Gender Reassignment Media Queries with Responses: June 2017- March 2018
6 June 2017, TVNZ Breakfast, transgender
Queries around transgender
Response:
An individual meeting the eligibility criteria for gender reassignment surgery, as outlined on the
Ministry's website, can be referred by their DHB specialist to the waiting list for gender
reassignment surgery. This is for genital surgery only. Other surgeries for trans* people (e.g.,
mastectomy, hysterectomy, breast augmentation, etc) can be funded and provided by DHBs.
All genital reassignment surgery is currently undertaken overseas. At present no other surgeon
has been identified as being able to offer this type of surgery in New Zealand though the
Ministry remains in conversation with the New Zealand Association of Plastic Surgeons about
future provision of services. For this reason the operations are currently offered overseas.
The process for arranging overseas surgeries involves many steps and individual operations
can take some time. The Ministry is able to arrange surgery once it receives completed funding
applications from the relevant DHB specialists. Surgery is prioritised for patients at the top of
the surgery waiting list. There is a good explanation of the process followed for gender
reassignment on the Ministry’s websit
e (http://www.health.govt.nz/our-work/hospitals-and-
specialist-care/high-cost-treatment-pool/gender-reassignment-surgery). The process takes some time to ensure that the person wishing to undertake the surgery has a
good understanding of what the outcome will be – and recognises that the surgery is effectively
irreversible. Some steps in the process take considerable time, for instance the full physical
response to hormones may take up to 2 years of continued use – the criteria for surgery set out
that hormones must be used continuously for more than 12 months. The four phases of gender
transition after a diagnosis of Gender Identity Disorder are:
real life experience in the desired role hormones of the desired gender surgery to change
genitalia and other sexual characteristics
post-transition monitoring.
Not everyone with Gender Identity Disorder will need or want all these elements of transitioning
– for example many people do not progress to surgery. There is also a difference
between eligibility for a phase and readiness to undertake it. The most recent gender
reassignment surgery for New Zealand patients funded through the Government’s High Cost
Treatment Pool was late last year when a female to male operation undertaken in the United
States. Also either late last year or early this year corrective surgery for an earlier female to
male operation was carried out, also in the United States (I can confirm timing tomorrow).
Currently, there are 72 people wishing to have male to female gender reassignment surgery on
the Ministry waiting list. There are 21 people wishing to have female to male surgery currently
on the wait list. The Ministry funds three male to female surgeries and one male to female
operation every two years. Four male to female people are currently being processed for
surgery in order to help make up for the pause in provision in recent years.
As already stated, the process for arranging overseas surgery takes many steps and individual
operations can take considerable time.
23 August 2017, Fairfax Media, Gender Reassignment Surgery I'm profiling a trans woman for the website and wanted to check that the surgery numbers
quoted i
n this story are still accurate. It reports:
There are currently 71 people waiting for male to female surgery and 19 people waiting for
female to male surgery.
The cost of male to female surgeries is about $35,000-$40,000. For female to male it can be as
much as $180,000.
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The Ministry of Health has identified five surgeries for 2017, all of which will be conducted
overseas. This is twice the normal allocated amount.
Please let me know if there are updates to any of those figures. My deadline is midday
tomorrow.
Response: There are currently 72 people waiting for male-to-female gender reassignment surgery and 21
waiting for female-to-male surgery.
Male to female surgeries cost about $16,000 - $40,000. For female to male surgeries it can be
as much as $180,000
The Ministry funds 3 male-to-female and 1 female-to-male surgeries every two years.
18 October 2017, AUT Student, Gender identity
If I could get some answers from the Ministry around the following questions that would be
great, ideally before the end of the week.
1. How is a diagnosis of 'Gender Identity Disorder' made?
2. How do people become eligible for hormone therapy? What, if any, are the criteria they
must fulfill to be prescribed testosterone in particular?
3. Of the transgender patients the Ministry is currently working with, what percentage are
female-to-male? Has this percentage increased or decreased in recent years?
4. Is 'gender dysphoria' recognised by the Ministry as a diagnosable condition?
5. Seeing as the wait time for gender reassignment surgery can be decades, what advice
does the Ministry have for transgender individuals for whom surgery is not a viable
option? What are some non-surgical steps people can take to feel more comfortable with
their current body and appearance?
6. Does the Ministry foresee gender reassignment surgery becoming more accessible in
the future?
Response
Q: How is a diagnosis of 'Gender Identity Disorder' made?
