Social stigmatisation and discrimination, including within the health care system, is a barrier to accessing health services and contributes to adverse outcomes. Transgender people have the right to respectful health care.
General health care needs are best supported in primary care.
Services providing gender-affirming health care vary across the country and may be found in primary care, youth one-stop-shop services, sexual health and other district health board services.
Hormone therapy creates a hormone balance more like that of your affirmed gender, and affects the appearance of secondary sex characteristics like fat distribution.
Service providers who can help access hormone therapy include:
- primary health care teams
- sexual health services
- youth health services
Note that prescribing of some medications such as cyproterone and testosterone is restricted in New Zealand, and requires specialist sign off.
The process of starting hormonal therapy includes assessing readiness, from a medical and psychosocial perspective, to begin. More visits may be required for people with complex physical or mental health issues. Information needs to be provided to support an informed consent approach.
Some hormone therapy may produce irreducible changes that you’ll need to consider, such as to your fertility. You may want to investigate fertility preservation (like freezing sperm or eggs) before you start hormones.
Voice therapy can help you train your voice to achieve a more gender neutral pitch and communication style.
Gender affirming surgeries include:
- 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)
- Masculinising and feminising gender affirming genital surgery.
Availability of these surgeries (except for genital surgery) will depend upon the surgical expertise and capacity within your DHB and the clinical priority given to your surgery.
An assessment of your readiness for surgery may be required before you can be referred for consultation with a surgeon. Guidance on eligibility for all gender affirming surgery is available in the Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People, published by The World Professional Association for Transgender Health.
Gender affirming genital surgery
With regard to gender affirming genital surgery, the Ministry of Health has funded a limited number of these surgeries since 2005, 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.
Referrals for gender affirming genital surgery are generally 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 DHB may have an agreed process where a referral from a general practitioner with special expertise in transgender care can be accepted.
If you wish to be considered for this surgery you should discuss this with your transgender care specialist. If you are not currently under the care of a specialist, then you should discuss this with your GP, who can make a referral to an appropriate specialist.
Counselling and mental health services
Seeking help with a counsellor or mental health professional is a key part of managing any distress.
The experiences of stigma and discrimination can stop people from reaching out and accessing support. It is important to know that some of the uncomfortable experiences of social and medical transition are temporary – and that health professionals are available to help when you face these barriers.
If you want to know more about mental health providers, you can contact one of the following services, or check with your GP or primary care provider for a referral.
Medical and social transition encompasses many changes in our values, relationships and life choices. Finding an understanding person to share the experience with can help to get through some of the doubts, concerns and worries.
It is common to feel isolated, to feel like you are the only person who has had to face barriers or concerns. But often there are many networks and people in our everyday community who are more than willing to introduce or link others to peer support networks.
Check out the Resources page for support networks outside of the medical and mental health sector.
If you need urgent help
If there is any concern for the safety of a person or yourself, seek help and guidance from mental health services.
- Crisis assessment teams – local contact numbers for mental health emergencies
- Mental health services – helplines and other resources