Gender-affirming healthcare

When we say ‘gender-affirming healthcare’, we’re talking about medical interventions that people access to affirm their gender. For many trans and non-binary people, this healthcare is medically necessary and can be life saving.

Depending on people’s individual needs and transition goals, gender-affirming healthcare can include counselling, hair removal, voice therapy, puberty blockers, hormones and surgeries.

We advocate for wider access to gender-affirming healthcare that is:

• guided by the principle of mana motuhake - respecting trans people’s autonomy over their own bodies and wellbeing.

• based on informed consent - that is, enabling trans people to make their own supported decisions with their doctors, consistent with their self-determined gender goals, given clear information about the known risks and benefits of any medical treatment.

• depathologised - based on the core understanding that transgender identities, bodies and lives are not expressions of illness or disorder.

• holistic and supportive of broader understandings of what supports a person’s wellbeing, such as those described by Te Whare Tapa Whā (which encompasses the health of people’s tinana (body), hinengaro (mind), whānau (family and social connections) and wairua (spirit and sense of purpose and belonging) as well as their connections with whenua (land or environment)).

• developed and led by and with trans communities - informed by lived experience at every level of decision making.

• in solidarity with intersex healthcare needs and aspirations - recognising shared issues such as bodily autonomy, as well as differences.

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For decision makers, policy writers and advocates

If you’re advocating for wider access to gender-affirming healthcare, or developing policies or plans to support gender-affirming healthcare services, these resources will help you understand the issues and needs:

• PATHA’s Vision for Transgender Healthcare Under the 2022 Health Reforms (summarised in the NZ Medical Journal) sets out a vision for transgender healthcare in the context of the current health reforms.

• PATHA’s Transgender Health: Briefing to the Incoming Minister of Health 2023 describes current concerns about trans health in Aotearoa, and gives five recommendations for action (see also their 2020 briefing).

• An Update for the Provision of Gender-Affirming Healthcare across the District Health Boards of Aotearoa New Zealand - a 2021 survey by Dr Jeannie Oliphant outlining what gender-affirming services are provided in each DHB.

• Counting Ourselves - a comprehensive national survey of the health and wellbeing of trans and non-binary people living in Aotearoa New Zealand.

  • The Community Report shares an overview of key findings and recommendations about trans health and gender-affirming healthcare.

  • A journal article that reinforces the need for gender-affirming healthcare: Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand

• The Identify survey (looking at the experiences of rainbow young people aged between 14 and 26) includes data about young people’s use of gender-affirming medications in its community and advocacy report.

• Manalagi (which surveyed Pacific Rainbow LGBTQIA+ MVPFAFF+ people in Aotearoa) includes data about awareness or and access to gender-affirming healthcare in its community report.

• The Youth’19 study includes population data for trans and gender-diverse secondary school students. Some results are shared in their transgender brief and the report Negotiating Multiple Identities: Intersecting Identities among Māori, Pacific, Rainbow and Disabled Young People.

• Our submissions to Pharmac share some of our perspectives on equitable access to medications:

  • submission on proposals to widen access to progesterone and antiretrovirals (note: Pharmac’s final decisions on these proposals about progesterone and PEP/PrEP acknowledged equity issues for transgender people).

  • submission on proposal to fund testosterone gel (Pharmac’s decision about testosterone gel acknowledged the benefits of expanding choice for people requiring gender affirming therapy)

  • submission on proposal to fund oestradiol gel (the proposal was approved)

• Our previous webinars on transgender wellbeing and advocacy:

  • Trans and Intersex Health: Community Support and Patient Centred Care

  • From Awareness to Action: advice for advocates and champions about working on trans inclusion beyond Transgender Week of Awareness

  • More Than a Law Change: a conversation about gender identity conversion practices with Counting Ourselves

  • Bodily autonomy - intersex and trans conversations - a discussion about what bodily autonomy and self-determination can mean for intersex and trans people.

You can also get in touch with us for advice.

For healthcare providers

Gender-affirming healthcare is not just for specialists - everyone in the health system has a role to play in improving services. In particular, we want GPs and primary care clinicians to feel confident discussing gender-affirming healthcare with patients, providing access to hormone therapy and making referrals to other relevant services.

• Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa New Zealand is the national guideline for gender-affirming healthcare, based on the framework of Te Whare Tapa Whā.