A: Please see information on our website, in the publication 'Gender Reassignment Health
Services for Trans People in NZ' in the executive summary it states: 'Although currently
there are no New Zealand-specific guidelines, internationally accepted guidelines all
stipulate that before hormone prescribing can occur, a mental health practitioner (MHP)
must evaluate the patient and confirm a diagnosis of gender variance.' The internationally
accepted standards can be found at:
http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association
_webpage=3926How do people become eligible for hormone therapy? What, if any, are the
criteria they must fulfill to be prescribed testosterone in particular? The same NZ document
sets out options available once someone is diagnosed with Gender Identity Disorder. A
range of services are able to prescribe hormone therapy - GPs, some sexual health
services, some youth health services, and endocrinology. Each will have their own
requirements before prescribing hormone therapy, but this typically involves an overall
health check and mental health assessment. Management of individual patients is by the
specialist doctor caring for them, and it would be a good idea to talk to an endocrinologist at
any of the major DHBs. Testosterone is restricted in New Zealand and requires specialist
sign off.
Q: Of the transgender patients the Ministry is currently working with, what percentage are
female-to-male? Has this percentage increased or decreased in recent years?
A: There are currently 72 people waiting for male-to-female gender reassignment surgery
and 21 waiting for female-to-male surgery.
Male to female surgeries cost about $16,000 - $40,000. For female to male surgeries it can
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be as much as $180,000
The Ministry funds 3 male-to-female and 1 female-to-male surgeries every two years. The
proportions have remained similar over recent years (correct? - I think so)
Q: Is 'gender dysphoria' recognised by the Ministry as a diagnosable condition?
A: Gender Identity Disorder acknowledges the distress an individual can experience where
their sex and gender do not match.
Q: Seeing as the wait time for gender reassignment surgery can be decades, what advice
does the Ministry have for transgender individuals for whom surgery is not a viable option?
What are some non-surgical steps people can take to feel more comfortable with their
current body and appearance?
A: The Ministry's general advice would be similar to that it provides generally about living
healthily, eating well and exercising regularly. For the range of treatment options the
Ministry would recommend individuals see their general practitioner.
Q: Does the Ministry foresee gender reassignment surgery becoming more accessible in the
future?
A; There are no plans to change the level of surgery currently offered in New Zealand.
19 Jan 2018, Radio NZ, Transgender
tomorrow morning we are publishing a story on the attached research paper (provided by the
Science Media Centre) which shows the following
New Zealand has limited data on the number of people identifying as transgender, and
nationwide data won't be forthcoming after a gender identity question didn't make the cut for the
2018 census. Wellington researchers used data on referrals for advice on gender reassignment
to see whether there had been an increase similar to that seen overseas. Between 1990 and
2016, there were 438 people identifying as transgender referred to the Wellington clinic. They
found there was a steady increase - particularly since 2010 - and especially in people under 30-
years-old.
Please can I ask the following:
Is the Ministry satisfied with the levels of health care and support services available to people
who identify as transgender?
With this data showing the number of presentations is increasing, has/will the Ministry offer
similar increases to its health care and support services?
Also, if other statements regarding this are sent to other media, please can I be cheeky and
request them too?
Deadline: 5pm today.
trans paper.pdf
Response
District Health Boards (DHBs) are responsible for providing or funding the provision of health
services to meet the needs of this districts within the funding provided to them.
This includes health care services for transgender people (except for gender reassignment
surgery).
Gender reassignment surgery is funded by the Ministry of Health through its High-Cost
Treatment Pool.
An individual meeting the eligibility criteria for surgery, as outlined on the Ministry's website, can
be referred by their District Health Board specialist to the waiting list for gender reassignment
surgery.
More on eligibility:
https://www.health.govt.nz/our-work/preventative-health-wellness/delivering-
health-services-transgender-people/gender-reassignment-surgery
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The Ministry also has a number of resources available on its website for people who identify as
transgender and for health professionals. Those can be found here:
https://www.health.govt.nz/our-work/preventative-health-wellness/delivering-health-services-
transgender-people
23 Jan 2018, TV1 News, Gender Reassignment Surgery
I am wanting to talk to someone (off camera to start) about gender reassignment surgery. Some
things I want confirmed are:
·That there are currently no doctors in NZ that are able to perform male to female &
female to male gender reassignment surgery?
·Has NZ ever had a doctor who can perform these surgeries, and if so, when did that
person finish their post?
·If there currently is no doctor of this description, where do you send patients who need
this surgery?
·If patients are sent abroad for the surgery, what is the cost per patient? Highest cost,
lowest cost and average cost?
·How long is the waitlist for gender reassignment surgery, for both male to female &
female to male operations?
