‘Health Pathway’ is a generic term referring to the pathway from first contact with a health care provider – usually a GP – through the health care system to meet a patient’s medical needs.
For irawhiti takatāpui, transgender, and intersex people whose health needs may include puberty blockers, hormone replacement therapies, affirmation or transition related surgeries, and other medical treatments, the pathways are often unclear – even to health care providers.
Read our Health Pathways 101 to find out what GMA recommends that health pathways should look like, and click the buttons below for more information.
How health pathways should function
Gender affirming healthcare should ideally be primary health led, with all GPs competent to prescribe hormone treatments and make referrals for surgeries. This should be complemented by gender affirming healthcare being available through sexual and reproductive health clinics.
All DHBs should provide gender affirming surgical interventions, and Genital Reconstruction Surgeries should be adequately funded to meet the need – clearing the waiting list and ensuring a future wait time of less than 6 months.
GMA affirms that binders are medical aides/prosthetics which should be provided by DHBs or centrally through the Ministry of Health.
GMA affirms that permanent facial hair removal by electrolysis, laser, or IPL is an essential medical treatment and should be provided by DHBs.
Initiation of hormone therapies should be on the basis of Informed Consent or Assumed Competence.
Informed Consent means that if a patient can demonstrate that they are well informed, and have the intellectual capacity to make their own healthcare decisions, then they should have the freedom to choose the medical treatments they are seeking.
There are some health concerns which need to be managed alongside hormone treatments, but very few conditions which ultimately contraindicate hormone therapy – hormone sensitive cancers such as breast, cervical, testicular, and prostate cancer are the main concerns.
It is best practice to use informed consent and if GPs are sufficiently trained they are the best placed to provide this care throughout the country.
Gender Minorities Aotearoa advocates for the placement of puberty blockers within a similar Harm Reduction framework as contraceptives – that young trans people must be able to access these completely reversible medical treatments without barriers. This should sit within a wider context of bodily autonomy, protecting intersex infants from non-essential surgical interventions.
Gender Minorities Aotearoa advocates for DHBs to provide gender affirming healthcare as part of their standard service provision. It also advocates for the inclusion of comprehensive training in medical school curriculum, to ensure a consistent and evaluated approach to competency. Continuing medical education after initial training should be provided by both the medical sector and expert transgender led organisations.
In some regions, health pathways are being developed by interdisciplinary health teams or working groups. These teams or groups may include representatives from District Health Boards, Sexual Health teams, Endocrinology, General Practice, Mental Health, and Youth Services, as well as Transgender, Irawhiti Takatāpui, and Intersex Community experts. Health teams often prefer this approach, however a patient should be able to access appropriate healthcare whether or not these exist in their region.
A patient is entitled to a second opinion, or to change healthcare providers. There are consent forms, as well as extensive information, available here. GMA provides health navigation and peer support to patients who are experiencing difficulties accessing gender affirming healthcare.