It can be confusing trying to figure out how to access hormone replacement therapy (HRT) in Aotearoa New Zealand, as practices vary between both regions and individual healthcare providers.
Usually, the first step is to get in contact with your sexual health doctor or general practitioner (GP).
If your GP is clinically competent to treat transgender patients, they will usually carry out the screening as below, and prescribe hormones for you. If they don’t know what to do or don’t feel confident to do this, they might refer you to an endocrinologist, or to a psychologist for a readiness assessment before going to an endocrinologist.
It is a common misconception that a psychological assessment and endocrinologist assessment are mandatory, but this is false. Some GPs will choose to require an endocrinologist assessment, and some GPs or endocrinologists will choose to require a psychological assessment, but these are not required by a regulatory body or by law.
Under the Health and Disability Commissioner Regulations (1996), Right 7., you have the “Right to make an informed choice and give informed consent”.
You should not be required to undertake any ‘extra assessment’ unless your healthcare provider has reason to believe that you may not have capacity to give your informed consent.
If you are asked to undertake a psychological readiness assessment, this should never be a “mental health screening”, nor a test of your gender, nor ask you invasive questions relating to partners or sexual activity. It should be a simple assessment of your ability to give informed consent. It should aim to determine:
1. If you have mental capacity to make your own healthcare decisions, and
2. If you understand the effects of hormone therapy.
You must have both 1 and 2 in order to give your ‘Informed Consent’.
An endocrinologist’s job is to test your blood for the levels of certain hormones, and make sure your endocrine system (hormone related system) is safe to receive hormone therapy. A GP can run these tests in most cases, however if you have complex issues or coexisting conditions an endocrinologist may be necessary.
There are also a few general health conditions which may affect treatment – your GP can assess these general risks. Hormone sensitive cancers may be serious contraindications. Other risk factors can usually be managed and should not prevent hormone treatment.
Our guide for patients, Gender affirming hormone treatment, is essential reading for both you and your GP. Other resources are available on our website, such as information on informed consent, recommended doses, and the Guidelines for Gender Affirming Healthcare in Aotearoa (Pages 30 to 37, and appendixes C through F).
You can also download our checklist for clinicians below.