How hormones shape our world and why endocrinologists are so important

What does your work entail and why does it matter?

I’m an endocrinologist and a researcher, which means I split my time between seeing patients in clinic and running a research program at the University of Melbourne focused on trans health. My clinical work is all about hormones, how they shape the body, and what happens when we adjust them. My research side is about generating the evidence base that didn’t exist until pretty recently. For decades, trans people were prescribed hormones with almost no long-term data to guide us. That’s finally changing, and I get to be part of the reason why.

Why does it matter? On one level, it’s simple. Trans people deserve the same quality of care everyone else gets. Evidence-based, respectful, and actually designed with them in mind, not cobbled together from studies done on cisgender populations and guessed at.

But it goes deeper than that for me. I care a lot about health equity. Everyone should get to live without barriers and everyone should have a real shot at thriving. When people can be themselves, the world just works better. Families are closer, workplaces are more creative, communities are stronger. That’s not wishful thinking, it’s what the research actually shows.

And there’s so much misunderstanding out there about trans people, about hormones, about what the science does and doesn’t say. I feel a real responsibility to push back on that. To debunk the myths, share what the evidence actually tells us, and help build a society where people are accepted for who they are. If I can shift even a small part of that conversation, that’s work worth doing.

How does it impact people’s lives?

On the clinical side, the right hormone regimen can be life-changing. People feel more at home in their bodies, their mental health often improves, relationships shift, careers open up. It’s not magic. It’s medicine doing what medicine should do.

On the research side, our work can have global impact. Every paper we publish becomes part of the evidence clinicians use to make decisions and contributes to our understanding of hormones and trans health. When our work is translated into a new program or service, or gets into clinical guidelines, it means someone is more likely to get safe, appropriate care. That ripple effect is what keeps me going.

What kind of support, care, or information can people expect from you?

Straight talk, mostly. I typically ask a lot of questions to get to know people individually. I’ll explain what we know, what we don’t know, and what the options look like for each individual person based on their unique health conditions and circumstances. Treatment decisions are personal, and my job is to help people understand the pros, cons, and options, so they can make the decision that’s right for them. I’ll also usually check blood tests to assess overall health, because hormones don’t exist in a vacuum, they interact with the rest of your body.

Who should consider seeing you, and what can they come to you for?

Anyone needing specialist input on gender-affirming hormone therapy, whether that’s starting, adjusting, troubleshooting side effects, or managing long-term. I also see people with other endocrine conditions like thyroid issues, pituitary problems, osteoporosis, hormone therapy for prostate cancer and so on. Trans people often have intersecting hormone questions that GPs feel less comfortable with, and that’s where I come in.

What motivated you to specialise in endocrinology?

Honestly? Hormones are fascinating. They’re these tiny molecules that shape pretty much everything about how we feel, think, and move through the world. I was drawn to the detective work of it, the puzzle-solving. And then once I started seeing trans patients early in my career, I realised how much unmet need there was, was alarmed at the health inequity, and how little research existed to guide us. That’s when it stopped being just interesting and started feeling urgent.

What does an appointment with you look like?

First appointments usually run about 45 minutes. We’ll talk through a person’s medical history, their individual circumstances, their goals, what they’ve tried before, and what they’re hoping for. I will usually check blood tests, and we’ll map out a plan together for the individual and their GP. Follow-ups if needed, are shorter, and focused on how things are going and what needs adjusting.

I try to keep things unhurried. Rushing a hormone consultation is how mistakes happen, and it’s also how people end up feeling like a number instead of a person.

What are some common conditions or issues people come to see you for?

I see people with all sorts of hormone conditions or people requiring hormone therapy for different reasons. In terms of gender-affirming hormone therapy specifically, there’s a huge range: people just starting out, people who’ve been on hormones for years and want to optimise, people dealing with side effects like mood changes or blood pressure issues, people worried about bone health or cardiovascular risk as they get older. I also see a lot of people wanting to understand what the research actually says versus what they’ve read online.

What’s one thing you wish more people knew about endocrinology?

Hormone levels on a blood test are only part of the picture. Two people on the exact same dose can feel completely different, have different hormone levels, and that’s not a failure of the medicine, it’s biology being messy. Good endocrinology is about treating the person in front of you, not chasing a number on a page.

What’s one myth about your practice?

That hormones are the explanation for every symptom a person has. They’re not.

Don’t get me wrong, hormones matter. They shape mood, energy, sleep, libido, body composition, bone density, cardiovascular risk, pretty much every system you can name. But when someone walks in convinced that their hormones are behind their fatigue and their anxiety and their weight gain and their brain fog and their low mood… sometimes the answer is yes, and we can fix it. Other times the hormones look fine and we need to look elsewhere. Sleep, stress, thyroid, nutrition, mental health, a dozen other things that hormones get the blame for.

Part of my job is untangling that. Working out what’s actually a hormone problem, what’s wearing the costume of a hormone problem, and what needs a completely different kind of help. It’s detective work, and jumping straight to “let’s just tweak the dose” without asking the bigger questions usually doesn’t get anyone where they want to go.

Health Care Navigation

How can someone access your services?

As my research program has grown over time, I have decreased my clinical time seeing patients so I actually only treat patients one day a week. People usually start with a consultation with their GP and their GP will refer to me if they feel it is needed. If a trans person is not sure where to start, resources such as AusPATH service providers list, transhub.org.au or community organisations are great places to start. Many other options exist for endocrinology, in public clinics with no out-of-pocket costs or other private clinics as well.

What kind of costs can they expect? And what are some alternatives?

Private appointments with a specialist endocrinologist have out-of-pocket costs. There is a Medicare rebate, but there’s usually a gap. Public clinics are free but have waiting lists. For alternatives, a lot of GPs now offer gender-affirming care under an informed consent model, which means you don’t necessarily need a specialist to start or maintain hormones. That’s often the most accessible and affordable path. Equinox Gender Diverse Health Centre in Melbourne is a great example. I’d encourage people to see a specialist endocrinologist if things are complicated, like if you’ve got other health conditions or if standard approaches aren’t working, but for many people a knowledgeable GP is plenty.

What are some challenges you think our community faces when accessing care?

A lot of trans people have had very variable experiences in healthcare, from great to sometimes terrible experiences including misgendering to outright refusal of care. A lot of work and training is needed in healthcare to ensure that everyone can access safe and affirming care, when and where they need it.

How do you approach building trust with patients and providing a space that is safe and non-judgmental?

I listen first. Try to stay open. Everyone walks in with their own story, their own reasons for being there, and their own sense of what they need. People usually know their bodies and their goals better than I do, and my job is to bring the medical knowledge to the table, not to decide what’s right for them. The basics matter. Explaining processes, why I’m asking a question or why I’m examining them, using names and pronouns. I also try to be straight about what the evidence shows and where the gaps are, what we’re still working out, and ultimately based on all the information we have available for the individual, making decisions together.