HNZ00081111 Response.pdf

16 June 2025
Mr. A.H.
[FYI request #30288 email]
Tēnā koe
Your request for official information, reference: HNZ00081111
Thank you for your email on 3 March 2025, asking Health New Zealand | Te Whatu Ora for
information on gender affirming chest reconstruction (‘top surgery’) under the Official Information
Act 1982 (the OIA). Your ful request is set out in Appendix One.
Response
We have provided a response below in line with the sections you have identified in your request. I
apologise for the delay in providing our response. The time taken is not what we aspire to. This is
something we are working to get on top of as we deal with a high volume of requests and the
understandably high public interest in our work.
Section 1: Which regions under Te Whatu Ora currently provide gender affirming Chest
Reconstruction?
Counties Manukau is currently providing gender affirming Chest Reconstruction.
Section 2: I request any and all information, including but not limited to, memoranda,
reports and communications relating to resource allocation and capacity for chest
reconstruction for gender affirming care (‘top surgery’) in the Auckland region, including but
not limited to:
Total capacity for top surgeries for the foreseeable future
The total capacity for top surgeries service has limited numbers to 20 per year.
Whether or not the region is accepting new referrals
Yes (subject to the limitation noted above).
Number of people on the waitlist in the region
The number of people on the waitlist in the region is 13.
Number of referrals received each year or in a specified period of time
This data is yet to be confirmed, and further consultations are required. We wil provide this
information to you as soon as possible.
Expected estimated longest wait time for surgery
Average wait time for surgery;
The expected estimated longest wait time for surgery is 12 months after acceptance. The average
wait time for surgery is four to six months.

Summary of how patients are triaged and prioritised for these services.
Patients are triaged and prioritised for these services on clinical grounds.
Patients accessing gender affirming (non-genital) surgery (including top surgery) are prioritised
alongside other patients accessing surgery. Referred cases are prioritised in line with standard
prioritisation tools, which are ‘weighted’ towards patients with life-threatening conditions.
Consequently, where capacity and/or capability is limited, those conditions with the greatest clinical
need and which wil  benefit the most are prioritised.

Some prioritisation tools used by the districts may include the following:
• National Prioritisation Tool for plastic surgery
• Clinical Prioritisation Assessment Criteria
• ‘Readiness Assessments’ to be performed by a psychologist
These tools are provided by the Ministry of Health.
You can find further helpful information on our website here:
https:/ www.tewhatuora.govt.nz/health-services-and-programmes/providing-health-services-for-
transgender-people/updates-from-the-gender-affirming-genital-surgery-service.
Further consultations are required to identify the requested memoranda or reports within scope of
Section Two. We aim to provide this information to you as soon as possible.
Section 3: I request the following information relating to chest reconstruction for gender
affirming care (‘top surgery’) for the Auckland Region.
-If in the event patients are being declined service, when did this begin?
If in the event patients are being declined service, what is the reasoning for this? Please
provide memoranda, reports or communications relevant to the decision making process. Is
there a relevant Te Whatu Ora policy about this?
Patients began to be declined for this service in November 2024.  Patients were declined due to
capacity issues. Further consultations are required to identify the requested memoranda or reports
within scope of Section Three. We aim provide this information to you as soon as possible.
What consultation, if any, has been done with interested who may be affected by patients
being declined for top surgery? Please include any internal correspondences, including but
not limited to internal memoranda, documents and emails.
- If in the event patients are being declined service, how many referrals have been declined
since patients began being declined?
- Have or are patients whose referrals have been originally accepted, been discharged
without surgery? If so:
a. How many patients have been discharged before consultation compared to
patients discharged after consultation?
b. How many more patients are expected to be discharged without surgery?
c. Why was this action taken? Please include any internal correspondences,
including but not limited to internal memoranda, documents and emails.
- When does the region expect to reopen to new patients?
The body of work related to consultations “with interested stakeholders or members of the public
who may be affected by patients being declined for top surgery” has not been undertaken to date.
Therefore, the relevant parts of your request are refused under section 18(e) of the OIA.
If the region plans to accept new patients in the future, what plans wil  be in place to ensure
equitable, consistent, and long-lasting service provision? Please include the following
where applicable, including whether this wil  be different from what was previously in place,
and if so how:

