Although the clinic is based at Monash Medical Centre, a large part of the patient assessment and supervision occurs in the practitioners private practices.

We provide an assessment service for patients with gender identity disorders and in particular we provide supervision and counselling for those who are suitable candidates for sex reassignment surgery.

For those patients who have gender dysphoria but are not "true" transsexuals, we also attempt to provide counselling, although this is more difficult as the clinic is extremely short of resources and it is difficult to engage these patients in treatment.

For a patient to be accepted on to our program, they need to see the clinic director, Dr. Trudy Kennedy and at least one of the other psychiatrists associated with the clinic (Dr. Herbert Bower). Psychological testing is also performed and if the patient has already commenced hormones they are also seen by our endochnologist, Dr. Anthony Hunter. We prefer patients not to have commenced hormones prior to being assessed by our clinic if possible.

If a patient is considered on our assessment to be a true transsexual who might benefit from reassignment surgery, then a minimum period of two years living full time in the chosen gender role with regular supervision by clinic members occurs. This "real life" test forms a significant part of the assessment in which we establish whether living in the chosen gender role does seem to be beneficial to the patient. It also allows any ambivalence to hopefully declare itself and be resolved and for the patient to be fully informed about the consequences of their choice prior to any surgical intervention.

During the two year period the patient has to continue on hormones and have regular endochnological checks. If they are accepted for surgery they would be referred to one of our plastic surgeons for surgical assessment. We recommended that patients take out the highest level of private health insurance possible as there is extremely limited funding for patients to be operated on in the public hospital system, even with top private cover the patient is usually out of pocket $7000 approximately (this could change at any time), as not all the surgical procedures are covered by Medicare item numbers and there are other costs which the health funds do not reimburse because they are considered of a cosmetic nature.

If patients from interstate have been seen by doctors who are known to the clinic, these reports are taken into consideration and the length of two years is all is well can quite often be reduced.

It is worth noting that people residing outside Australia e.g. New Zealand are not covered by Medicare and costs incurred would have to be met in full by the patient.

If surgical reassignment is achieved we are always keen to keep in touch with patients post- operatively and monitor their progress.

If you are requiring an assessment by the clinic, he/she should get in touch with the Clinical Secretary, Dawn Wailwork, c/- Clayton Community Mental Health Service, 270 Clayton Road, Clayton 3168 (Tel) 03 85416303. The patient needs to provide a referral letter from the doctor, a self written letter describing schooling, friends and family (this to be a short note and non medical) and two recent photographs for identification purposes only on the file.

I hope this letter covers most of the areas in which you needed information. Obviously there is much more than can be said about these complicated procedures involved in the assessment and management of gender dysphoria and I would be happy to hear from you if you want more information.