Associate Professor Ada Cheung is a clinician scientist and holds an Australian Government National Health and Medical Research Council (NHMRC) Fellowship and a Dame Kate Campbell Fellowship in the Department of Medicine (Austin Health), The University of Melbourne. She is also an endocrinologist in private practice and at Austin Health.
She currently leads a research group which aims to provide robust evidence to improve the health and wellbeing of the trans, gender diverse, and non-binary community.
How did you come to work in this area?
“About six years ago, when I was nearing completion of my PhD exploring the long-term bone and muscle effects of hormone therapy for prostate cancer, I met for lunch with my supervisor, Professor Jeffrey Zajac.
“He mentioned he was having a lot of difficulty finding doctors who were willing to see trans people. Whilst I had very little knowledge about transgender people, I was shocked to hear that doctors were refusing to see patients – it goes against the Hippocratic oath.
“Jeffrey and I then set up a small clinic nearby that assisted trans people who were seeking gender-affirming hormone therapy. I listened to hundreds of stories of mistreatment and discrimination across all aspects of life – including difficulty finding employment, secure housing and access to basic healthcare.
“One of my patients told me he tried to see a dermatologist to treat his acne. After reading the referral, the dermatologist said that the clinic ‘doesn’t see people like you’ in front of other patients in the waiting room.
“As someone who comes from an immigrant background and has experienced many instances of racial and gender-based discrimination, these injustices that trans people were facing really struck a chord with me. All people regardless of their race, religion, gender or ability deserve respect, affirmation and as Australians, “a fair go”, however this was simply not the case for trans people.
“Hearing these stories, I quickly became aware that trans people needed access to holistic care beyond just gender-affirming hormone therapy. Even for people who were able to access hormone therapy, there was very little research to guide how best to treat, or understand the long-term effects and adverse effects. Given I had the research skills to answer many of the unknowns, I set up Trans Health Research with a goal to improve the health and wellbeing of the trans community. Our research team members, half of whom are trans or non-binary themselves, seek to address knowledge gaps by working to understand the effects of gender-affirming hormone therapy, improve mental health and wellbeing, and optimise health service delivery.”
Which of the MDHS Faculty values speaks the most to you and why?
“Accountability – I think it’s really important to be accountable to the community we serve and to work with trans and gender-diverse people rather than on their behalf. It means our work remains relevant to the needs of the community and has maximum impact.”
How are you embedding the MDHS Faculty values and standards into your own work?
“Everything we do follows the ‘nothing about us without us’ principle, and I always ensure trans and gender-diverse voices are front-and-centre. Our research and advocacy are informed by a diverse community advisory group, composed of trans and gender-diverse people from various backgrounds, enabling us to address the issues affecting them most.
“For example, after identifying access to care as the leading health issue facing trans and gender-diverse people, we were able to secure Victorian State government funding for two multidisciplinary trans health clinics and a state-wide training program for health professionals. In their first year of operation, these initiatives were able to provide care to over 500 new patients and trained more than 700 health professionals.
“Our research has also demonstrated that an informed-consent approach to gender-affirming hormone therapy provides improved patient satisfaction. This involves a more consultative process which shares decision-making between the patient and the physician, rather than a top-down prescriptive approach. This work has informed national guidelines we’ve written on how to provide gender-affirming hormone therapy – hopefully improving the confidence of physicians who are seeing trans patients.
“Working with and being held accountable by the community has enabled our team to make a real impact. Seeing how we have driven policy change and delivered care and education on the ground, leading to positive flow-on effects for many more trans and gender-diverse people, is really rewarding.
“After many years of fighting for their rights, we can see that there’s much better visibility for trans and gender-diverse people now than there was even ten years ago. However, there is still a long way to go and much more work to do. I hope that our work can continue to build upon this progress by making important contributions towards reducing barriers and achieving health equity for all trans people.”
As told to Harry Wood