Dr Michelle Guttman-Jones graduated from Sydney Medical School and will soon attain fellowship with the Royal Australian College of General Practitioners. She enjoys seeing a broad range of patients for all reasons. She has a specific interest in LGBTIQA+ health, and is a provider of gender affirming hormone therapy under the informed consent model of care.
All advice is general and may vary according to individual circumstances.
Q: I want to start gender affirming hormone therapy. What should I expect?
A: The first consult will be 45 minutes long. I will take a detailed history. You do not need to “prove” that you’re trans – just be yourself. I will measure your height, weight and blood pressure. We will discuss the treatment plan and go through the consent form. You will be asked to have a blood test and read the consent form again at home. You will return for a second session where you will have the opportunity to discuss questions and concerns. Hormones are usually commenced in the second session.
Q: Do I need a letter from a psychologist or a psychiatrist before I can start hormones?
Mental health support will be offered as part of the hormone initiation process, but patients are not obliged to see a mental health professional as part of this process.
Q: What hormone levels do you target?
A: I target the normal physiological hormone range for a person’s affirmed gender. Regarding oestradiol therapy, the target is derived from theluteal phase of the menstrual cycle, about 400 – 1000 pmol/L.
Q: Do you offer hormone implants?
A: Yes, I prescribe and insert compounded subdermal hormone implants where it is clinically appropriate to do so.
Q: Do you offer 200mg (2x 100mg) oestradiol implants?
A: Sometimes. A dose of 200mg is required for some people to achieve target hormone levels. For other people, a dose of 200mg is too high. Doses are determined on an individual basis.
Q: Why don’t you target higher levels?
A: We currently lack scientific data to support the long term safety or efficacy of hormone levels that are above normal physiological ranges. Until new data emerges, I must prescribe within the bounds of medical consensus.
Q: I was maintained at higher levels by my previous doctor. Will you continue my previous treatment plan?
A: Not permanently. I will support people who have been maintained at higher levels but who are willing to follow a long term weaning plan towards physiological hormone levels. All weaning plans will be individualised and take into account a person’s mental and physical health. However, I will not continue long term therapy that results in hormone levels persistently higher than the physiological range for the person’s affirmed gender.
Q: How much do you charge?
Hormone implant procedures cost $174 with a $82.40 rebate from medicare. The charge may be higher if other issues are dealt with during that consult. The implant procedure fee does not include the cost of the implant. Patients will pay the pharmacy directly for the cost of the implant.
Q: Do you offer concession rates?