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Author Topic: Dr Ada Cheung Endocrinologist  (Read 133 times)

Mary-Jane

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Dr Ada Cheung Endocrinologist
« on: July 02, 2018, 04:38:34 PM »
Dr Ada Cheung Endocrinologist
MBBS (HONS) FRACP PHD MAICD


Dr Ada Cheung, is a leading specialist consultant Endocrinologist providing comprehensive, accessible, state-of-the-art endocrine care for those living in Melbourne as well as rural Australia in close collaboration with local GPs. She welcomes any General Endocrine referrals in adult patients.

Dr Cheung holds a prestigious Australian Government National Health and Medical Research Council Fellowship to support her medical research at The University of Melbourne, striving to advance health outcomes for individuals with hormone conditions. She is also an Endocrinologist in the Department of Endocrinology at Austin Hospital and the Australian Prostate Centre. Dr Cheung has research interests (click here for publications) in understanding the effects of testosterone and oestrogen on the body, in particular preventing side-effects of androgen deprivation therapy for men with prostate cancer and improving health outcomes for trans and gender diverse individuals (www.transmedicalresearch.org). Dr Cheung has won a large number of international and national awards for her research including being one of five recipients worldwide (and the only Australian) of the prestigious US Endocrine Society Early Investigator Award in 2016 and a finalist in the Premier’s Award for Health and Medical Research (Government of Victoria) in 2018.

Dr Cheung is also a tutor, lecturer and supervisor at the University of Melbourne Medical School. Furthermore, she is actively involved in the Endocrine Society of Australia and Australian Diabetes Society, recently involved in developing the Type 1 Diabetes Consulting Skills book and was also on the Program Organising Committee for the Endocrine Society of Australia Annual Seminar. She is also a member of the US Endocrine Society, American Diabetes Association and the Australian and New Zealand Professional Association for Transgender Health and regularly presents at national and international conferences and meetings. Committed to community service in the not-for-profit sector, Dr Cheung is a Member of the Australian Institute of Company Directors.

Transgender

Transgender is a broad term and each person is individual. Gender Dysphoria, Gender Incongruence and Gender Identity Disorder are all common medical terms used to describe people who don’t conform to traditional gender identities. Improving the health and well-being of those identifying as transgender, gender diverse or gender non-conforming is critical to improve the significantly increased risk of mental health issues, social disadvantage and suicide experienced by the transgender community.

Managing transgender health requires a multidisciplinary team which may include one or a number of health professionals such as a general practitioner, endocrinologist, psychiatrist, gynaecologist, urologist, general surgeon, sexual health physician, speech pathologist or dietician. Peer support and family support is also very beneficial.

Some transgender people may wish to transition to an alternate sex, but others may not, and the degree of transition varies from one individual to another. It is important to discuss this with your treating practitioners. One of the first steps to transition includes mental health support by either a psychiatrist or psychologist experienced in gender dysphoria. Gender dysphoria is not a mental illness, but this step is important to provide mental health support, exclude other possible psychiatric conditions such as psychoses or dissociative disorder and also support you through the transitioning process if you decide to proceed down that route. To find a list of experienced adult psychiatrists or psychologists, click here.

Endocrinologists (hormone specialists) can assist with medical transition to provide hormone replacement therapy, sometimes known as cross-sex hormone therapy to induce sex-steroid levels in the range of an individual’s preferred sex. This will induce hormonal changes in the body as well as physical changes and lead to the development of secondary sex characteristics, similar to what occurs at natural puberty.

Although hormone therapy is thought to be reasonably safe, there is very little good quality research on the best regimens for treatment and also the long-term side-effects on the body. There are many unanswered questions and more good quality medical research is needed to provide evidence-based care. The True Colours Medical Research Fund has recently been established to improve transgender health through medical research and is currently 100% crowdfunded by the public. Support transgender health at tc.org.au
Hormone Replacement Therapy/Cross-Sex Hormones

Cross-sex hormone therapy is given once an individual has a clear understanding and appreciation of the facts, implications and future consequences of treatment (otherwise known as informed consent). Individuals should be aware that some effects of hormones are irreversible, such as voice deepening with testosterone treatment and that every treatment carries some risks.

The precise hormone regimen should be individualized and discussed with your doctor. In general, masculinizing hormones (testosterones) are given for those wanting to transition from female to male, and feminizing (oestrogens) are given for those wanting to transition from male to female. Transhealth in general is understudied and under-researched and there is no “perfect regimen” and long-term side-effects are not 100% clear, however current treatments are based on current standards of care recommended by professional organisations; WPATH and the US Endocrine Society. Although care is broadly based on available clinical guidelines, care is flexible and is tailored to the needs of each individual.

