HKWDA Newsletter
(March 2023)

1 / President's Message

Dr Clara Wu

Dear Members,

It is my great honour to communicate to you in my capacity as President of the Hong Kong Women Doctors Association (HKWDA). I am overwhelmed by the warm welcome that I have received from Dr Cissy Yu, all Committee Chairpersons and so many of you. Thank you very much.

HKWDA has been providing invaluable opportunities for meaningful engagement, innovative professional development and outreach activities for our members and friends since its establishment. The success of HKWDA over the years is the collective effort and dedication of our Committee members, especially during the past three years in the face of often insurmountable odds during the COVID-19 pandemic. My heartfelt thanks to Dr Cissy Yu, Dr Loraine Chow, Dr Sharon Chow, Dr Connie Ngai, Dr Rose Ting, Dr Tsoi Wai Ki, Dr Sarah Chan, Dr Angie Fong, Dr Chan Kit Sheung, Dr Wong King Ying, Dr Mandy Ng, Dr Yolanda Lee, Dr Fiona Luk, Dr Josephine Ip, Dr Amy Keung, Dr Victoria Tang, Dr Helen Hui, Dr Jenny Fong, Dr Jane Yeung, Dr Mandy Wong, Dr Fanny Yip, Dr Jenny Chan, Miss Fanny Tang, Miss Betty Au Yeung and Ms Vanessa Yim for their enthusiasm and support.

I shall, with my utmost endeavours, continue the mission of HKWDA to forge connections and maintain ties with our unique professional community. Please stay tuned for more updates on the activities and CME programmes that we have planned for you. Please do not hesitate to contact me should there be any topics that you are particularly interested in.

Thank you and wishing you and your family a healthy and prosperous 2023!

Clara

2 / Association News

Hong Kong Women Doctors Association 15th Anniversary

Multi-specialties Virtual Conference

Dr Cissy Yu (Immediate Past President)

Hong Kong Women Doctors Association was established in 2006. Over the past 16 years we have grown from strength to strength. In terms of size, our association has grown to more than a thousand members and friends. Structurally we have thirteen committees each taking up different functions of our operation. We have networked with women doctors in mainland China and worldwide, women accountants and lawyers in Hong Kong, and many local Non-government organizations to serve our community. During the past three years of COVID pandemic, we mobilized our members to support the Hong Kong government’s fight against COVID. No matter how hard the challenge is, our association never forgets our missions and objectives. At our 15th anniversary, it is worth celebrating our association’s achievements and to highlight our milestones, in a Multi-specialties Conference. Due to the requirement of social distancing during COVID time, we decided to hold the conference online.

To execute this Multi-specialties Conference, an organization committee and a scientific committee were formed. Dr Rose Ting, Dr Wong King Ying, Dr Mandy Ng, Dr Wai Ki Tsoi, Dr Fiona Luk, Miss Fanny Tang worked tirelessly to design the program, identify speakers and sponsors, publish the digital conference booklet, film the opening congratulatory video, and promote the event using social media. Ms Vanessa Yim, our HKWDA Executive Officer, also provided this event with the best administration support. I felt very privileged to work with this great team. On 25 July 2022, our core team was stationed at the control room of the virtual conference. Despite the last minute assignment, Dr Wai Ki Tsoi hosted the event in a most professional way. There were overall 9 speakers, 8 sponsors and over 400 participants from the Greater Bay Area, Philippines and Australia. Moreover, CME points were accredited to this conference by different specialty Colleges. With such a good outcome, I would like to thank all of the above people and institutions for making our 15th Anniversary Multi-specialties Conference a big success.

