29 June 2018
Gloria Fraser
mailto:[FYI request #7892 email]
Dear Gloria Fraser
Official Information Act Request – Our Reference 2018/101
Thank you for your e-mail received by Capital and Coast District Health Board (CCDHB) on 22 May 2018,
in which under the Official Information Act 1982 you requested information regarding gender-affirming
healthcare services.
Your 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 responses under
each.
Hormone therapy This service is available from the endocrine service at CCDHB, or the paediatric service for those
patients under 18 years of age, for patients referred from primary care.
Mastectomy
The General Surgery service does not perform this procedure as part of gender affirming healthcare.
Hysterectomy
The Women's Health Service offers hysterectomy to patients as part of gender affirming healthcare.
Referral is through a general practitioner or the Endocrine clinic and all patients need to undergo
psychological testing prior to being seen at the gynaecology clinic. 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 the CCDHB
Psychology service. 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.
Breast augmentation
CCDHB does not offer this procedure as part of gender affirming healthcare. CCDHB has three breast
surgeons but none are trained in gender reassignment surgery.
Voice training
The Speech Language Therapy offers this service as part of gender affirming healthcare with access
being through specialist referral.
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
In addition you asked the following questions:
Specifically, is an assessment by a mental health professional required in order to access gender-
affirming healthcare services? If so, which services?
For patients over 18 years of age:
A readiness for hormonal therapy assessment is required prior to a meeting with an endocrinologist.
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 by a clinical psychologist
working within the Endocrinology department, 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 clinician from the Child and Adolescent Mental Health Service (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.
In the case of hormone therapy, can primary health providers prescribe hormones, or does this have
to be initially approved by an endocrinologist?
There are presently no primary care practices commencing hormonal therapy in the Greater Wellington
region and therefore all hormone therapy is commenced by an endocrinologist. However, most of the
medications used in this context can be prescribed by any medical doctor, with the exception of some
forms of testosterone and cyproterone, both of which require endorsement from an endocrinologist.
The endocrinology department at Wellington hospital believes that the majority of people wishing to
commence hormone therapy could do so in primary care, with only a small number requiring specialist
input from an endocrinologist. Again, this aligns with international trends and best practice.
Accordingly, there is ongoing work to facilitate this at the major regional referrers to our service,
focussing on Youth practices and tertiary student practices.
Is any period of real life experience required to access surgery?
There is no strict criteria that governs the access for surgery other than assessment by one of the
mental health professionals as identified above.
Finally, could you please advise what the process is if transgender patients require one of the above
services, but the Capital & Coast District Health Board does not offer this service? Does the Capital &
Coast District Health Board currently fund patients to travel to other areas to access this healthcare?
CCDHB does not fund patients to travel to other areas to access gender-affirming healthcare.
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
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
