Southern District Health Board
Dunedin Hospital
201 Great King Street
Private Bag 1921
DUNEDIN 9054
Chief Executive Officer
Phone 03-476 9456 Fax 03-476 9450
15 June 2018
Gloria Fraser
Email: [FYI request #7913 email]
Dear Ms Fraser
Re:
Official Information Act Request
I refer to your Official Information Act request received on 25 May 2018 in which you specifically
requested the following:
1) Could you please advise whether the following gender-affirming healthcare services are funded
by the Southern District Health Board for transgender patients, and whether the services are
currently available: - Hormone therapy - Mastectomy - Hysterectomy - Orchidectomy - Facial
hair removal - Breast augmentation - Voice training.
Gender- affirming services are not routinely funded, however funding is considered when a
specialist submits a funding requests for a specific patient. Southern DHB have approved
funding for individual patients for the following procedures: voice training, laparoscopic
hysterectomy and oophorectomy.
2) 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?
Services are available according to the individuals mental health needs, which may include
psychology, psychiatry inpatient admission, day programmes are therapeutic options, but
access is not solely determined by diagnosis. Not all patients treated for gender dysphoria
remain in contact with mental health services, though they may remain in contact with non-
psychiatric medical professionals if they wish to continue medical/surgical treatments for
gender dysphoria. Some patients with gender dysphoria will not be in contact with either
mental health services or with medical services.
Patients referred to the endocrinology department for consideration of hormonal therapy
must have been formally diagnosed with gender dysphoria by an appropriate health
professional. In Dunedin this is usually performed by consultants with experience in gender
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dysphoria in the psychiatry service, but occasionally by a suitably experienced clinical
psychologist. Primary care may continue hormonal therapy with the advice of an
endocrinologist, however, almost all patients with gender dysphoria commence their
hormonal treatment under the supervision of an endocrinologist. Although there is no firm
ruling on this matter it is generally accepted that patients should be living in the new gender
for approximately 2 years before being considered for irreversible surgical intervention.
3) Finally, could you please advise what the process is if transgender patients require one of the
above services, but the Southern District Health Board does not offer this service? Does the
Southern District Health Board currently fund patients to travel to other areas to access this
healthcare?
Mental Health services would refer to the appropriate physical health services within the
Southern District Health Board for any service outside of mental health. The National Travel
Assistance programme would be used if necessary.
Psychiatric services and endocrinological services have always been available for patients
with gender dysphoria. Surgery has not always been available but previously was performed
in Christchurch upon referral. This is now no longer available. Some limited surgical
interventions have recently become available in Dunedin – e.g. orchidectomy, breast
reduction surgery.
You have the right to seek an investigation and review of our decision by the Ombudsman. The
Ombudsman's Office can be contacted on 0800 802 602 or on-line at
http://www.ombudsman.parliament.nz/. Yours sincerely
Chris Fleming
Chief Executive Officer
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