Frequently asked questions about stage 2 treatment

This fact sheet covers some of the common questions young people and parents have about stage 2 hormone treatment.

Why would a young person need access to stage 2 treatment?

A young person may need access to stage 2 hormone treatment if their biological sex does not align with their gender identity. In other words, the sex they are assigned at birth is different from the gender with which they identify.

How can medical intervention help individuals align with their gender identity?

Trans and gender diverse young people can receive stage 1 and stage 2 treatment to help them align their gender:

Stage 1 consists of the administration of puberty suppressant hormones (“puberty blockers”). This treatment suppresses the onset of puberty and physical characteristics which may be incompatible with your gender identity. Stage 1 allows young people to explore their gender identity before beginning Stage 2. Stage 1 is reversible.

Stage 2 involves the administration of either estrogen or testosterone. Stage 2 results in the development of physical characteristics which are compatible with your gender identity (such as facial hair and muscle growth for those taking testosterone and breast development and reduced visibility of body hair for those taking estrogen). Certain effects of stage 2 are irreversible without surgical intervention.

In addition to stage 1 and stage 2 hormone treatment, sex affirmation surgery is also available (usually once the child reaches 18 years of age) (Stage 3).

What does “affirming your gender identity” mean?

Irrespective of whether a trans or gender diverse person receives hormone treatment, they may at some point begin to affirm their gender publicly. This may be known as “transitioning”.  “Affirming one’s gender identity” usually involves using a preferred pronoun and a new name that aligns with the individual’s gender identity.  It may also include wearing clothes, hairstyles and accessories that are consistent with their gender identity.

Why is it important for a young person to get access to stage 2 treatment quickly?

According to the Royal Children’s Hospital, “The health risks associated with inadequate care and support of transgender adolescents are well known. For example, Australia’s third national survey about the health and wellbeing of transgender young people (2010) found that almost half of gender questioning young people had self-harmed. 28% had attempted suicide”.

If medical professionals have determined that a young person needs access to stage 2 treatment, it is important that they receive it in a timely fashion.  Without treatment, a young person may begin to develop physical characteristics of the gender they do not align with.  For example, if a young person is born a male, but identifies as a female, there is a risk their voice may break before they receive treatment.  This may cause them extreme distress.

When does the Family Court have to authorise stage 2 treatments? 

Under Australian law, the following scenarios may require a young person to seek a court order so that they can gain access to Stage 2 treatment:

• where there is a genuine dispute between parents, or people who have parental responsibility for a child, as to whether treatment should proceed
• where there is a dispute between the child and / or their parents and medical staff as to whether treatment should proceed
• where there is a genuine dispute between the child and their parents as to whether treatment should proceed (if the child is not competent)
• where a child is under the protection of a state welfare authority.

How long can the process take?

Including the time it takes to obtain medical report and affidavit evidence from parties, it will take a number of months before the matter is finalised.

What is the process of applying to the Family Court for stage 2 treatment?

If an application is required, an application to the Family Court can be made by:

• a parent/guardian of the child
• the child themselves
• an independent children’s lawyer
• any other person concerned with the welfare of the child.

An application must be served on the Child Protection Authority (CPA) and the Office of the Public Advocate (OPA). These bodies will decide whether they wish to be involved in the proceeding.

To make the application, affidavit evidence must be collected from medical and psychiatric experts, parents, guardians, and other individuals involved in the child’s upbringing. The matter will then be listed for hearing.

Will I have to attend the hearing?

If the application is being made by a parent then they will usually have to attend Court for the hearing. However, applicants will not be questioned or cross examined by the Judge and will just be required to sit in the back of the Court room and observe the proceedings. The lawyers and Barristers will be talking directly to the Judge and answering his/ her questions on the applicant’s behalf.

It is not possible for the child to enter into a Family Court session without permission from the judge.

Usually, hearings in relation to special medical procedures are closed, which means that no one other than the parents or guardians of the child and their lawyers can enter the Courtroom and listen to the proceedings.

What will the Court decide during the hearing?

During the hearing, the Court will likely consider two questions:

1. Can the child consent to the treatment on their own? That is, whether the child is Gillick competent? To be Gillick competent, the child must have a sufficient level of maturity and intelligence to understand the impact of the treatment on their body, the enormity of the decision being made, and the implications of the decision (particularly its irreversibility and potential impact on fertility). This decision is usually based on the medical evidence presented to the Court. If the child is declared Gillick competent by the Court, they can consent to the treatment by themselves, and the Court no longer needs to be involved.

2.     If the child is not Gillick competent, the Court must decide whether the treatment is in the child’s best interests. The Court will consider the affidavit evidence (including medical evidence) in making this decision, as well as the views of the resisting parent.  If the treatment is in the best interests of the child, the Court will make an order allowing the child to access stage 2 treatment.

Which identity documents can I change my gender on in Victoria?

Birth Certificate

The Victorian Registry of Births, Deaths and Marriages currently requires Victoria-born people to undergo sex affirmation surgery before they can apply to have their change of sex recognised on their birth certificate. For more information, please refer to the Births Deaths and Marriages Victoria website.

Passport

The Australian Passport Office can issue a passport to sex and gender diverse applicants, identifying them as M (male), F (female) or X (indeterminate/intersex/unspecified), and surgery is not a prerequisite for a passport to be issued in your preferred gender.

To apply for a passport in your preferred gender, you would need a declaration from your treating medical professional. For more information, please refer to the Australian Passport Office’s website.

Medicare Card

You can notify the Commonwealth Department of Human Services of your preferred gender, and surgery is not a prerequisite.

You would need to provide the Department of Human Services such as a statement from a registered medical professional. For more information, please refer to Department of Human Services’ website.

More services and support for young trans people

Justice Connect can help you in finding legal assistance.

There are also many other support services available for trans and gender diverse individuals, their partners, families, and friends, including:

Gender Help for Parents: an online hub for gender dysphoria resources

Minus18:  Australia’s largest youth led organization for gay, lesbian, bisexual, trans and gender diverse youth

Seahorse Victoria: Social group for the Victorian transgender community

Transcend Support: Peer led support network and information hub for transgender and gender diverse children and their families

Transgender Victoria: Transgender Victoria strives to achieve justice, equity and quality health and community service provision for trans and gender diverse people, their partners, families and friends.

Zoe Belle Gender Collective: An online not-for-profit seeking to provide support, training & resources for the Victorian trans and gender diverse community

Parents of Gender Diverse Children: Provides peer support to parents and those parenting trans and gender diverse children