Ms Vanessa Yim, Dr Wai Ki Tsoi, Dr Cissy Yu, Miss Fanny Tang (left to right)

71st Annual Convention of the Philippines Medical Women’s Association (PMWA)

Dr Cissy Yu (Immediate Past President)

When I was the Western Pacific Region Vice-President of Medical Women’s International Association from 2016-2019, I visited one of the member nations, the Philippines Medical Women’s Association at Cebu. The Philippines medical women gave me a warm welcome and since then, our friendship has grown. On 11 November 2022, I was invited by the Philippines Medical Women’s Association to speak at their 71st Annual Convention. The theme of their convention was ‘New Directions, New Opportunities in Current Health Situations Affecting Women’s Health’. I was one of the speakers at the Plenary Session, and the given topic of my speech was ‘Experience in Creating Diversity and Harmony: Different Generations, Gender, Professions, and Social Class’.

I was most happy to share my Hong Kong Women Doctors Association’s experience with the PMWA. Right from our inception, we have had members from private and public sectors, from different specialties and from different generations. Since 2007, our student members have been actively engaged in our mentorship program, our microsurgical skills workshop, in cross border study tours and clinical attachments, and they have even contributed to our Information and Communications Technology Committee. We have also included non-medical and non-female persons into our organization under the category of Friends of HKWDA. Friends of HKWDA are welcome to join our community service programs and our continuous medical education activities. In the past 15 years, we have established long term working relationships with women accountants, women lawyers and NGOs in serving the grassroot and underprivileged people in Hong Kong. Our friendship with Shenzhen Medical Women’s Association and Guangdong Medical Women’s Association in the Greater Bay Area continues to grow and develop. Our linkage with the Medical Women International Association has given us a global perspective and opportunities to learn the culture, healthcare system and medical knowledge of other countries and regions. To conclude, because HKWDA has always been respectful, tolerant and inclusive, we have naturally created diversity and harmony after 16 years of continuous hard work.

3 / Community Service Update

Dr Mandy Ng

寒流中的點點燭光 - 記第五波疫情

「盼可將燭光交給我，讓我也發光芒⋯⋯」

回顧第五波疫情期間的義工服務，讓我想起了這句歌詞。誠然，香港的醫護人員在困難中表現出的守望相助精神，實在令人驕傲。

第五波疫情來得既急又猛，一下子使整個城市進入接近癱瘓的狀態。不少免疫力弱的市民病倒了，醫護人員疲於奔命地照顧，同時亦要做足防疫措施，以免自己受到感染甚至傳染給病人，壓力之大可想而知。然而在圍封強檢和家居隔離政策的實施下，有部分的醫護人員需要在家接受7至14天的隔離，無法返到醫院或診所幫忙照顧病人。這並沒有阻卻他們助人的熱情，他們找到了另一個辦法去幫忙。

在2月中旬疫情最嚴峻的時候，我收到了一些機構的查詢，希望安排一些網上舉行的醫生講座給育有幼兒的家長，讓他們在等候到醫院治療的時候能給予染病的幼兒適當的照顧。在機緣巧合下，我們找到了兩位正在家居隔離的醫生為我們進行網上講座，為過百名幼兒家長提供了及時的資訊，解答了他們心中的疑問。我在此再一次感謝醫生們和機構幹事們的努力！

在3月份的時候，我亦收到幾位私人執業的醫生會員的查詢，因疫情期間工作較輕鬆，他們希望能在工餘時間為基層市民提供幫助。很感恩，我們很快便聯絡到幾間社會服務機構為我們安排了疫苗講座、外展疫苗接種和網上醫療諮詢服務，會員們也反應熱烈，義工名額不消一天便填滿了！

此外，香港女醫生協會亦在3月份為伊利沙伯醫院急症室的同事送上防疫物資，為他們打打氣，感謝他們在疫情最嚴重的時候緊守崗位服務病人。

「盼共我，結伴去，以心中暖流...和風對抗」

我為香港的醫護人員感到自豪，感謝你們在第五波疫情期間的無私付出，為市民點亮心中的燭光，帶領他們走出逆境。

Screenshot 2023-02-28 at 12.36.56 AM.png

4 / Doctor on Duty

Interview with Dr Clara Wu

Dr Wai Ki Tsoi

Dr Clara Wu graduated from Hong Kong University in 1997. She completed her training in Emergency Medicine at Queen Mary Hospital before joining Union Hospital as a resident specialist. She is currently the Deputy Medical Director and Director of the Emergency Medicine Centre at Union Hospital, President of the Hong Kong College of Emergency Medicine, and Chief Medical Officer (CMO) of the Hong Kong Jockey Club. She became the President of HKWDA in 2022.

