20 June 2018
Via FYI.Org website
E-mail: [email address]
Dear Ms Fraser, Official Information Act (1982) Request
I write in response to your Official Information Act request, dated 23 May 2018. You requested
information on Gender-Affirming healthcare services in Counties Manukau:
For context, Counties Manukau District Health Board is committed to improving the health outcomes
for all people in our community. We regard gender as a self-identified attribute, and only relevant if it
affects clinical treatment. We acknowledge that our gender-diverse communities have both general
health needs (e.g., chronic conditions, mental health and primary care needs), and have specific health
needs that relate to gender identity and transition (e.g., hormonal, surgical). All health providers have a
duty to deliver services that are respectful to our entire community.
Regarding specialist gender-affirming health services available for the Counties Manukau community,
these are provided via the Northern Region Transgender Health Services,
which is a collective name for
a number of services that work together to provide gender-affirming healthcare for transgender and
gender-diverse people in the Auckland and Northland region. 1. Could you please advise whether the following gender-affirming healthcare services are funded
by the Counties Manukau District Health Board for transgender patients, and whether the services
are currently available:
• Hormone therapy
• Facial hair removal
• Breast augmentation
• Voice training
Publicly available information on the Northern Region Transgender Health Services
(NRTHS) service, and
which may answer many of your questions can be accessed on our HealthPoint website at the following
Counties Manukau District Health Board
19 Lambie Drive, Manukau, Auckland 2104 | Private Bag 94052, Manukau, Auckland 2241
T: 09 276 0000 | cmdhb.org.nz
Please refer to the NRTHS services link (above) for information on the available services including current
information on the levels of provision of the procedures you have listed, and availability of a range of
other supportive services and resources. This includes hormone therapy, nursing, medical, psychology
and counselling services.
A small number of surgical procedures have been completed as part of general elective services in the
last three years, primarily for upper body plastic surgery. Counties Manukau does not allocate specific
funding for surgical interventions for gender reassignment procedures, and referred cases are assessed
and managed in line with our standard elective surgery prioritisation criteria. 2. Could you please provide information about the process of accessing those services that are
a. Specifically, is an assessment by a mental health professional required in order to access
gender-affirming healthcare services? If so, which services?
Please refer to the NRTHS services link on Healthpoint (above) for information on processes to access
services, including service referral expectations, information on consent and other services available.
Referrals to NRTHS can be made directly by a primary care team (e.g. GP, practice nurse), other health
services (for example by Mental Health and Endocrinology), or by school-based health teams (e.g. School
Counsellor or Nurse). The NRTHS also accepts self-referrals or referrals from family members.
The team works with service users to establish health goals and individualised health plans that may
include accessing other Specialist health procedures, services and teams.
The NRTHS clinicians support primary care health teams to provide on-going supportive services, and
link service users to other community networks and NGO providers who have particular expertise in this
area. When assessed as required, referral to a mental health professional will occur, either in primary
care or specialist mental health services.
Referrals for surgery may be sent by primary care referrers or Specialists to the relevant clinical service.
All referrals for elective surgery are assessed against standard elective processes and criteria.
b. In the case of hormone therapy, can primary health providers prescribe hormones, or does
this have to be initially approved by an endocrinologist?
We note that the prescribing of some hormonal medications is restricted in New Zealand and requires
a Medical Specialist authorisation.
Within the NRTHS, the process of starting hormonal therapy includes a multi-disciplinary assessment
process, including assessing readiness for hormones from a medical and psychosocial perspective.
General Practitioners may provide maintenance treatment, including some prescribing with specialist
oversight and review.
c. Is any period of real life experience required to access surgery?
For all surgery, excluding genital gender-affirming surgery, real-life experience is not required.
Please refer to the ‘Gender Reassignment Surgery’ page on the Ministry of Health website, for the
agreed current New Zealand clinical practice:
The journey towards gender reassignment surgery is complex. Suitability for gender reassignment
surgery can be assessed using the internationally accepted World Professional Association for
Transgender Health Standards of Care.
These Standards are minimum requirements, and therefore it is also important to be mindful of other
factors not related to gender identity that may preclude surgery (for example, a co-existing medical
conditions or surgical risk).
Gender reassignment surgery is a complex area of health service delivery, both technically and in
capacity terms. For upper body procedures, gender reassignment services can only be provided when
capacity and funding allows. Our surgical and plastics teams strive to provide services within the limits
of a capacity and funding constrained public hospital environment.
Access to and funding for Gender Reassignment procedures is managed by the Ministry of Health.
Currently, a limited amount of funding is available nationally for treatment that is not available in New
Zealand, and needs to be accessed overseas. Funding is accessed via the Special high cost treatment
We also note the information on the ‘Transgender New Zealanders’ page on the Ministry of Health
website as the most current detail on services availability in New Zealand:
3. Finally, could you please advise what the process is if transgender patients require one of the
above services, but the Counties Manukau District Health Board does not offer this service?
a. Does the Counties Manukau District Health Board currently fund patients to travel to other
areas to access this healthcare?
Services provided for Counties Manukau are provided within the Auckland region; with access to
available services for the transgender community is by a referral to the NRTHS as outlined above.
Counties Manukau Health contributes to the funding of these services. If patients meet the criteria for
the National Travel Assistance (NTA) policy to access services, this will be provided.
Please also refer to the Ministry of Health website for more information on these services:
I trust this information satisfactorily answers your query. If you are not satisfied with this response you
are entitled to seek a review of the response by the Ombudsman under section 28(3) of the Official
Please note that this response or an edited version of this may be published on the Counties Manukau
Gloria Johnson Chief Executive (Acting)