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 their transition (eg, hormone therapy and gender affirming surgery). It is important to note that not all transgender people choose to access gender affirming health care.

All health providers, both in primary and secondary health care settings, have a duty to deliver services that are respectful of transgender people. Central to this care is respect of the patient’s gender identity and expression. 

  • 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.
  • If possible, offer your patients and their whānau as much support as possible and screen for mental distress when appropriate.

Transgender people are often overrepresented in poor physical and mental 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.

Health professional resources

Guidelines for Gender Affirming Health Care 

In 2018, the Professional Association for Transgender Health Aotearoa (PATHA) endorsed the ‘Guidelines for Gender Affirming Health Care for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand’. PATHA is an interdisciplinary organisation working to promote the health, wellbeing and rights of transgender people. 

New Zealand Doctor | Rata Aotearoa article: Gender-affirming healthcare 

In 2020, New Zealand Doctor | Rata Aotearoa in partnership with the Royal New Zealand College of General Practitioners (RNZCGP) published an article on the diverse aspects of providing gender affirming healthcare for transgender and non-binary people. 

The article has been endorsed by RNZCGP and the ELearning assessment attached to the article has been approved for 1 Continuing Medical Education (CME) credit for the General Practice Educational Programme and continuing professional development purposes.

You need to be a subscriber of New Zealand Doctor and Pharmacy Today to read the article and access the ELearning assessment.

Supporting Transgender People: Online Course

Gender Minorities Aotearoa offers a free online course for people who want to build their confidence in supporting transgender people. This course is designed to increase your knowledge of issues affecting transgender people in Aotearoa. It is a 101 course and suitable for people with any level of knowledge on transgender issues.

The course takes 2-3 hours to complete and is broken into three sessions. You can stop at any time and continue later by logging in again.

Rainbow and takatāpui competence training for the mental health and addiction workforce

In 2021, InsideOUT Kōaro launched a new service to provide free rainbow and takatāpui competency training for the mental health and addiction workforce in Aotearoa. This service will make it easier for rainbow and takatāpui service users to access safe and inclusive care for mental health and addiction challenges. 

Rainbow competence training is delivered within three ‘streams’: kaupapa Māori, Pacific, and Tauiwi. The streams draw on their rich bodies of knowledge to help mental health and addiction services meet the needs of their rainbow and takatāpui service users.

Training is free to all mental health and addiction services.

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
  • masculinising chest reconstruction
  • 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. Since 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 protected].

People on the waiting list will be contacted every 12 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 twelve 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: [email protected].

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