We’re so proud of Assoc. Prof Michelle Telfer, Director Gender Service at the RCH, for having her personal story published in the latest edition of The Lancet Child and Adolescent Health. Read the story below.

Michelle Telfer is not afraid to take a stand. “One of the things that has been really important for me and my career is learning to be publicly criticised”, she explains. “When you work in trans health, you upset people by doing the right thing.” Telfer is Director of the Gender Service and head of the Department of Adolescent Medicine at the Royal Children’s Hospital (RCH) in Melbourne (VIC, Australia). Her advocacy work led to a change in Australian family law to allow transgender children to receive hormonal treatment under age 18 years. Telfer developed the first Australian Standards for the Care and Treatment of Transgender and Gender Diverse Children and Adolescents, which were published in 2018. “I knew that it might be controversial because of the changes we made from the previous guidelines”, Telfer told The Lancet
Child & Adolescent Health, “but that was the whole point—to make changes so that the guidelines were clinically relevant”.

Telfer grew up in Perth (WA, Australia) in a typical middleclass family. But other than that, her childhood was far from typical. At the age of 7, she was talent spotted by
gymnastics coach Liz Chetkovich. Telfer went on to represent Australia in many international competitions, including the Commonwealth Games and the World Gymnastics Championships, culminating in the Barcelona Olympics in 1992. “She was dependable, consistent, reliable, but also a beautiful and stylish gymnast”, comments Chetkovich, who Telfer still describes as her second mum. Despite missing around 60% of her schooling and spending up to 6 months of the year competing abroad, Telfer somehow managed to keep up with her school studies. “There was a huge amount of self-discipline and sacrifice. But I had so many wonderful experiences that really opened my eyes to the world.”

In the year running up to the 1992 Olympics, Telfer spent a lot of time with the medical team, physiotherapists, and sports psychologists to ensure that she could perform
to the best of her abilities. “We had some fascinating conversations and discussions around what medicine can do and the interesting interactions between the physicality
and psychology of gymnastics”, Telfer remembers, and it was as a result of these discussions that she began to consider a career in medicine. Much to everyone’s surprise, she decided to sit (and pass) her Year 12 exams just a few months after returning from Barcelona. After the stress and pressure of being on the Olympic team, she found studying for her exams “actually quite therapeutic”.

After completing her medical training at the University of Western Australia in her home town of Perth, Telfer felt the need to spread her wings. “I decided to apply to the RCH in Melbourne and managed to get a job as a junior resident in 2003”, she remembers. Telfer found her niche in the adolescent medical team, which fulfilled her interest in both paediatrics and child psychiatry. In 2012, after the retirement of Professor Garry Warne—a paediatric endocrinologist who had been responsible for transgender patients at the RCH since 2003—Telfer volunteered to take on his caseload. This was the beginning of the Gender Service at the RCH, which was the first—and remains the largest—transgender service in Australia. In 2012, the Service received just 18 referrals; by 2018 that number had boosted to 269. “When I first took on these patients, Garry said ‘this is going to be a relatively small aspect of your clinical practice’, but it’s actually taken over my life!” laughs Telfer.

It’s clear from speaking to Telfer that her work with transgender children has had a huge impact on her. “You feel that you are genuinely helping someone and changing the trajectory of their life just by acknowledging how they feel and empowering them to be that person”, she explains. “I find it interesting the way that the rest of society reacts to these young people. I often think that if only they met and spoke to these trans kids, they would understand.”

Telfer has always tackled the controversy surrounding her clinical and advocacy work head on: “She has had to deal with significant negativity, particularly from strangers who disagreed with the support she was giving to young people with gender dysphoria”, comments Sarah McNab, a close friend of Telfer’s and Head of General Medicine at the RCH. “While I know this affected her personally, she was undeterred in her determination to provide her patients with exceptional care that was otherwise unavailable.”

As well as her clinical work, Telfer and her colleagues have launched a longitudinal cohort study, Trans20. “It is going to be a vital contributor in [improving] the outcomes for trans and gender-diverse young people”, Telfer explains. The study will look at not only physical health but also mental health, family functioning, emotional functioning, school functioning, and quality of life over 4 years initially, although Telfer hopes to secure funding for up to 20 years.

Telfer has been delighted to see first-hand how the new Australian guidelines have been received by both the transgender and the medical communities, and how the change in the law has been so beneficial for her young patients. But a lot remains to be done to continue to change people’s perspective on gender fluidity and tackle the stigma that transgender children and adolescents face. “I am proud of her for choosing something that is going to make such a difference to people’s lives”, says Chetkovich. “She has a degree of empathy and ability to put herself into other people’s situations and to fight for those people who cannot fight for themselves.”

Rebecca Akkermans