We would like to have answers by mid-morning Monday.
Reponse
A limited number of gender reassignment surgeries (GRS) are funded centrally through the
Ministry of Health. These centrally funded surgeries are specifically for genital surgeries either
male to female or female to male .There is public funding through the Ministry’s High Cost
Treatment Pool for three male to female and one female to male surgeries every two years.
Male to female surgeries cost about $16,000 - $40,000. For female to male surgeries it can be
as much as $180,000. There are currently 72 people waiting for male-to-female gender
reassignment surgery and 21 waiting for female-to-male surgery.
No GRS is currently performed in New Zealand. Since the retirement of the plastic surgeon on
the gender reassignment surgery team in 2014 there has been no one in New Zealand with the
specific expertise and training to carry out the male to female gender reassignment surgery.
Male to female surgeries will be provided overseas until a surgical team is able to carry out the
procedure in New Zealand. Female to male surgery is highly specialised surgery and has
always been carried out overseas).
It is the responsibility of the referring specialists (eg endocrinologists and psychiatrists) to find
the most appropriate surgeon to refer their patient on to.
Any other surgeries requested for GRS, such as breast reduction, hysterectomy or
orchidectomy or hormone treatment, are publicly funded procedures/treatments and are
accessed through the patients DHB of domicile.
A person’s suitability for Gender Reassignment Surgery can be assessed using the
internationally acce
pted World Professional Association for Transgender Health’s Standards of
Care. The journey towards Gender Reassignment Surgery is complex. The decision to offer surgery is
by consensus and just meeting the pre-requisites for surgery is only one part of the process and
does not necessarily mean an operation would be appropriate.
Further information on this is available on the Ministry websit
e: http://www.health.govt.nz/our-
work/hospitals-and-specialist-care/high-cost-treatment-pool/gender-reassignment-surgery The Ministry of Health is not involved in the referral of patients to specialists, this is a clinical
decision.
People often choose to self-fund their surgery overseas because of the small number of gender
reassignment surgeries publicly funded in New Zealand.
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24 Jan 2018, TVNZ, Gender Reassignment Surgery
Further to this, and after the retirement of the plastic surgeon on the gender reassignment
surgery team, are there any plans afoot to have a new specialised plastic surgeon to fill this
role?
Also – what is the cost to employ someone in this role? I want to look at the cost difference and
efficiency rates between sending people overseas for GRS, versus employing someone here in
New Zealand to do them.
Response
In New Zealand, publicly funded gender reassignment surgery has historically been provided in
the private sector, with funding through the High Cost Treatment Pool. The surgeons have not
been employed by District Health Boards.
Only male to female surgeries have been performed in New Zealand. Female to male surgeries
have always been performed overseas.
The cost of male to female gender reassignment surgery overseas is between $16,000 and
$40,000. The cost of providing that surgery in New Zealand would be at the upper end of that
price band.
The journey towards Gender Reassignment Surgery is complex. The decision to offer surgery is
by consensus and just meeting the pre-requisites for surgery is only one part of the process and
does not necessarily mean an operation would be appropriate.
Further information on this is available on the Ministry websit
e: http://www.health.govt.nz/our-
work/hospitals-and-specialist-care/high-cost-treatment-pool/gender-reassignment-surgery A person’s suitability for Gender Reassignment Surgery can be assessed using the
internationally acce
pted World Professional Association for Transgender Health’s Standards of
Care. 2 Feb 2018 Information provided to Fairfax Media on Gender Reassignment Surgery
I'm working a feature about gender reassignment surgery and have a few question for the MoH:
- How many people are currently on the waiting list for state funded male-to-female and female-
to-male surgery?
- How has that number changed over the last three years?
- How much money was spent of GRS in the last year? The last two years?
- Is it still three male-to-female and one female-to-male GRSs every two years? How was that
amount determined?
- How many Kiwis have had state funded GRS in the last year? The last five years?
- Where is the preferred location for Kiwis to be referred to for the procedure? Why? Do you
refer them to surgeons in Thailand?
- Will the Labour government be making any changes to National's policy around the
procedure? If so, what?
- A study has show
n increasing numbers of transgender people are seeking advice and support
on gender reassignment - trans advocates say that means funding should be boosted. Do
these sorts of trends make the MoH reconsider funding and options for trans-related health
services?
- Can trans people get state funded hormone therapy?
If I could get answers by the end of Monday it would be fantastic.
Response
How many people are currently on the waiting list for state funded male-to-female and
female-to-male surgery?
5
76 male-to-female, 26 female-to-male
How has that number changed over the last three years?
