NSW Health is committed to providing evidence-based, holistic, age-appropriate and developmentally informed care for trans and gender diverse young people across NSW. To enhance existing services, NSW Health is developing a coordinated, statewide Specialist Trans and Gender Diverse Health Service (TGD Health Service) to provide gender affirming health care for people aged under 25.
The TGD Health Service is delivered through two specialist hubs. The Rural and Regional Hub was established in March 2021 at Maple Leaf House by Hunter New England Local Health District. The Sydney Metropolitan Hub is delivered at two sites - Sydney Children's Hospitals Network supports referrals under 16 through their Trans and Gender Diverse Service and South Eastern Sydney Local Health District supports referrals over 16 through True Colours, a new community-based site.
The scope of the hubs is limited to specialist trans and gender diverse health care. The hubs work closely with existing support services and primary care to provide holistic care for young people and their families and carers.
For further information regarding how the service will operate, refer to the Framework for the Specialist Trans and Gender Diverse Health Service for People Under 25 Years.
The TGD Health Service will provide evidence-based, multidisciplinary, holistic care to trans and gender diverse young people and their families. The service will provide access to medical, nursing, mental health and allied health specialists, offering services such as medical review, specialist nursing care, psychological assessment and diagnosis, and social work consultation. The service will also provide access to gender affirming medical treatment (e.g. puberty suppression treatment and hormone treatment) when clinically appropriate and in line with an individual's goals. While surgical referrals may be provided, gender affirming surgery will not be provided by the TGD Health Service.
The TGD Health Service is delivered through two Specialist Hubs. The Rural and Regional Hub was established in March 2021 at Maple Leaf House by Hunter New England Local Health District. The Sydney Metropolitan Hub is delivered at two sites - Sydney Children's Hospitals Network supports referrals under 16 through their Trans and Gender Diverse Service and South Eastern Sydney Local Health District supports referrals over 16 through True Colours, a new community-based site.
The Hubs will provide specialist trans and gender diverse health care only and will be networked with existing support services to ensure wrap around, holistic care, for young people and their families and carers. The service will support a young person and their goals, including if their goals change along the way.
The TGD Health Service will be implemented through a phased rollout.
The TGD Health Service will see young people who are trans and gender diverse or gender exploring of all ages up to their 25th birthday.
Children and young people who are showing signs of distress or discomfort about their gender should visit a General Practitioner (GP) to seek professional help. The GP can ensure that the young person is appropriately supported through local services and can provide a referral for assessment and care through the TGD Health Service, as appropriate.
Depending on your location, you may be referred to one of the Specialist Hubs.
Maple Leaf House
Young people up to their 25th birthday residing in these areas can be referred by a GP to Maple Leaf House. Further information can be accessed on Maple Leaf House - Transgender & Gender Diversity.
Sydney Metropolitan Hub
Sydney Children's Hospitals Network Trans and Gender Diverse Service
If you are under 16, you can be referred to the Sydney Children’s Hospitals Network Gender Service. Referrals can be made to the service by your clinician through ConsultMed or emailed to SCHN-CHW-GenderService@health.nsw.gov.au.
True Colours
Young people aged 16 to 24 years old residing in these health districts can be referred by a GP to True Colours.
GP referrals can be recieved via fax: 9332 9787.
Additional enquiries via email: seslhd-truecolours@health.nsw.gov.au
NSW Health's expert clinicians work with families and young people to determine the best individual treatment and care pathway. It is important to recognise that being trans and gender diverse is experienced and expressed by individuals in many different ways. As such, the care and support provided will vary from person to person and may or may not include medical treatment.
Clinicians operate within relevant Australian and NSW laws, policies and safeguards, including appropriate consent procedures.
If gender affirming medical treatment (e.g. puberty suppression treatment or hormone treatment) is being considered for a young person under 18, comprehensive assessments and diagnosis are required by a multidisciplinary team. These assessments are undertaken across multiple consultations to develop an age-appropriate care plan in consultation with the young person and their families and carers. Care planning occurs in close consultation with the young person, parents or guardians and treating clinicians, who must all agree that gender affirming medical treatment is in the best interest of the young person. If there is any disagreement, an application to the Family Court of Australia is required to determine the best interests of the individual.
The TGD Health Service delivers gender affirming care which can include any single or combination of a number of social, psychological, behavioural or medical interventions designed to explore, support and affirm an individual's gender identity.
