14 May 2019
Gloria Fraser
Mail to: [FYI request #10074 email]
Dear Gloria Fraser
Official Information Act Request – Our Reference 2019/070 Thank you for your email received by Capital and Coast District Health Board (CCDHB) on 12 April 2019
in which, under the Official Information Act 1982, you requested information related to gender-
affirming healthcare services.
The first part of the request asks whether the following gender-affirming healthcare services are funded
by CCDHB for transgender patients, and whether the services are currently available. Please see our
answers below each.
Puberty Blockers
Puberty Blockers are prescribed by the Paediatric Endocrinologists, and a readiness assessment is
completed by Child and Adolescent Mental Health Services (CAMHS).
Hormone Therapy
Gender-affirming hormonal therapy in clients >18 years of age is commenced by the endocrine service
at CCDHB following referral from a general practitioner (GP); or is now commenced at several selected
primary care sites throughout the region, including youth one stop shop practices and tertiary
education student health practices. Patients under 16 years of age are seen by the CCDHB paediatric
endocrinology service, while clients between the ages of 16-18 may be seen by any of the above
services. Those clients who commence hormones within a DHB service are discharged back to their
primary care provider at an early stage.
Mastectomy
CCDHB service does not perform this procedure as part of gender-affirming healthcare.
Hysterectomy
The Women's Health Service offers hysterectomy to patients as part gender-affirming healthcare.
Referral is through a general practitioner and all patients need to undergo a readiness assessment prior
to being seen at the gynaecology clinic. The readiness assessment is not currently funded. Once surgery
is undertaken, patients are then discharged from the service.
Orchidectomy
There is access to this procedure through the Urology service. Referral is through a GP following a
readiness assessment. The readiness assessment is not currently funded. Once this surgery is
undertaken, patients are then discharged from the service.
Facial Hair Removal
CCDHB does not offer this procedure as part of gender affirming healthcare.
Capital & Coast DHB
| Private Bag 7902, Newtown, Wellington 6242
Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021
www.ccdhb.org.nz
| Phone: 04 385 5999
| Fax: 04 385 5856
Breast Augmentation
CCDHB does not offer this procedure as part of gender affirming healthcare.
Voice Training
The Speech Language Therapy service offers this as part of gender affirming healthcare with access
being through specialist referral.
Facial Feminization Surgery
CCDHB does not offer this procedure as part of gender affirming healthcare.
In addition, the request also asks the following questions. Please see our answers below each.
Are transgender healthcare providers under the Capital and Coast District Health Board encouraged
to follow Oliphant et al’s (2018) Guidelines for gender affirming healthcare for gender diverse and
transgender children, young people and adults in Aotearoa New Zealand? If not, which guidelines do
they follow, if any?
Prescribers of GAHT in the endocrinology service at CCDHB and selected primary care practices follow
several international guidelines that are considered to reflect best practice. Presently there is very little
high quality evidence to indicate precisely how GAHT should be prescribed and managed over a life
time. Two of the eight authors of the Olpihant et al (2018) guidelines are CCDHB health professionals
and this document was written to reflect current practices around the country. Healthcare
practitioners in CCDHB and regional primary care services are therefore encouraged to use these
guidelines to guide their practice.
Is a readiness assessment required to access gender-affirming healthcare services? (This is an
assessment of readiness for treatment from a medical and psychosocial perspective, as well as
whether the client understands the risks and benefits of treatment, and is sometimes referred to as a
‘mental health assessment’)
For patients over 18 years of age:
A readiness for hormonal therapy assessment is required prior to a meeting with an endocrinologist or
prescribing general practitioner. The assessment comprises a number of specified aspects and is
typically conducted by a mental health professional, although potentially this assessment could be
conducted by any health professional with adequate skills and experience. In Wellington this
assessment is provided for young adults and adults (16+) by a clinical psychologist working within the
endocrinology department. A clinical psychologist employed by Wairarapa District Health Board
(WaiDHB) is due to complete these for adults (18+) in the Wairarapa region, or by one of a number of
clinical psychologists working in the private sector.
For patients under 18 years of age:
A paediatric endocrinologist will assess children entering puberty for discussion on puberty blocking
hormones and manage them thereafter. The agreed protocol is that the paediatric endocrinologist will
assess the child once a clinical psychologist (CCDHB & Hutt Valley DHB) or a Psychiatrist (WaiDHB) from
the CAMHS has performed a screening assessment of mental health and supports. Thus, any referral is
discussed between and accepted by both services, and then there is a CAMHS assessment followed by a
paediatric endocrinology assessment and further treatment.
Capital & Coast DHB | Private Bag 7902, Wellington South
Wellington Hospital, Riddiford Street, Newtown, Wellington 6021
www.ccdhb.org.nz | Phone: 04 385 5999 | Fax: 04 385 5856
If a readiness assessment is required to access gender-affirming healthcare services, who carries out
this assessment? Is this assessment funded by the Capital and Coast District Health Board? Does the
assessment use an informed consent model?
As per above. The readiness assessment is provided by the 3DHBs to access medical interventions (i.e.
puberty blockers or hormone therapy, but is not yet provided to access surgical interventions. The
readiness assessment is based on recommendations as provided in Oliphant et al’s (2018) Guidelines
for gender-affirming healthcare for gender diverse and transgender children, young people and adults
in Aotearoa New Zealand, and adhering to the WPATH Soc7 guidelines, and includes an informed
consent model (as per these guidelines).
What steps is the Capital and Coast District Health Board taking to improve healthcare provision for
transgender New Zealanders?
Pathway development for primary and secondary clinicians was published on 3D Health Pathways
website December 2018
Shorter waiting times through increased clinical time to access a readiness assessment for hormone
therapy, and this service now offered for 16-17 year olds via the endocrine department
Progressing increased capacity to support the paediatric population
Process development within CCDHB to improve appropriate access to the High Cost Treatment Pool
(HCTP) list for gender reassignment surgery. Work underway to better understand the options and
process to access gender-affirming surgeries provided directly by CCDHB.
CCDHB professionals and our community partners sit together on the Wellington Sex and Gender
Diversity Working Group to discuss any current issues and work toward better outcomes for our
gender diverse population.
I hope this information addresses your query. You have a right to seek a review, under section 28(3) of
the Official Information Act, by way of a complaint to the Ombudsman, about the information that has
been provided to you.
Yours sincerely
Carey Virtue
Executive Director (Operations)
Medicine, Cancer and Community Directorate
Capital & Coast DHB | Private Bag 7902, Wellington South
Wellington Hospital, Riddiford Street, Newtown, Wellington 6021
www.ccdhb.org.nz | Phone: 04 385 5999 | Fax: 04 385 5856