• PATHA (the Professional Association for Transgender Health Aotearoa) is an interdisciplinary professional organisation working to promote the health, wellbeing and rights of transgender people. You can become a PATHA member if you work join professionally for transgender health, including in unpaid roles. PATHA holds a biannual symposium on trans health - recordings of past symposium presentations are online.

• The Ministry of Health has official advice about providing health services for transgender people.

• Watch recordings of our webinars:

  • Trans and Intersex Health: Community Support and Patient Centred Care - a series of two webinars we ran with Intersex Aotearoa, looking at work respectfully with trans and intersex people in healthcare settings.

  • A Conversation about Trans Health and Primary Care is a webinar series we ran in June-July 2022 with colleagues from Gender Minorities Aotearoa, the Professional Association for Transgender Health Aotearoa (PATHA) and Counting Ourselves.

  • Human Interactions: two webinars about working with patient management software and lab testing systems in ways that respect the self-determination and autonomy of trans people.

  • Bodily autonomy - intersex and trans conversations is a discussion about what bodily autonomy and self-determination can mean for intersex and trans people.

• These short videos, that we helped to develop for University of Otago medical students, share tips about how doctors can improve their practice:

  • Informed consent for health professionals providing gender affirming health care

  • Tips for engaging with transgender patients and creating a welcoming practice

  • What can you do as a medical student?

• Supporting Transgender People is an online course developed by Gender Minorities Aotearoa. They have a range of other resources for healthcare providers including their short video informed consent 101, an introduction to the concept of ‘informed consent’ models of healthcare.

• Supporting Aotearoa’s Rainbow People: Practical Guide for Mental Health Professionals was developed as a guide for the mental health sector, but is a good introduction to trans and rainbow identities and experiences.

• The Counting Ourselves Community Report shares an overview of key research findings on the health and wellbeing of trans and non-binary people living in Aotearoa. It’s worth reading to understand more about community needs for gender-affirming healthcare, and how gaps in access affect people.

• Takatāpui: Part of the Whānau shares stories and information about takatāpui identity, wellbeing and suicide prevention.

If you’re thinking about how to improve your service’s responsiveness, our evaluate tool is a great place to start.

For people accessing gender-affirming healthcare

If you’re looking to access gender-affirming healthcare, or you’re supporting someone, these are places where you can find direct support:

• Gender Minorities Aotearoa is a nationwide organisation, which is run by and for transgender people. It offers one-to-one peer support and information nationwide, including information about gender-affirming healthcare. It runs The Gender Centre in Wellington, and provides online support to people across Aotearoa including through its Facebook group Transgender & Intersex NZ.

• In Auckland and Northland, RainbowYOUTH and OutLine run a Transgender Peer Support Service that provides support and information, including about gender-affirming healthcare.

• Te Whatu Ora has a website section about healthcare for transgender New Zealanders. Other information about publically-funded health services includes:

  • the Gender Affirming (Genital) Surgery Service (run nationally)

  • Northland and Auckland: Hauora Tāhine - Pathways to Transgender Healthcare Services - information about accessing gender-affirming healthcare in the Northern areas (previously Northland, Waitematā, Auckland, Counties Manukau DHBs)

  • Waikato: Hamilton Sexual Health is a point of access for gender-affirming care in the Waikato.

  • Wellington: Gender Affirming Services for the Capital, Coast and Hutt Valley region; Mauri Ora services for students at Victoria University of Wellington.

  • Hawkes Bay: Tamatea Medical Centre has a gender-affirming healthcare service for people across Hawkes Bay

  • Christchurch & Canterbury: Gender-affirming health services in Canterbury (part of a wider information hub on Healthinfo Canterbury/Waitaha about gender identity)

  • Gender Minorities Aotearoa’s national transgender health directory

• Information about puberty blockers - three information sheets for families and whānau.

• TransHub is a comprehensive resource guide for transgender and gender diverse people, written by trans people. It is based in Australia, so links to specific health services won’t be relevant here, but it includes helpful information on many relevant topics.

• If you just want to talk to someone, OutLine provides a free nationwide peer support service for trans and other rainbow people (free call 0800 OUTLINE (0800 688 5463) or access online chat any evening between 6pm and 9pm to talk to a trained volunteer).