***

You are a seasoned and well-accomplished Emergency Medicine doctor! When did you realise Emergency Medicine was the specialty for you?

I was inspired by a combination of factors! At the time of my graduation, employment of doctors changed from permanent to contract-based, meaning a sudden reduction in job security. This drove me to look for more unique and challenging opportunities to define my career. I was attracted to the teamwork aspect of Emergency Medicine, whilst being led by passionate leaders and teachers. I must also add that I was partially inspired by a very hit television show at the time, ER!

What has your journey from junior doctor to your present day position been like?

I completed my training in Emergency Medicine at Queen Mary Hospital. For better exposure, I also rotated through internal medicine, orthopedics and intensive care. After becoming a resident specialist, I started looking at career opportunities at private hospitals, and Union Hospital caught my attention. At the time, Union Hospital was a relatively new private hospital opening up in an area with increasing demand for private health services. Over time, our Accident & Emergency (A&E) Department has evolved into the first emergency medicine training centre to be accredited by both the Department of Health and the Hong Kong College of Emergency Medicine in the private sector. This means we can provide teaching to trainees of the Hong Kong College of Emergency Medicine, as well as to medical students.

How has life as a doctor in A&E changed over the years?

Traditionally doctors in emergency medicine have had to cope with a long career of shift work and frequently unsociable hours, which would put pressure on those with strong family roles. Over time, emergency medicine work in public hospitals has improved: doctors are now offered the choice of working or training part-time. Attitudes are evolving for the better: we recognise there is a need to tailor to individual needs in order to maintain a happy workforce. We recognise that both females and males may wish for time away from work but it is important that they are well-supported so that they do not feel too disconnected from medicine to return.

As President of the Hong Kong College of Emergency Medicine, what are your hopes for the future of Emergency Medicine in Hong Kong?

We are striving for an attitude of fairness, responsibility, empathy and consideration amongst colleagues. We are looking to build a strong peer support system so that anyone can seek help when they need it and we can take turns supporting each other. With a stronger support network, hopefully doctors will have the option of extending and maintaining their career longevity with a good work-life balance.

On a lighter note, we are looking to develop emergency medicine support for more sports functions, for example horse racing and diving. Emergency medicine doctors tend to enjoy sporting and outdoor activities, and sometimes a bit of adventure and chaos!

Can you tell us a bit about your role as CMO of the Hong Kong Jockey Club?

The need for such a role emerged after the death of female jockey Willy Kan in 1999, which highlighted the lack of established trauma protocol at the time. This led to the establishment of the Prince of Wales Hospital Trauma Centre. The role of CMO is to help coordinate a Hospital Authority (HA) team of two doctors, two nurses, and St. John’s Ambulance crew members, which follows the jockeys and horses from starting gate to finish at each race organised by the Hong Kong Jockey Club. Cases of simple trauma are transferred to Union Hospital, complex trauma cases are transferred to an HA hospital. We regularly brainstorm emergency scenarios and practise drills so that everyone is better prepared in emergency situations. In recent years there has been more of a focus on COVID-related regulations.

How do you view your new role as HKWDA President?

I see women doctors as a privileged group of highly-educated individuals with access to many resources. We are therefore in a strong position to help underprivileged groups, especially after the impact on individuals and the economy of COVID. Amongst ourselves, we should strive to provide peer support for personal issues such as mental well-being, as well as professional issues such as medico-legal matters. We should also continue our support to medical students, who will become our next generation of young doctors.

