Dr Ada Cheung, a consultant endocrinologist and researcher at Melbourne’s Austin Hospital, has recently been awarded a grant to investigate the effects of cross-sex hormone therapy on the bones of transgender individuals. She tells us about her work which she hopes will ultimately improve the quality of healthcare for trans and gender diverse individuals. 

Can you describe the aim of your research in 10 words?

To advance healthcare for trans and gender diverse individuals.

What do you know/have discovered about this topic so far?

Cross-sex hormone therapy for gender dysphoria is used to alleviate distress and allows an individual to transition to their desired gender. It can significantly improve quality of life, psychological distress and suicide rates in the large majority of patients. Transgender individuals also offer a unique model to understand the effects of testosterone and oestrogen on the body. Despite cross-sex hormone treatments being prescribed indefinitely, there is very little research on the long-term effects, particularly on bone health and osteoporosis.

This makes it difficult to provide evidence based care. Given the importance of testosterone and oestrogen in maintaining bone mass, we hypothesise that cross-sex hormone therapy will have deleterious effects on bone microstructure in both male-to-female individuals and female-to-male individuals. Understanding bone microstructure in transgender individuals may provide impetus to increase monitoring and optimisation of bone health, or if the hypotheses are not supported, provide evidence to limit potentially unnecessary investigations.

What aspect of this research excites you the most?

The decision from Austin Medical Research Foundation to offer their largest grant to support a project about transgender individuals for the first time is in itself a huge advance and provides important recognition. We are so grateful. This grant is going to enable us to kickstart this research program, to gather pilot data and investigate the biological actions of testosterone and oestrogen on bone, whilst also being able to provide information to inform healthcare of trans and gender diverse individuals undergoing cross-sex hormone therapy.

What’s your Holy Grail – the one thing you’d like to achieve in your research?

To improve access to, and the quality of healthcare for trans and gender diverse individuals, and to reduce the attempted suicide rate from 40% to zero (or at least on par with the general population).

What has been/will be your biggest hurdle?

Lack of acceptance and discrimination – also known as transphobia – occurs in the community, but also amongst health professionals, often stemming from a lack of understanding and awareness. This is the biggest hurdle. Identifying as trans or gender diverse is a biological and not a lifestyle choice. Open-mindedness can make a world of difference.

How long before your work impacts patient care?

To produce good quality research takes a long time. We are just at the beginning!

Who has inspired you and why?

• My patients inspire me. The challenges they face, their strength and persistence in adversity. They know much more than I do.

• I’ve also been so inspired by Daniel Flynn, the founder of the Thankyou group. He has an incredible story of perseverance and determination to turn an idea into reality. He inspired me to challenge the way things are done. No matter the circumstances, everyone has the power to change stuff, one small step at a time.

• Most of all, my children inspire me. This may sound idealistic, but I really want them to grow up in a world where diversity is celebrated and where they are accepted, regardless of gender, race, sexuality, religion or beliefs, provided that they are not causing any harm to others.

If you could only keep three possessions, what would they be?

My iPhone, my bike, and my coffee cup. I couldn’t get around without them.