Transgender Women in Mid-Life

Professor Jeffrey Zajac AO,  MBBS (Melb) FRACP PhD (Melb) AO

Department of Medicine, University of Melbourne at Austin Health.

Transgender individuals now make up nearly 1% of the population. Unfortunately, much of transgender medicine is not evidence based and this results in a diverse approach to management. Trans women seeking hormonal transition generally require estrogen, antiandrogens and sometimes progestogen cyproterone. Approaches to this will be discussed.

Issues to be addressed in this review include the following:

  1. Which formulations of estrogen therapy are appropriate for transwomen in the mid-life?
  2. Should estrogen therapy in transwomen mimic the menopause or menopausal hormone therapy or continue lifelong
  3. Data from a study of 390 transwomen identifying their feminizing hormone therapy regimens and cardiovascular risk factors will be discussed
  4. Cancer screening in transwomen
  5. Transition issues and cancer screening in transmen


  1. Feminizing hormone therapy prescription patterns and cardiovascular risk factors in aging transgender individuals in Australia. Brendan J Nolan… Jeffrey D. Zajac, Ada S. Cheung (In Press: Frontiers in Endocrinology, 29 June 2021)


Jeffrey Zajac is Academic Lead (Head) of the Department of Medicine, University of Melbourne at Austin Health. He is the Chairman of the Division of Medicine; Medical Director of the Medical Services Division and Director of the Department of Endocrinology at Austin Health. He is a Clinical Endocrinologist with research interests in clinical and molecular endocrinology. Professor Zajac trained in Medicine at the University of Melbourne and undertook a PhD in the Department of Medicine, Austin & Repatriation Medical Centre. Following postdoctoral work at Massachusetts General Hospital Boston, he returned to the University of Melbourne initially at Royal Melbourne Hospital and now Austin Health. His clinical research group has had a long-term major research program investigating the function of androgens and androgen withdrawal in patients with prostate cancer. He heads a molecular endocrinology group who use genetically modified mice to investigate functions of the androgen receptor. His clinical interests include general endocrinology, the use, misuse and abuse of testosterone. Professor Zajac has had a long-standing interest in transgender medicine. He has been involved in hormonal management of trans individuals for over 10 years and was instrumental, in setting up the Austin Health’s Trans and Gender Diverse in Community Health (TGDiCH) clinic.