5 / Medical Update

Medical Treatment for Transgender Adults

Dr Rose Zhao-Wei Ting

In Hong Kong, the number of individuals seeking for medical care for gender dysphoria is increasing. Nowadays it is not uncommon for clinicians to encounter situations like Josephine. “Gender identity” refers to a person’s sense of being a male or female. “Gender incongruence” means a person’s gender identity does not align with one's biological sex. Just like Josephine, though the gender at birth was female, Josephine’s gender identity was male. “Gender dysphoria” describes the clinical and/or functionally significant distress arising from the gender incongruence.

The transitioning to desired gender involves 3 steps: (1) social transitioning (totally reversible), (2) gender affirming hormone therapy (partially reversible) and (3) surgery (irreversible). A psychiatrist experienced in gender medicine confirms the diagnosis of gender dysphoria and assesses the need for gender affirming hormone therapy. Social transitioning means living in the gender role that is consistent with one’s gender identity. This step assists individuals and clinicians to assess the capacity to function in the preferred gender and adequacy of social, economic, and psychological support. Gender affirming hormone therapy is prescribed by endocrinologists; it aims to induce physical changes in patients to match their gender identity.

In Hong Kong, Prince of Wales Hospital is the only public hospital providing multi-disciplinary services to people with gender dysphoria. Any registered doctor in Hong Kong can refer patients to the gender clinic of the Psychiatry specialist out-patient clinic of Prince of Wales Hospital. Said patient will then receive psychiatric assessment and management, and will later be referred to the endocrinologists and surgeons for gender affirming therapy and sex reassignment surgery respectively. In the private sector, the process is similar.

Gender affirming hormone therapy for transgender men

Testosterone is the mainstay of treatment for transgender men. Options available in Hong Kong are: the 4-weekly injection (Sustanon®), the 3-monthly injection (testosterone undecanoate), and the daily testosterone gel application. The masculinizing effects of testosterone replacement are listed in Table 2. As hormonal therapy is started after puberty, height is not affected.

Table 1: Masculinizing effects of gender affirming hormone therapy in transgender males (list is not exhaustive)

Gender affirming hormone therapy for transgender women

The therapy consists of anti-androgen (to suppress endogenous androgen production) plus estrogen replacement (to lower testosterone and to raise estradiol level to normal female level). The anti-androgens can be high dose spironolactone (100-200mg/day), cyproterone (12.5-25mg/day), and occasionally GnRH agonist injection. The feminizing changes after gender affirming hormonal therapy are presented in Table 2. Serum oestradiol, testosterone and prolactin are monitored every 3 months in the first year of therapy for medication fine titration. However, the laryngeal prominence and deep voice cannot be altered by hormonal therapy; the latter can be changed to a certain degree via voice training.

Table 2: Feminizing effects of gender affirming hormone therapy in transgender females (list is not exhaustive)

Side effects and potential risks of gender affirming hormone therapy

Gender affirming hormone therapy is generally considered safe under medical supervision. It is very effective in improving gender dysphoria and quality of life. The use of oestradiol in transgender women may irreversibly impair spermatogenesis, while there is still paucity of data on the effect of testosterone therapy in transgender men on fertility. Taking these together, desire for fertility should be discussed in detail prior to gender affirming hormone therapy.

Testosterone replacement in transgender men is commonly associated with acne, high hematocrit level, androgenic alopecia and a few metabolic side effects such as hypertension, obstructive sleep apnea and dyslipidaemia. For transgender women, high dose spironolactone potentially causes hypotension and hyperkalaemia, while long-term use of cyproterone is associated with the occurrence of meningioma and hyperprolactinaemia; the latter can be exacerbated by concomitant estrogen use. The long-term use of estrogen increases thromboembolic risk. To reduce the risk, thrombogenic ethinylestradiol should be avoided.