Gender affirming health care is a non-judgemental, respectful, shared-decision making model that tailors support based on the individual and their health goals.
Gender affirming medical treatment, such as puberty suppression treatment or hormone treatment, will only be considered once specialised and comprehensive assessments have taken place and a formal diagnosis has been received. The decision to proceed with medical treatments occurs in close consultation with the young person, parents and treating medical teams, who must all agree that the treatment is in the best interests of the young person and ensure that the specific consent requirements are fulfilled.
Surgical treatments are not within the scope of the TGD Health Service.
There are currently specific consent requirements for young people to access gender affirming medical treatment (e.g. puberty suppression treatment and hormone treatment). The TGD Health Service will provide case-by-case advice to young people and parents or carers about these requirements.
In general, for gender affirming medical treatment to commence for a person under 18, written consent of both parents or legal guardian(s) and the young person (if Gillick competent) is required. If there is any uncertainty about consent, Gillick competence, diagnosis or treatment, an application to the Federal Circuit and Family Court of Australia is required before treatment commences. On a case-by-case basis, additional approval may be required from the NSW Civil and Administrative Tribunal.
For those aged 18 and over, an informed consent model is generally appropriate. If there is concern about the capacity of a young adult to consent to the treatment, a developmental and mental health assessment is recommended to ensure appropriate management.
For more information on the consent requirements for gender affirming medical treatment for minors, refer to Section 8.12 of Consent to Medical and Healthcare Treatment Manual (Minors).
For more information on the consent requirements related to children in out-of-home care, refer to the Medical and Dental Consent Tool.
As trans and gender diverse health care is an evolving practice area, it is important that clinicians working in the service contribute to the emerging evidence base.
To support evidence-based service delivery, a Clinical Advisory Group has been established to review emerging evidence and clinical guidance and provide advice to the Specialist Hubs. Their work will be supported by an updated evidence check by the Sax Institute on the benefits and risks of gender affirming care.
When young people and their families enter the TGD Health Service, there will be an opportunity to participate in research projects that contribute to understanding and improvements in care for trans and gender diverse young people. Detailed information will be provided to help young people and their families decide if they want to participate. Participation is voluntary and will not impact access to care. Consent to participate in research can be withdrawn at any time. We encourage young people and families attending the TGD Health Service to discuss any questions or concerns about how their information may be used before providing consent.
All future research endorsed by the TGD Health Service will be designed in consultation with consumers and trans and gender diverse community stakeholders to support high quality findings.
Trans and gender diverse healthcare is a complex and evolving practice area. NSW Health continues to monitor developments in the evidence to ensure the care we provide remains consistent with national and international best practice.
The 2024 Sax Institute Evidence Check Update includes summaries of both international and domestic peer-reviewed literature published since 2019 into treatment options for young people with gender dysphoria, in what is a constantly evolving research field. The Evidence Check Update builds on a previous Evidence Check conducted in January 2020. The report does not make recommendations for policy and clinical practice.
The Evidence Check Update found:
• new research supports previous evidence on gender affirming hormone therapy, finding that it is beneficial for mental health with minimal risks or potential harms;
• puberty suppression treatment is broadly safe and beneficial and has the advantage of being reversible; and
• there is emerging evidence supporting a range of psychosocial therapies. The evidence check found benefits and effectiveness in improving mental health outcomes, with no reported risks or potential harms.
To support evidence-based service delivery, a Clinical Advisory Group has been established to review emerging evidence and clinical guidance and provide advice to the TGD Health Service. The 2024 Sax Institute Evidence Check Update will support this work and inform understanding of priority areas for research, including the need for further collaboration with other Australian service providers on longitudinal research.
For more information, please see Effective interventions for children and young people with gender dysphoria update.
In March 2021, NSW Health released the landmark NSW LGBTIQ+ Health Strategy. The strategy's vision is for LGBTIQ+ people in NSW to receive high quality, safe, inclusive and responsive healthcare that delivers outcomes that matter to them.
Since the launch of the strategy, NSW Health has announced various initiatives to support trans and gender diverse communities including:
In addition, the NSW Government is supporting implementation of the NSW LGBTIQ+ Health Strategy through:
If you or someone you know needs mental health support, please call one of the following services and speak with someone.
Further mental health resources are available on HERE – a digital suicide prevention hub for LGBTQ+ communities.
For NSW Health staff, additional support is available through the Employee Assistance Program.
