Gender Service

John Hunter Children’s Hospital Gender Management Program aims to provide outpatient services geared towards supporting the physical, mental, and social health of children and youth and their families as they progress through their gender identity development.

Gender dysphoria refers to the distress that a person may experience when there is incongruence between their biological gender and their expressed gender. Transgender and gender diverse young people have considerably higher rates of self-harm, attempted suicide, depression and anxiety compared to their cis-gender peers. Outcomes for these young people can be significantly improved through medical support.

As specialists in paediatrics, adolescent medicine, and psychology, we recognise that the process of gender identity development is uniquely individual. Our providers determine the best treatment plan for each individual in collaboration with youth, families, physicians, and mental health therapists, and other specialists provide improvement to the physical and mental wellbeing outcomes of children and adolescents who experience gender dysphoria.

The JHCH Gender Service is not a crisis service. Should you have immediate or urgent concerns for your or your child's mental wellbeing please contact your regional mental health service.

Our Gender Service includes:

  • Consultation for families with gender non-conforming children and adolescents
  • Consultation for the use of medications to suppress puberty
  • Consultation for masculinizing and feminizing hormonal therapy
  • Readiness evaluations for puberty suppression and cross-sex hormonal therapy by mental health providers
  • Referrals to experienced mental health providers in the community
  • Support and advocacy for patients and families through various aspects of transition, including working with school systems and completing legal name and gender marker changes in identifying documents.


Children and adolescents up to 18 years, who live in the Hunter New England Health Service area with concerns regarding gender diversity or gender dysphoria, can be referred by a General Medical Practitioner (GP) to the Gender Service for assessment and support with ongoing treatment and care.

Families may need considerable support in understanding and responding to their child or adolescent's needs. The initial consultation for children and adolescents will involve an assessment with the Gender Service clinical nurse consultant.

This initial assessment will allow the Gender Service team to provide you and your child or adolescent with information regarding relevant supports that are available both within the John Hunter Children’s Hospital and through external groups and community organisations.

Diagnosis and Treatment

Following your initial assessment with the Paediatric Endocrinologist you will be offered an appointment with a child and adolescent psychiatrist.

Treatment provided by the Gender Service therefore involves diagnosis and then development of a comprehensive management plan in collaboration with the child or adolescent and their family.

For prepubescent children treatment may be gender affirmation with assistance and support in home and schooling environments. Once puberty starts two psychiatric opinions are required and options for medical treatment are divided into two stages:

Stage 1

Puberty blockers – these need to be prescribed by a paediatric endocrinologist.

Puberty blockers suspend the development of secondary sex characteristics whilst providing time for cognitive and social development. They are reversible, therefore if an adolescent stops taking them puberty will resume in the biological sex.

Stage 2

Cross hormones – prescribed by paediatric endocrinologist.

Cross hormones initiate puberty in the affirmed gender and may be commenced around the age of 16 years. A transgender female would be initiated on oestrogen and a transgender male would start testosterone. They are only partially reversible. In Australia, this stage requires court approval for adolescents under the age of 18 years.

Patient and Parent Information


The John Hunter Children’s Hospital Gender Service treatment guideline follows the Endocrine Society Clinical Practice Guidelines and The World Professional Association of Transgender Health (WPATH) Standards of Care (Version 7 Published 2011) which highlight that "being transgender… is a matter of diversity, not pathology".