CORPORATE OFFICE
Level 1
32 Oxford Terrace
Telephone: 0064 3 364 4160
Christchurch Central
Fax: 0064 3 364 4165
CHRISTCHURCH 8011
[email address]
19 June 2018
Gloria Fraser
Email: [FYI request #7891 email];
Dear Gloria
RE Official information request CDHB 9864
We refer to your email dated 22 May 2018 and received in our office on 23 May 2018, requesting the
following information under section 12 of the Official Information Act (the ‘Act’) from Canterbury DHB.
Could you please advise whether the following gender-affirming healthcare services are funded by the
Canterbury District Health Board for transgender patients, and whether the services are currently
available?
a. Hormone therapy
b. Mastectomy
c. Hysterectomy
d. Orchidectomy
e. Facial hair removal
f. Breast augmentation
g. Voice training
Canterbury DHB funds and provides all the above services for transgender patients on a limited basis,
except for facial hair removal.
Could you please provide information about the process of accessing those services that are
available?
a. Specifically, is an assessment by a mental health professional required in order to access gender-
affirming healthcare services? If so, which services?
b. In the case of hormone therapy, can primary health providers prescribe hormones, or does this
have to be initially approved by an endocrinologist?
c. Is any period of real life experience required to access surgery?
Canterbury DHB follows the guidelines set down by the Ministry of Health.
There are four phases of gender transition after a diagnosis of Gender Identify Disorder has been made.
Information on these phases, which can help assess a person’s readiness for gender reassignment
surgery is provided on the Ministry of Health website. (Attached as
Appendix 1 and can be found at:
https://www.health.govt.nz/our-work/preventative-health-wellness/delivering-health-services-
transgender-people/gender-reassignment-surgery;
The Canterbury Clinical Pathways guidance for clinicians (extract attached as
Appendix 2) we believe will
provide the information you require.
Please note: Clinical pathways are practice guidance written by
clinicians for clinicians and this information is not available to the general public.
However the Canterbury DHB also provides a complementary website that is available to the public
https://www.healthinfo.org.nz/ Finally, could you please advise what the process is, if transgender patients require one of the above
services, but the Canterbury District Health Board does not offer this service? Does the Canterbury
District Health Board currently fund patients to travel to other areas to access this healthcare?
No, Canterbury DHB does not currently fund patients to travel to other areas to access this healthcare.
I trust that this satisfies your interest in this matter.
Please note that this response, or an edited version of this response, may be published on the
Canterbury DHB website.
Yours sincerely
Carolyn Gullery
Executive Director
Planning, Funding & Decision Support
Gender Dysphoria
This pathway is about the suitability for hormone therapies which is managed either by the
Endocrinology Department in adults, or by the paediatric endocrinologist in children.
About gender dysphoria
Gender dysphoria is when a person, who identifies as a gender that is different from their
biological sex, experiences discomfort or distress about this discrepancy.
Gender nonconformity (or gender incongruence) refers to a person who identifies with a
gender that is different to their biological sex.
Treatment for gender dysphoria may involve psychological assessment and support, hormonal
or surgical treatment. Treatment is individualised.
Other names include: gender variance, gender incongruence, gender identity disorder, and
transgenderism.
"Trans" is often used as an umbrella term but some people may prefer to be referred to as
transsexuals, transgender people, trans people, trans woman (male becoming a female) or a
trans man (female becoming a male).
Some transsexual people do not gender identify as either male or female, but feel they are
both, or somewhere in between, and are considered "gender variant".
Check with your patient about their preferred term.
Assessment:
1. Assess history of gender non-conformity and gender dysphoria.
Obtain a history of symptoms, age of onset, whether trial of desired gender role has occurred
and for how long and supports available.
Ask about depression, anxiety, PTSD, suicidality, self-harm, and drug or alcohol dependence.
Check sexual history.
2. Discuss what treatments your patient is wishing to pursue:
Psychological treatment alone may be all that is needed.
Hormone manipulation. Assess whether the patient meets the Canterbury DHB
criteria for
endocrine manipulation through hormone treatments, which are all arranged through
secondary care.
Criteria
For adults, endocrine manipulation through hormone replacement is not undertaken lightly and
usually only performed in adults who fulfil the following 3 criteria:
Aged > 18 years.
Has clear knowledge of the risks and benefits of endocrine therapy (undertaken in secondary
care).
Has either a documented real life experience of consistently filling the desired gender role for at
least 3 months before the administration of hormones, or has a minimum of 3 months of
regular psychotherapy with the conclusion that the gender reassignment and endocrine
manipulation is appropriate.
Note: If aged 15 to 18 years, endocrine therapy may be considered on a case-by-case basis after
psychological assessment.
Gender Reassignment surgery is not currently funded by the Canterbury DHB, but there are a small
number of gender reassignment surgeries (GRS) funded overseas through the Ministry of Health High
Cost Treatment Pool.
3. Consider sexual health check and blood tests for hepatitis B, hepatitis C, HIV either through
general practice or a non-acute sexual health assessment.
4. Look at any lifestyle changes which will reduce any risks associated with hormone treatments
e.g., smoking cessation, and assessment of cardiovascular risks such as lipids, blood pressure,
and diabetes.
M
M Management:
1. Provide patient information and support.
2. If psychological treatment only is required, arrange an appointment with a psychologist with
appropriate experience in gender dysphoria.
3. Address any comorbidities such as mental health, sexual health, and drug or alcohol
dependency. For more specific general practitioner care and management, see section 1.2 of
the Gender Reassignment Health Services for Trans People within New Zealand guidelines.
Hormone manipulation:
1. For adults, refer for either psychiatric or psychological assessment
before endocrine referral.
Psychiatrists – initial assessments for approval before hormone manipulation are available
through the public health system. Ongoing counselling is not provided by the public system.
Psychologists with appropriate experience in gender dysphoria.
2. If aged between 15 and 18 years, two psychiatric or psychological assessments are desirable
before an endocrinology referral.
3. For children aged < 15 years, refer to CAF. They will refer onto paediatric endocrinologists if
appropriate for hormonal treatment to suppress puberty.
4. If a patient is accepted for hormone treatment, the Endocrinology Department or the paediatric
endocrinologist will direct treatment with appropriate interim monitoring by general practice.
5. If gender reassignment surgery is requested, an endocrinologist makes a referral to the Ministry
of Health High Cost Treatment Pool.
Request:
Consider referral to a Psychologist.
For psychiatrist assessment before hormonal manipulations, request non-acute adult specialised
mental health assessment.
For children aged < 15 years, refer to Child, Adolescent and Family Mental Health.
For adults and if aged >15 years, request endocrinology assessment if the
criteria are fulfilled and
include the psychiatric or psychological reports.
Criteria
For adults, endocrine manipulation through hormone replacement is not undertaken lightly and
usually only performed in adults who fulfil the following 3 criteria:
Aged >18 years
Has clear knowledge of the risks and benefits of endocrine therapy endocrine therapy
(undertaken in secondary care).
Has either a documented real life experience of consistently filling the desired gender role for at
least 3 months before the administration of hormones, or has a minimum of 3 months of regular
psychotherapy with the conclusion that the gender reassignment and endocrine manipulation is
appropriate.
Note: If aged 15 to 18 years, endocrine therapy may be considered on a case-by-case basis after
psychological assessment.
If sexual health check and blood tests are appropriate, but unable to be completed in general
practice, request a sexual health assessment.
Document Outline