There is still debate about the effect of gender affirming hormone therapy on bone health, cardiovascular risk and malignancy risk. Before further high-quality evidence specific to transgender population emerges, lifelong regular monitoring of the metabolic profile, screening for osteoporosis, cardiovascular disease and malignancy are necessary; frequency can be personalised according to patients’ age and medical background. Furthermore, many transgender people have concomitant mood disorders and mental stress, which require regular follow-up with mental health professionals.

Surgery for transgender people

Surgery can be considered at least one year after consistent and compliant gender affirming hormone therapy. This means oophorectomy and hysterectomy and phalloplasty in transgender men; or orchiectomy and penectomy plus neo-vagina construction in transgender women. After the sex-reassignment surgery, transgender men will still require testosterone replacement and transgender women will require estradiol replacement. They may also consider other cosmetic surgeries or other procedures, such as chest reconstruction for transgender men, laser hair removal and chondrolaryngoplasty (“tracheal shave”) in transgender women.

Previously in Hong Kong, transgender people could only change their gender after full sex-reassignment surgery is completed.

On 6th February 2023, two transgender persons won the verdict in the Court of Final Appeal that it was unconstitutional to require transgender people to undergo surgery to change their genders on Hong Kong identity cards. After the verdict was announced, the Security Bureau is seeking legal advice for follow-up action.

References:

1. Wylie C Hembree, Peggy T Cohen-Kettenis, et al. Endocrine Treatment of Gender-Dysphoric/ Gender-incongruent persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 102: 3869-3903, 2017

2. E Coleman, AE Radix et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022 Sept 6;23(Suppl 1):S1-S259.

6 / Advertisement

7 / Youth Committee Update

Dr Jenny Chan

The Youth Committee has been established as a bridge between our members and medical students. Despite the pandemic, we have resumed most of our activities.

We’ve kickstarted the year with our Mentor-Mentee Student Program, followed by our Annual Virtual Careers Talk. This year we have successfully paired 20 mentors with 77 medical students, and attracted more than 50 students in our Careers Talk in Ophthalmology, Orthopaedics, Accident & Emergency, Anaesthesia, Paediatrics and Radiology.

In October this year, we held our Microsurgical Skills Workshop where more than 30 medical students were gathered. Thanks to CUHK Ophthalmic Microsurgical Training Centre, helpful surgeons and ophthalmologists, the microsurgical skills workshop was hugely successful. After a brief intro in suturing and microsurgical skills, students were then split into two groups where they would rotate between the general suturing and microsurgical suturing stations.

Dr Gillian Siu introducing microsurgery

Microsurgical station: suture on foam pad under microscope with 10-0 nylon

General suturing station: hand-tie and instrumental tie on skin pads & bananas

“The microsurgical workshop has been a fruitful experience. When I first attempted microsurgery, I found it difficult to operate, yet very fascinating. Doctors there were willing to explain the principles thoroughly and showed us several techniques in suturing. Not only did I acquire some surgical skills in this activity, but I also got my interest in this field reinforced. This workshop was indeed a valuable learning opportunity for medical students. With the rapid development and application of microsurgery in the realm of hand, vascular and urological surgeries alike, this workshop is just in time to promote the brilliance of microsurgery and spark the interests of medical students to be a potential member of the microsurgical field.”

— Moon, participant and Youth Committee member

8 / Fellowship and Welfare Committee Update

Dr Mandy Wong

HKWDA Welfare and Fellowship Committee continues to organise different events to enrich our members’ experiences and wellbeing in different areas. During the past year, we have collaborated with the Hong Kong Trade Development Council and provided free admission, guided tours and gift coupons for our members for the Hong Kong International Jewellery Show and the Watch & Clock Fair. We have also organised the Fencing Experience Day in which our members and their family got together and explored their interest in the sport, and had an enjoyable and exciting afternoon!