Numbers on Waiting List
Date
MtF
Ftm
Jan-15
56
7
Jan-16
62
13
Jan-17
68
19
Jan-18
76
26
How much money was spent of GRS in the last year? The last two years? The cost of male to female surgeries is about $35,000-$40,000. For female to male it can be as
much as $180,000.
The figures below include the cost of surgery and the cost of any postoperative complications.
Financial Year Amount ($)
2008/09
83,384
2009/10
10,272
2010/11
97,409
2011/12
53,055
2012/13
180,525
2013/14
401,343
2014/15
214,347
2015/16
65,793
2016/17
564,910
Is it still three male-to-female and one female-to-male GRSs every two years? How was
that amount determined? Yes, this is still the current rate. It is based on an estimate of demand for the surgery in 2004.
How many Kiwis have had state funded GRS in the last year? The last five years? The last cases were in 2016 (two). There have been 7 cases since 2013.
Where is the preferred location for Kiwis to be referred to for the procedure? Why? Do
you refer them to surgeons in Thailand? Where a patient is sent is a decision made by the DHB specialist, in consultation with the
patient. Patients have been sent to Belgium, London, USA and Thailand.
Will the Labour government be making any changes to National's policy around the
procedure? If so, what? Please refer this question to the Minister’s office
A study has shown increasing numbers of transgender people are seeking advice and
support on gender reassignment - trans advocates say that means funding should be
boosted. Do these sorts of trends make the MoH reconsider funding and options for
trans-related health services? See above
Can trans people get state funded hormone therapy? Yes this can be accessed through GPs and DHB specialists.
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14 Feb 2018 Fairfax Media, Gender reassignment
I also have a couple of follow up questions for you:
- To go with a 2015 theme, how many GRS cases have been funded since 2015?
- Why were only two cases funded in 2016? Shouldn't there have been three (as three cases
are meant to be funded every two years)? Are there some two year periods where less than
three surgeries have been funded? If so why? And does that mean more can be funded in the
next two year period as a carry over?
- How many people were on the waitlist in 2004, when the rate was determined due to then-
current demand? Also, how many people were on it in 2005?
Response
To go with a 2015 theme, how many GRS cases have been funded since 2015? Two cases in 2016
Why were only two cases funded in 2016? Shouldn't there have been three (as three
cases are meant to be funded every two years)? The two cases in 2016 were female to male. One was a new case from the waiting list; one was
a revision of a case previously operated on.
Are there some two year periods where less than three surgeries have been funded? If
so why? There is an under provision of around nine Male-to-Female cases if we count from 2005 to the
end of 2018. Reasons for this include:
· The previous surgeon maintained the waiting list and undertook the surgery in batches.
Four surgeries were to have been performed in 2014, but the surgeon announced his retirement
in that year so the four cases were cancelled.
· Attempts were then made by the surgeon and the New Zealand Association of Plastic
Surgeons to identify a plastic surgeon in New Zealand to provide the surgery, but these were
not successful. The male-to-female waiting list was then transferred to the Ministry, to establish
a system of sending people overseas for surgery.
· The process of sending patients overseas for surgery has taken time to establish. Eight
patients at the top of the surgery waiting list were contacted by the Ministry and referred back to
their DHB specialists for reassessment and referral overseas.
Of these:
· two eventually declined the operation;
· three are on hold because of current personal circumstances,
· one has moved DHBs and is still being processed,
· one is on an overseas waiting list,
· one will be operated on in March 2018.
And does that mean more can be funded in the next two year period as a carry over? The surgeries are funded out of the High Cost Treatment pool and there is no carry over of this
budget.
How many people were on the waitlist in 2004, when the rate was determined due to then-
current demand? Also, how many people were on it in 2005? There had been 8 male to female and 2 female to male funding applications to the Ministry
when the rate was determined.
By the end of 2005, a further 5 male to female applications and 1 female to male application had
been added.
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2 March 2018 The Wireless, Gender confirmation surgery
At the moment I'm writing a story for The Wireless about a transgender woman who travelled to
Thailand for confirmation surgery.
I talked to Dr Peter Walker last year and he told me there was no one in New Zealand anymore
who could perform the surgery to give her a vagina/vulva.
Are you able to let me know if this is still true?
Response
The Government is aware there hasn't been a New Zealand-based surgeon since 2014.
Right now we’re working with key players on progress for the transgender community here.
We might be able to develop better options for surgery, closer to home. Watch this space.