a. Intended requirements for top surgery referral.
b. Intended requirements for undergoing top surgery.
This body of work has not been undertaken. As such your request for information about future
planning is refused under section 18(e) of the OIA.
c. How patients wil  be prioritised. E.G. if someone had been referred immediately after the
waitlist closed and therefore had been declined, wil  that person have greater priority over
people who have not previously sought referral?
I refer you to my response in section 2 ‘Summary of how patients are triaged and prioritised for
these services.’
Section 4: I request any and all information, including but not limited to, memoranda,
reports and communications, relating to policies and processes for chest reconstruction for
gender affirming care (“top surgery”) in the Auckland region including but not limited to:
Whether prospective patients seeking referral for top surgery are required to be on
testosterone hormone therapy for a minimum period of time, and if so what that minimum
period is;
Patients are required to be on testosterone for at least one year prior to referral.
Whether there is a BMI requirement for referrals and/or surgeries and if so, what that BMI
requirement is;
The BMI requirement is below 30.
- Any other requirements for a person to be referred to a top surgery waitlist, such as ‘Real
Life Experience’.
Patients must be non-smoking or vaping. Must have Readiness Assessments’ to be performed by
a psychologist.
- Any other requirements for a person to undergo top surgery.
The request for surgery is required to be supported by the gender health
team.  - Any policies regarding top surgery specifically; Any policies regarding gender affirming
surgeries which affects top surgery; Any policies regarding transgender healthcare as a
whole, especially policies which attempt to address disparities associated with the trans
community.
You will find relevant information on the Health NZ website link provided above.
Please note that in order to provide information relevant to your request for “any and all information
including communications”, Health NZ would need to divert personnel from their core duties and
allocate extra time to complete these tasks. The diversion of these resources would impair Health
NZ’s ability to carry out our other core functions. To avoid refusing this part of your request under
section 18(f) of the OIA due to the substantial collation needed, are you able to refine down the
scope of this part of the request?
I have considered whether fixing a charge for the supply of the information or extending the
timeframe for response would enable Health NZ to respond. I do not consider that either option
would remove the impact that supplying the information would have on our other operations.
I would be grateful if you could confirm by the end of the day Friday 20 June if you are wil ing to
refine the request. If we don’t hear from you, we wil  proceed with the request as it is currently
framed.

How to get in touch
If you have any questions, you can contact us at [email address].
If you are not happy with this response, you have the right to make a complaint to the
Ombudsman. Information about how to do this is available at www.ombudsman.parliament.nz or
by phoning 0800 802 602.
Nāku iti noa, nā

Danielle Coe
Manager (OIAs) – Government Services
Health New Zealand | Te Whatu Ora

Appendix One: Full request

I am seeking information on gender affirming chest reconstruction (‘top surgery’) in order to provide
our transgender community with clarity and to make  advocacy for transgender healthcare better
informed.

This request is made up of 4 sections. Please prioritise them in order from 1-4 and send each section
when it is completed.

Section 1:
Which regions under Te Whatu Ora currently provide gender affirming Chest Reconstruction?

Section 2:
I request any and all information, including but not limited to, memoranda,  reports and
communications relating to resource allocation and capacity for  chest reconstruction for
gender affirming care (‘top surgery’) in the Auckland region, including but not limited to:
- Total capacity for top surgeries for the foreseeable future;
- Whether or not the region is accepting new referrals;
- Number of people on the waitlist in the region;
- Number of referrals received each year or in a specified period of time;
- Expected estimated longest wait time for surgery;
- Average wait time for surgery;
- Summary of how patients are triaged and prioritised for these services.

Section 3:
I request the following information relating to chest reconstruction for gender affirming care
(‘top surgery’) for the Auckland Region.
- If in the event patients are being declined service, when did this begin? - If in the event
patients are being declined service, what is the reasoning  for this? Please provide
memoranda, reports or communications relevant to the decision making process. Is there a
relevant Te Whatu Ora policy about this?
- What consultation, if any, has been done with interested stakeholders or members of the
public who may be affected by patients being declined for top surgery? Please include any
internal correspondences, including but not limited to internal memoranda, documents and
emails.
- If in the event patients are being declined service, how many referrals have been declined
since patients began being declined?
-  Have or are patients whose referrals have been originally accepted, been  discharged
without surgery? If so:
a. How many patients have been discharged before consultation compared to
patients discharged after consultation?
b. How many more patients are expected to be discharged without surgery? c. Why
was this action taken? Please include any internal correspondences, including but
not limited to internal memoranda, documents and emails.
When does the region expect to reopen to new patients?
If the region plans to accept new patients in the future, what plans wil  be in place to ensure
equitable, consistent, and long-lasting service provision?
Please include the following where applicable, including whether this wil  be different from
what was previously in place, and if so how:
a. Intended requirements for top surgery referral
b. Intended requirements for undergoing top surgery
c. How patients wil  be prioritised. E.G. if someone had been referred immediately
after the waitlist closed and therefore had been declined, wil  that person have greater
priority over people who have not previously sought referral?

Section 4:

I request any and all information, including but not limited to, memoranda,  reports and
communications, relating to policies and processes for chest  reconstruction for gender
affirming care (“top surgery”) in the Auckland region including but not limited to:
Whether prospective patients seeking referral for top surgery are required  to be on
testosterone hormone therapy for a minimum period of time, and if so what that minimum
period is;
Whether there is a BMI requirement for referrals and/or surgeries and if so, what that BMI
requirement is;
Any other requirements for a person to be referred to a top surgery waitlist, such as ‘Real
Life Experience’;
Any other requirements for a person to undergo top surgery;
Any policies regarding top surgery specifically;
Any policies regarding gender affirming surgeries which affects top  surgery;  Any policies
regarding transgender healthcare as a whole, especially policies which attempt to address
disparities associated with the trans community.

TeWhatuOra.govt.nz
Health NZ, PO Box 793,
Wel ington 6140, New Zealand