Gynaecology Service at Monash Health

 

 

Dear trans and gender diverse community members and service providers,

I write to inform you of the surgery and fertility preservation options for trans men at Monash Health.

The Gynaecology Service at Monash Health offers these services to trans men:

  • Tubal ligation for contraception
  • Removal of internal reproductive organs
  • Initial assessment of fertility preservation options

To access these services, referral is required via the Gender Clinic, Monash Health. For more detail, see the document below and attached, or contact the Clinic: (03) 9556 5216, genderclinic@monashhealth.org

Kind regards

Dr Riki Lane
Project/Research Worker
Gender Clinic

Surgery and fertility preservation options at Monash Health for trans men

The Gynaecology Service at Monash Health offers a range of service to trans men, through referral from medical specialists at the Gender Clinic, Monash Health. Their staff have received initial training in trans-affirmative health care, which will be updated from time to time, and will seek to provide a trans–inclusive environment. However, they are part of Monash Women’s Health, and trans male clients will necessarily be attending clinics that are predominantly female.

Surgeries on internal reproductive organs

For contraception alone, tubal ligation is available through the Monash Health Contraception Counselling clinic which is held on a Monday afternoon at Clinic D at MMC Clayton. To facilitate trans-affirmative treatment, it is essential to refer through the gender clinic.

Removal of internal reproductive organs is available on referral from the Gender Clinic to a Gynaecology clinic with Claire Ransome on Friday afternoons. The surgeons do not anticipate these will be especially difficult operations: as testosterone reduces the size of the organs, they should be relatively simpler to remove.

Evaluation for surgery would require a minimum of: an internal examination, a pap smear test and an internal ultrasound. The waiting list for surgery is between a few months and a year from receipt of initial referral, depending on a number of factors.

Surgeries are done through laparoscopy, which reduces scarring and recovery times. The Monash Health gynaecology surgeons are world leaders in laparoscopy.

Fertility preservation

It is best to consider fertility preservation options prior to commencing hormones. A first step is to assess current fertility, which can be done at the Monash Health reproductive medicine clinic (once a month), on referral from the Gender Clinic, or privately.

If fertility preservation is only required until the client is in their early 30’s, an approach is to suppress menstrual cycles with Testosterone until that time, then cease T treatment and allow menstrual cycles to resume and harvest eggs. If parenthood may be later than that, or the client seeks removal of internal reproductive organs, egg harvesting and freezing is suggested.

There is currently no public facility for in-vitro-fertilisation and other assisted reproductive technologies, although this may be available at Monash Health in a few years’ time. Harvesting and preservation of eggs or embryos is done privately. There is a Medicare rebate for parts of IVF treatment where there is a medical necessity (for example due to cancer), but not for social reasons.  There would be no Medicare rebate for trans men, unless the referring clinician was able to successfully argue for medical necessity.

Harvesting and preservation of eggs has to take place prior to administration of testosterone, or after having a break from Testosterone to allow cycles of egg production to resume. Consultations, blood tests and ultrasound on the ovaries are undertaken to assess fertility, followed by cycles of follicular stimulating hormone (FSH) to induce hyper stimulation. The eggs are then harvested through a needle and ultrasound inserted through the genital opening.

To maximise chances of a viable pregnancy later, it is best to freeze about 20 eggs. For someone young and fertile, this may be achieved in a single cycle, through using high doses of FSH. Otherwise, it would take several cycles. Each cycle costs around $10,000, and egg storage around $500 per year.

Many people (cis and trans) have strong emotional responses to the hyper-ovulation and egg-harvesting process. It is thought these are mainly due to the social situation and tensions around the procedure, rather than as a direct impact of the hormones themselves.

For more info please download the Monash Health Ob-Gyn options for TGD people assigned female at birth or visit http://www.monashhealth.org/page/gender_clinic

Have your say! :D