What can I expect from hormone therapy?

Hormones work to cause effects that are closer to an individual’s desired gender identity, however it certainly is not an instant effect. Most changes take 1 to 2 years to take full effect and are highly variable. Below are some tables that describe expected effects and expected time course of masculinizing (testosterone) hormones and feminizing (oestrogen) hormones but bear in mind that each individual is different.

Effects And Expected Time Course of Masculinizing Hormones
Effects    Expected onset    Expected maximum effect
Skin oiliness/acne    1-6 months    1-2 years
Facial/Body hair growth    3-6 months    3-5 years
Scalp hair loss    >12 months    Variable
Increased muscle mass/strength    6-12 months    2-5 years
Body fat redistribution    3-6 months    2-5 years
Cessation of menses    2-6 months    n/a
Clitoral enlargement    3-6 months    1-2 Years
Vaginal atrophy    3-6 months    1-2 Years
Deepened voice    3-12 months    1-2 Years

WPATH Standards of Care Version 7
Effects And Expected Time Course Of Feminizing Hormones
Effect    Expected onset    Expected maximum effect
Body fat redistribution    3-6 months    2-5 years
Decreased muscle mass/strength    3-6 months    1-2 years
Softening of skin/decreased oiliness    3-6 months    unknown
Decreased libido    1-3 months    1-2 years
Decreased spontaneous erections    1-3 months    3-6 months
Male sexual dysfunction    variable    variable
Breast Growth    3-6 months    2-3 Years
Deceased testicular volume    3-6 months    2-3 Years
Deceased Sperm Protection    variable    variable
Thinning and slowed growth of body and facial hair    6-12 months    > 3 year
Male pattern baldness    No growth, Loss stops 1-3 Months    1-2 year

WPATH Standards of Care Version 7

Hormone therapy may not lead to all of the desired effects for an individual and other useful procedures may also include laser facial hair removal, speech pathology to change voice, facial feminisation surgery, hair transplants, trachea shave, voice surgery, breast implants, chest reconstruction and sex reassignment surgery.

Risks and Side-Effects of Cross-Sex hormone treatment

All medications carry some risks and each person’s risk varies depending on factors such as their medical conditions, the dose, route, genetics and family history, and smoking status. Below is a table summarizing potential risks associated with hormone therapy.

Bolded Items Are Clinically Significant
Risk Level    Feminizing hormones    Masculinizing hormones
Likely increased risk    Venous thromboembolic disese    Polycythemia
Gallstones    Weight gain
Elevated liver enzymes    Acne
Weight gain    Androgenic alopecia (balding)
Hypertriglyceridemia    Sleep apnea
Likely increased risk with presence of additional risk factors    Cardiovascular disease    
Possible increased risk    Hyperprolactinemia    Elevated liver enzymes
hyperprolactinemia or prolactinoma    Hyperlipidemia
Possible increased risk with presence of additional risk factors    Type 2 diabetes    Destabilization of certain psychiatric disorders
Cardiovascular disease
Hypertension
Type 2 diabetes
No increased risk or inconclusive    Breast cancer    Loss of bone density
Breast cancer
Cervical cancer
Ovarian cancer
Uterine cancer

WPATH Standards of Care Version 7

Do-it-yourself hormones

Sometimes it can be frustrating going through the transition process and may seem like that there are “many hoops to jump through”. Health practitioners do want to make this as easy as possible in order to achieve the desired care for each individual.

Choosing to purchase do-it-yourself hormones online or from non-traditional methods is strongly, strongly advised against for several reasons.

    There are uncertain quantities of active ingredients
    No safety regulations or quality control.
    You don’t know what’s in it. Or what’s not in it!
    Cost
    Risks such as abnormal liver function may result.

If you are considering taking do-it-yourself hormones or alternative herapies, please speak to your doctor first.
Changing your gender and/or name with authorities

If you have decided to undergo cross-sex hormone therapy, changing your name with medicare is a useful first step to enable you to receive PBS-subsidized medications.

    Changing your gender with Medicare
    Changing your gender on your driver’s license Victoria,
    Changing your gender on your driver’s license NSW
    Changing your gender on your driver’s license QLD
    Changing your name with birth, deaths and marriages Victoria
    Changing your sex with birth, deaths and marriages Victoria
    Changing your name and sex on your Australian passport

For more information go to: http://www.endocrinologistmelbourne.com.au

Definition of Hats aka "Conflict of Interest" Statement: Mary-Jane is Editor of Perth Gay News, The Media Annuncio of the Perth Sisters of Perpetual Indulgence of the Abbey of the Black Swan & Editor @ HIV Institute of WA.

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Dr Ada Cheung Endocrinologist
« on: July 02, 2018, 04:38:34 PM »