20 June 2018
P Lamborn
Email:[FYI request #7904 email]
Dear P Lamborn
Official Information Act Request – Our Reference 2018/102
Thank you for your e-mail received by Capital and Coast District Health Board (CCDHB) on 23 May 2018,
in which under the Official Information Act 1982 you requested CCDHB to confirm whether the
following quote from a series of documents released by the Ministry of Health which included notes
from a meeting of clinicians held on 30 April 2003, was an accurate assessment of the situation in
regard to the provision of Gender Dysphoria Services in the Capital and Coast area at the time. The
quote reads:
"There are 4 endocrinologists [at Capital Coast Health] providing some service to around 48 patients,
psychiatry/psychology has varied over the years with currently 2 psychiatrists giving an initial or surgical
appraisal, surgery available is orchidectomy, hysterectomy, and masectomy."
In regard to the volume of patients having been seen by the endocrinology service at that time.
The Business Information Unit (BIA) at CCDHB has been able to identify that in 2003 there were 862
patient seen in the endocrine department. Of those 862, 22 had been identified as ‘Transgender or
Transexual’. It is possible that there were some other patients who were awaiting assessment for
gender dysphoria that were classified differently.
Secondly you asked CCDHB to provide the number of psychologists, psychiatrists, endocrinologists, and
other professionals currently working within CCDHB in this area, and an outline of how this has changed
since 2003.
Currently there are 6 endocrinologists at CCDHB that see adult transgender patients, whereas up until
3-4 years ago, almost all patients were seen by one endocrinologist. The focus is on hormonal
treatment and discharge back to primary care as soon as treatment is established. Typically this might
only mean 2 or 3 appointments in the service as opposed to the older model of maintaining longer term
follow up, and being involved in pathways and decisions around surgery. The process for consideration
for surgery is now by direct referral by the patient’s primary care provider to the relevant surgical
specialty.
A readiness for hormonal therapy assessment is required prior to a meeting with an endocrinologist.
This aligns with most guidelines and the practice of international expert centres. 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. As noted above previously all patients were assessed by a single endocrinologist.
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 to the above there are 2 paediatricians who see children entering puberty and one
pediatrician who sees pre pubertal children for discussion on puberty blocking hormones. The agreed
protocol is that they will assess once a clinician from the Child and Adolescent Mental Health Service
(CAMHS) has performed a screening assessment.
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