5 March 2018 Fairfax, Transgender surgery
I'm doing a story for the Sunday Star Times about NZ's new gender reassignment surgeon, Dr
Rita Yang and have a few questions I hope you can help me with:
- I understand she's at Middlemore Hospital and hasn't started performing GRS yet.
- Can you say when she might be able to start performing GRS
- What has been the hold-up?
- I understand the funding for GRS patients is still being worked out. Is that correct?
- I've been told the funding choice is between sticking with the high cost treatment pool and
having local DHBs fund people. Is this right?
- Does having her in the country mean NZ's three transgender people every two years getting
funded for surgery quota will be increased in the near future?
- If I could get these answers by the end of today it would be great.
Response
The Ministry of Health would welcome an opportunity to return to performing gender
reassignment surgery in New Zealand.
Since the retirement in 2014 of the last surgeon who could perform gender reassignment
surgery, New Zealanders, all operations have been performed overseas.
Prior to 2014, only male to female surgeries were performed in New Zealand. Female to male
surgeries have always been performed overseas.
Right now we’re working with key players on progress for the transgender community here.
We hope to be able to develop better options for surgery, closer to home in the future.
22 March 2018 Stuff, Gender reassignment surgery I was wondering if there's been any movement on the gender reassignment surgery (GRS)
front.
A spokesperson from Julie-Anne Genter's office said that an announcement was due to come
out a few weeks ago - but I don't think anything eventuated. Did I miss it?
I'm especially keen to find out if the quota for publicly funded surgery will be revised, and when
Dr Rita Yang will be able to start performing GRS.
Response
Referred to Minister Genter's office.
23 March 2018 NZ Herald, Gender reassignment surgery I've been approached by people from the trans community regarding Dr Rita Yang who has
been hired by Counties Manukau DHB. It was thought she would be the first surgeon able to
complete gender reassignment surgeries since surgeon Peter Walker retired in 2014.
However an OIA released to Amanda Ashley from Counties Manukau has said "Ms Yang has
been employed by CM Health as a Consultant (Senior Medical Officer) Plastic Surgeon, and will
not be carrying out surgeries associated with a gender assignment service."
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Can I get a response regarding:
Does the Ministry of Health have any role to play in this?
Is the Ministry actively trying to find a surgeon who can do gender confirmation surgeries in NZ?
Is there an opportunity to increase funding to decrease the wait list?
Any other relevant information is welcome.
My deadline is 4pm today.
Response:
The Ministry of Health would welcome an opportunity to return to performing gender
reassignment surgery in New Zealand.
Since the retirement in 2014 of the last surgeon who could perform gender reassignment
surgery, New Zealanders, all operations have been performed overseas.
Prior to 2014, only male to female surgeries were performed in New Zealand. Female to male
surgeries have always been performed overseas.
Right now we’re working with key players on progress for the transgender community here.
We hope to be able to develop better options for surgery, closer to home in the future.
24 March 2018 NZ Herald, Gender reassignment surgery
Further to my query yesterday the Human Rights Commission have said "We encourage the
Ministry of Health to look at diverting money used to fund overseas gender reassignment
surgeries (through the High Cost Treatment Pool) so Dr Yang could begin performing these
crucial surgeries in New Zealand as soon as possible." Can I get a response to that comment:
Is that possible?
How much would it cost to establish these surgeries in NZ?
How much does it cost for a MtF and FtM overseas and what country does it take place?
How much would those same surgeries cost in NZ?
Response:
Can I get a response to that comment: Is that possible?
Since the retirement in 2014 of the last surgeon who could perform gender reassignment
surgery, New Zealanders, all operations have been performed overseas.
Prior to 2014, only male to female surgeries were performed in New Zealand. Female to male
surgeries have always been performed overseas.
Associate Minister of Health, Julie-Anne Genter has asked the Ministry to investigate options for
performing gender reassignment surgeries in New Zealand, but this work is in a very preliminary
stage. We hope to be able to develop better options for surgery, closer to home in the future.
How much would it cost to establish these surgeries in NZ?
No costings have been undertaken for this.
How much does it cost for a MtF and FtM overseas and what country does it take place?
The cost of male to female surgeries in Thailand is between $16,000 and $24,000, depending
upon type of procedure. Where a patient is sent is a decision made by the DHB specialist, in
consultation with the patient. Patients have been sent to Belgium, London, USA and Thailand.
How much would those same surgeries cost in NZ?
Previous male to female surgeries in the private sector in Christchurch, up until the surgeon’s
retirement in 2014, cost around $35,000-$40,000. The procedure offered was equivalent to the
$24,000 procedure in Thailand. No other costings for surgeries in New Zealand are available.
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