healthcare needs and avoid any unnecessary barriers or delays – whilst also needing to ensure that she is working within what the law currently allows.
What happens after I have started hormone therapy?
You will have reviews with Dr Michelle approximately every three months for the first year of treatment, with blood tests prior to each of these appointments.
These follow up appointments will usually run for 15-30 mins.
After 1 year, if things are stable, you can have review and blood tests every 6-12 months. Eventually, 12 monthly review would be standard.
Do I need to keep returning to Prism for these reviews, or can my regular GP prescribe and monitor Gender Affirming Hormone Therapy?
Potentially – it depends on what their level of training, experience and confidence is in this area, which is not yet part of core GP training. Many GPs are happy to continue hormone therapy once doses are stabilized, and some are comfortable adjusting doses.
When you commence Gender Affirming Hormone Therapy a letter will be sent (if you consent to this) to your GP providing information about hormone therapy management and ways of them seeking advice and support from Dr Michelle if they need this.
Can Dr Michelle look after other aspects of my health? Can she be my regular GP?
All aspects of your physical and mental health will be considered as part of aiming for the best possible outcomes with respect to your decision around hormone therapy.
Dr Michelle will not be able to personally oversee the management of all these other conditions and will direct you to speak with your regular GP or other healthcare provider about these. This is because Dr Michelle’s limited appointment availability and the limitations of telehealth mean that it is not possible to provide a full spectrum of GP services to the standard that you deserve. This is why working with your existing healthcare team (or helping you to link with and build one) is a priority for Dr Michelle.
