A Victorian government-funded transgender health clinic, touted as being a one-stop shop for trans and gender-diverse people accessing health care, has not initiated prescriptions of gender-affirming hormones to patients in the four years since opening.
The state government set up two clinics in April 2019 — one in Ballarat and the other in Preston, a suburb of Melbourne — to address several key problems facing trans health including access and lengthy wait times.
Melbourne-based Your Community Health was given leadership of the $3.4m consortium, with the clinics' priority to attract and retain doctors with strong knowledge of hormone-driven transitioning.
It also hoped to upskill GPs to improve their confidence in prescribing gender-affirming hormones such as testosterone and oestrogen.
The third element of the clinics have since become the main focus of the Ballarat site: employing trans and gender-diverse people as peer navigators to help patients through the complex system.
'Over-promised and under-delivered'
Ballarat community organiser KL Joy underwent a "gender revolution" in late 2018 and began exploring their medical options to affirm their gender identity.
"I'm also disabled, so having a complex medical history and being trans it was really important to find a doctor who could deal with all of those at the same time," they said.
But when KL approached the Ballarat Community Health Clinic, they were surprised.
"The reality was, the clinic was a referral service trying to catch up with what they were promising," they said.
In its three-year operation, Ballarat Community Health has never employed a doctor who has felt confident to initiate patients on gender-affirming hormones.
Disappointed, KL tried for years to find another doctor in Ballarat to address their medical needs.
"There is not a single doctor in Ballarat, currently, who will do informed consent care for gender-affirming medication or gender-affirming hormone therapy. It's non-existent in Ballarat," they said.
"After [opening] three years ago, it should have already been well and truly established."
Ballarat Community Health Clinic refused interview requests, but chief executive Sean Duffy said in a statement the clinic was still committed to caring for the trans and gender-diverse community.
"Prior to the commencement of this initiative, there was no specific service available in Western Victoria," he said.
"It is recognised that ongoing GP availability in rural areas is a challenge for all health services, particularly within the area of treatment and care."
But the ABC understands the Ballarat clinic is in negotiations with a GP who is comfortable prescribing hormones to work at the service one day a week.
"One day a week is just not enough. They're going to be overwhelmed," KL said.
GP crisis to blame
In Melbourne, even the Preston clinic has twice had periods of time without GPs confident in initiating hormones.
General practitioner Nate Reed worked at the Preston clinic run by Your Community Health, but left the role two years ago.
"Being a member of the trans and gender-diverse community, there is probably a slightly higher pressure to advocate for community and to do it well," Dr Reed said.
He said the pandemic had stretched the capacity of GPs around the country, reducing the time and funding GPs had to undertake additional training.
"As a GP in the space, if I've initiated someone on hormones, it's broadly easier to find them GPs who are happy to continue prescribing than it probably was five years ago," he said.
Chief executive of Your Community Health Kent Burgess said the consortium had trained 90 GPs in providing gender-affirming care.
"The challenge of being a first service in an area where there is so much demand is that it's always going to be impossible to meet that demand," Mr Burgess said.
"It's a real shame to undersell the achievements that have been achieved by those trans and gender-diverse people within the program who have really built up an amazing resource."
Better 'gender practitioners'
Despite the shortfalls in delivery, Dr Reed said the model was working as well as it could with the resources it was allocated.
"There were pressures associated with [long waiting lists], not necessarily being able to see as many people as you'd want to be able to see," he said.
The consortium has twice made submissions to the state government for more funding in the budget and has twice been rejected.
The Victorian health department declined an interview, but in a statement, a spokesperson said doctors had reported higher confidence providing care after receiving training.
"We're monitoring the impact of these new clinics. Community feedback tells us that the clinics make Victorians feel safer and more empowered to achieve their health goals," the spokesperson said.
The spokesperson also said a further 1,300 allied health professionals had completed training in gender-affirming care.
But both Dr Reed and KL supported calls to enshrine training around gender-affirming care into the core education of general practitioners.
"We're going to have better doctors. We're going to have better gender practitioners as well as general practitioners," KL said.
