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Gender Incongruence

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Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Severe psychological distress directly related to gender incongruence/dysphoria resulting in immediate significant risk (e.g. suicidal ideation, genital mutilation)
  • Patients expressing regret in relation to medical or surgical gender affirming treatments
  • Patients already on gender-affirming hormone therapy (GAHT) with absolute (urgent) contraindications (e.g. venous thromboembolism, oestrogen sensitive malignancy, psychosis)

Category 2

Appointment within 90 days is desirable

  • Medical assessment and initiation of GAHT for those aged >17 years
  • People seeking other gender-affirming therapies due to gender incongruence/dysphoria (e.g. psychology, psychiatry, speech pathology, social work)
  • People seeking mental health assessment and formal documentation to undergo gender-affirming surgery (where relevant)
  • Patients already on GAHT with relative contraindications (e.g. polycythaemia with no symptoms of acute thrombosis, non-acute/controlled cardiovascular conditions, other mood disturbance with no active suicidal ideation or severe mental health crisis) (Referred to Endocrinology)

Category 3

Appointment within 365 days is desirable

  • Patients already on GAHT requiring routine follow-up (e.g. dose adjustments) for those aged >17 years (Referred to Endocrinology)

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

The Gender Service is located at the Royal Brisbane and Women’s Hospital and includes:

  • Recommendations to referring GP for community linking and referrals to relevant community services/private providers for the patient.
  • Assessment and affirmative treatment for adults (>17 years) with gender incongruence/dysphoria.
  • Time-limited support for patients with psychosocial adjustments related to gender incongruence/dysphoria.
  • Therapeutic assessment and affirmative treatment of gender issues (and co-existing mental health or neurodevelopmental conditions, which are directly and significantly impacting assessment and/or management of gender incongruence/dysphoria).
  • Speech Pathology including voice feminisation and masculinisation services to adults experiencing gender incongruence/dysphoria, who have already been seen by the RBWH Gender Service. Patients cannot be referred directly to the Speech Pathology service.
  • Assessment and reports by Psychiatrist for gender affirmation surgery, where a patient cannot access this privately.
  • Assessment (of capacity, mental health, medical status and risk) to determine patient suitability and readiness for GAHT.
  • Please note that the service discharges patients back to the referring GP for ongoing medical and mental health management once the patient is stable (or when clinically appropriate).
  • Due to an extensive wait list, most patients will not be offered an appointment for at least 14 months. Please continue to provide health care to the patient and refer to appropriate private providers/community services if required during this interim period.

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Brief gender-related history: preferred name, sex assigned at birth, gender identity, pronouns used
  • Relevant social history, including any safety concerns for the patient (e.g. whether it is safe for the Gender Service to contact the patient using the contact details provided in the referral).
  • Mental Health diagnoses (patients must have managed/supported mental health before being prescribed GAHT. Please manage any mental health concerns, including referrals to mental health care providers while the patient awaits their appointment). Please provide information on the following:
    • Diagnoses: mood disorder (anxiety, depression), disordered eating or eating disorder, psychotic illness, chronic severe mental health issue and whether the patient is under the care of a mental health specialist or team.
    • Mental health risks.
    • If no known mental health issues/if stable/well-supported.
    • Any neurodevelopment diagnoses/concerns (where relevant)
  • Physical Health diagnoses:
    • All current medical conditions (e.g. cardiovascular disease, cerebrovascular disease, haematological disease (including venous thromboembolism), diabetes, obesity, osteoporosis, hormone-dependent cancer (including breast cancer)).
    • Please document if there are no pre-existing medical conditions.
  • Current medications including dose(s).
  • Allergies
  • Essential blood test results:
    • FBC; E/LFTs; glucose/HbA1C, fasting lipids, oestradiol, testosterone, LH, FSH, vitamin D
    • For people seeking GAHT, these essential blood tests must have been completed within the last 6 months.
    • The results of blood tests must be included in the referral, otherwise the referral will be declined:

Please note: it is the duty of care of the GP ordering blood tests to follow up any abnormal results.

Additional Referral Information (Useful for processing the referral)

  • Capacity or medicolegal issues:
    • Any issues impacting the patient’s ability to demonstrate capacity (e.g. intellectual or cognitive impairment; under public guardian).
    • Patient capacity to make informed decisions about their health care.
    • For people under 18 years: custody/court orders if applicable, including any parental opposition to GAHT.
  • Nicotine (via smoking or vaping), alcohol and other substance use:
    • Nicotine use increases the risks associated with gender-affirming hormones and may prevent a patient from being able to commence hormones. Please discuss and manage nicotine and other substance use while the patient is awaiting review.
  • Patient’s current risk of pregnancy and current pregnancy prevention:
    • Please discuss and commence appropriate pregnancy prevention for the patient.
    • If the patient is being referred for commencement of testosterone, please consider progesterone-only contraception, including LARCs (long-acting reversible contraception).
  • Patient’s desire to preserve their fertility with gamete (egg or sperm) freezing.
  • Please refer the patient to a private fertility specialist if they would like to discuss and/or undergo fertility preservation
  • Neurodevelopmental diagnoses (please manage any concerns, including referring them, if appropriate, for private assessment and management):
    • g. Diagnosed/suspected Autism or ADHD
  • For people seeking GAHT, the following investigations should be considered (where relevant):
    • Sexual health screening depending on the patient’s risk: anti-HIV/HIV Ag, anti-HAV IgG, anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, syphilis serology, PCR for chlamydia and gonorrhoea on specimens from urine/genitals, pharynx and rectal sites, and cervical screening as applicable.
    • Please note: it is the duty of care of the GP ordering investigations to follow up any abnormal results.
    • Please follow up any issues related to the patient’s sexual health, including HIV and STI screening and management, and HIV prevention including PrEP (pre-exposure prophylaxis)
  • Relevant family history.
  • Height, weight, Body Mass Index (BMI), blood pressure.

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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