Health Report number: 20180307
Security classification: In-Confidence
Quill record number: H201800755
File number: HC01-52-0-2
Action required by: 2 March 2018
Briefing on Gender Reassignment Surgery
To:
Hon Julie Anne Genter, Associate Minister of Health
Copy to:
Hon Dr David Clark, Minister of Health
Purpose
You have asked for a briefing on gender reassignment surgery, covering a number of specific points.
This briefing will address your questions one by one, providing information and commentary where
appropriate.
Recommendations
The Ministry recommends that you:
a)
note that
the appointment to Counties Manukau DHB of a consultant plastic and
reconstructive surgeon with overseas training in gender reassignment surgery
provides an opportunity to reassess the provision of gender reassignment surgery
in New Zealand.
b)
agree to meet with Ministry officials in order to discuss options for providing
Yes/No
gender reassignment surgery.
Dr Andrew Simpson
Minister’s signature:
Chief Medical Officer
Office of the Chief Medical Officer
Date:
Contacts:
Dr Andrew Simpson, Chief Medical Officer
Dr David St George, Chief Advisor, Office of the Chief Medical Officer
Page 1 of 4
Briefing on Gender Reassignment Surgery
How many, if any, surgeons in New Zealand perform sex reassignment surgery?
1.
A range of surgeries are provided to people undergoing gender transition, including mastectomy,
hysterectomy, orchidectomy (removal of testes), facial appearance surgery, breast reconstruction
surgery and genital reassignment surgery.
2.
Most of these surgeries can be provided by general gynaecologists, urologists, breast surgeons,
and plastic and reconstructive surgeons, so there are a number of surgeons in New Zealand who
are capable of performing these gender affirming procedures.
3.
The one exception is genital surgery, which is highly specialised and requires advanced specialist
training. Since the retirement of New Zealand’s only gender reassignment surgery plastic surgeon
in 2014 (see paragraph 7(a), below), there has not been a surgeon in New Zealand with the
knowledge and skills to provide this surgery.
4.
However, in January 2018, a surgeon with recent extensive overseas training in gender
reassignment surgery took up a consultant appointment as a general plastic and reconstructive
surgeon in Counties Manukau DHB. This may provide the opportunity to explore the option of
providing genital surgery in New Zealand.
What, if any, types of sex reassignment surgery are performed in New Zealand, and what, if any,
types are only performed overseas?
5.
Mastectomy, hysterectomy, orchidectomy, facial appearance surgery and breast reconstruction
surgery are performed in New Zealand. However, because of competing priorities, only a small
number of DHBs publicly fund these surgeries for transgender people. A stocktake of DHB gender
reassignment services undertaken in 2015 identified four DHBs providing these surgeries for
transgender people: Auckland, Canterbury, Capital and Coast and Counties Manukau. Less than
20 people a year receive these surgeries. (See
Appendix 1, which is a summary table of the
stocktake.)
6.
With regard to genital surgery, the Ministry began to fund these procedures in 2005 using the High
Cost Treatment Pool (HCTP). The HCTP provides funds for treatments with proven efficacy that
are not otherwise available in the public health system. It funds the provision of treatments in the
New Zealand private sector or overseas.
7.
The Ministry-funded male-to-female and female-to-male surgeries have been provided differently:
a.
With regard to male-to-female surgeries, a surgical team in the private sector in Christchurch
provided these procedures between 2005 and 2014. With the retirement of the team’s plastic
surgeon in 2014, these surgeries are now provided overseas.
b.
With regard to female-to-male surgeries, no surgeons in New Zealand have performed these
procedures, so they have been provided overseas since 2005.
If there are any sex reassignment surgeries performed overseas, does the Ministry intend to
bring these services to New Zealand?
8.
No decision has been made to develop genital surgery in New Zealand. This is complex surgery
and requires appropriate expertise and support from a skilled team. However, the appointment of
the plastic surgeon to Counties Manukau DHB provides an opportunity to reassess the provision of
gender reassignment surgery in New Zealand.
9.
The current use of the HCTP to fund genital surgery would be potentially impacted as under the
HCTP’s rules it is not to be used to fund treatments overseas when they are available in New
Zealand.
10. We would welcome a meeting with you in order to discuss options for providing gender
reassignment surgery in New Zealand.
Page 2 of 4
How many, if any, transgender individuals have been referred to endocrine services in New
Zealand in the past five years, broken down by year?
11. The Ministry does not have access to this information.
How many, if any, transgender individuals have been referred to endocrine services in New
Zealand in the past five years, broken down by DHB?
12. The Ministry does not have access to this information.
13.
Appendix 1 gives the approximate number of transgender people using particular DHB services in
a 12 month period.
What, if any, is the size of the current waiting list for male-to-female surgeries?
14. There are 75 people currently on the waiting list for male-to-female surgery.
What, if any, is the size of the current waiting list for female-to-male surgeries?
15. There are 26 people currently on the waiting list for female-to-male surgery.
How long does the Ministry anticipate it would take for everyone currently on the male-to-female
waiting list to be seen?
16. At the current rate of provision, and assuming no attrition in the waiting list, the last person on the
male-to-female waiting list would receive surgery in 50 years.
END.
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Appendix 1
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