Delivering health services to transgender people

Advice for health professionals

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General advice

Transgender people have both general health needs (eg, oncology, chronic conditions, sexual health screening, influenza immunisations) and specific health needs that relate to transition (eg, endocrine, surgical).

All health providers, both in community and hospital settings, have a duty to deliver services that are respectful of our transgender community.

  • Use the patient’s correct pronouns (he/him, she/her, they/them, etc) and preferred name. If you are not sure how your patient wishes to be addressed, politely ask.
  • Being aware of local support services, groups, resources and relevant referral pathways for transgender people.
  • Don’t confuse being transgender with sexual orientation. Gender is about who we are and how we fit in the world. Transgender people can be heterosexual, lesbian, gay, bisexual, asexual, takatāpui, queer or one of many other words available.
  • Understand that there is a growing recognition of gender as fluid, or as a spectrum. Not all transgender people want to ‘achieve’ or ‘pass’ as the opposite gender to what they were assigned at birth. Many people are comfortable in a space between masculine and feminine, and this is not a reason to withhold gender-affirming treatments.

Transgender people are often over represented in poor health outcomes. Few of these poor outcomes are caused by a transgender identity itself, but rather by discrimination from whānau, health services and those in wider society.

The distress caused by the mismatch of sex assigned at birth and gender identity (often termed gender dysphoria) can be effectively reduced when access to timely, gender-affirming health care is available.

Referring for gender affirming surgery  

Gender affirming health care, including surgical procedures such as those listed below, are the responsibility of DHBs. Patients seeking these procedures should be referred to their local DHB provider:

  • feminising breast augmentation for trans women
  • masculinising chest reconstruction for trans men
  • hysterectomy (removal of the uterus)
  • salpingo-oophorectomy (removal of ovaries and fallopian tubes)
  • orchidectomy (removal of testicles)
  • facial feminisation
  • laryngeal shave (reducing the size of the Adam’s apple).

Referring for masculinising or feminising gender affirming genital surgery

The Ministry of Health has funded a limited number of these surgeries through its High Cost Treatment Pool. From 2019 gender affirming genital surgery can be publicly funded and provided in New Zealand in the private sector.  

People who have been referred for gender affirming genital surgery are on a waiting list to see a surgeon who can discuss surgery options. There is currently a long waiting list. 

New referrals for gender affirming genital surgery should be made by the DHB specialist who has been providing transgender health care for a person. This is normally an endocrinologist or a sexual health physician. In some cases a referral from a general practitioner with special expertise in transgender care can be accepted. 

To be considered for surgical assessment, patients need to:

Referrals should be made on the Gender Affirming (Genital) Surgery Service referral form (available below), with relevant clinical reports attached.

Referrals can be sent to email: gender.surgery@health.govt.nz.

People on the waiting list will be contacted every six months to update their contact details and health status. 

Gender affirming (genital) surgery service forms

Referrals for gender affirming genital surgery should be from a DHB specialist on this referral form. 

People on the waiting list will be contacted every six months and asked to complete this form. 

People who are on the waiting list and who are getting close to the 'top of the list' will be sent this form to complete. 

Queries can be sent to email: gender.surgery@health.govt.nz.

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