Referral for Genital Reconstruction Surgeries in NZ

If you need Genital Reconstruction Surgeries (GRS), you may be eligible to have them covered by public funding.

Summary

Recent gains in 2019:

  • There is now a surgeon in NZ – Dr Rita Yang, who performs vaginoplasty (penile inversion or sigmoid colon technique), metoidioplasty, and phalloplasty (as well as top surgeries privately).
  • The cap on the maximum number of GR surgeries per year has been lifted, and is now the minimum number.
  • $3million was allocated for GRS from the 2019 government budget for the next 3 years (aprox 13 – 15 surgeries per year).
  • The pathway for GRS referrals is changing to a GP initiated one – to improve access to the waiting list, particularly for those in small towns and rural areas without DHB or private specialists.

However, currently a DHB or private specialist does need to sign off – this could be a sexual health specialist, or an endocrinologist, for example.

The referral form asks for the ‘Readiness Assessment’ date and name of assessor. The Readiness Assessment is a mental health visit to ensure you can give ”Informed Consent”. To give informed consent, you must be able to demonstrate that you are well informed about the treatment and what it will mean for you – including undesired effects of GRS, and possibility for disappointment with results. You also must have mental capacity to make your own healthcare decisions.

If you have previously had a Readiness Assessment from a clinical psychologist in order to begin hormone replacement therapy (HRT), you do not need another assessment before being referred to the waiting list, as the wait time is longer than one year, so you will need a new assessment when you reach the top of the waiting list anyhow.

Here is the form that you and your referring specialist need to fill out, and it includes where to send it. We recommend you keep a copy for your records.

MoH Referral Forms and How to Fill Them In

2019 Referral Form

2019 Referral Questionnaire

  1. Gender Affirming Surgery: this application form ONLY applies to gender affirming genital feminising or masculinising surgery. Referrals for other gender affirming surgery should be directed to the appropriate DHB provider.
  2. Preferred contact:  The patient’s preferred method of contact will be the primary method of communicating with the patient, and should be the best way of contacting them, and the least likely to change.
  3. Ethnicity: Provide the ethnicity as self-reported by the patient. The patient may select more than one ethnic group.
  4. Eligibility: The following people are eligible:
    1. New Zealand Resident Class Visa Holders
    2. New Zealand citizens (including those from the Cook Islands, Niue or Tokelau)
    3. Australian citizen or permanent resident who has lived, or intends to live, in New Zealand for two years or more
    4. Work visa holder eligible to be in New Zealand for two years or more
    5. People aged 17 years or younger, in the care and control of an eligible parent, legal guardian, adopting parent or person applying to be their legal guardian [GMA note: contraindicated by WPATH SoC7 – people under 18 are not eligible]
    6. Interim visa holders
    7. New Zealand Aid Programme student receiving Official Development Assistance (ODA) funding
    8. Commonwealth scholarship students
    9. Foreign language teaching assistant
    10. Refugees and protected persons, applicants and appeallants for refugee and protection status, and victims of people trafficking offences
    11. More information on eligibility can be found at the following weblink:  https://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services.
  5. Clinical criteria declaration: The patient must meet the internationally agreed criteria for genital reconstruction (WPATH SOC v7 2011):
    1. Persistent, well-documented gender dysphoria;
    2. Capacity to make a fully informed decision and to consent for treatment;
    3. Age of 18 years or older;
    4. If significant medical or mental health concerns are present, they must be well controlled;
    5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the individual); [GMA note – Hormone therapy isn’t strictly required if it is not ”clilically indicated” – eg for non-binary people.]
    6. 12 continuous months of living in a gender role that is congruent with their gender identity.
  1. Readiness assessment: At least one satisfactory readiness assessment for transgender medical care from an appropriately experienced mental health practitioner.
  2. Prior gender affirming procedures: Please list gender affirming procedures completed, including where and when provided.  These may include chest procedures (mastectomy or breast augmentation or surgery on reproductive organs)
  3. Medical conditions: Please describe any medical conditions or history that may affect the patient’s fitness/suitability for surgery, particularly:
    1. High blood pressure
    2. A heart condition or heart surgery
    3. Asthma, lung problems, chronic lung condition or shortness of breath
    4. Stroke or TIAs
    5. Treatment for cancer
    6. Diabetes
    7. Liver or kidney problems
    8. Blood clots, bleeding conditions or anaemia
    9. Infectious conditions

Surgical Information

Information on surgeries, surgical techniques, and what Dr Rita Yang is offering in NZ

Changes in 2018

Click here to find out more.

How many on the list – how long is the wait

The current waiting list is around 190 patients, which puts the wait time  at around 12 years. A year ago, that figure was 50+ years. We’re making progress, but we need to keep advocating.
It’s MPs, not the MoH, who decide whether to allocate funding to finance surgeries.
Meet with your local MP, write letters, and lets all keep pushing till the waiting list is less than 6 months and anyone who needs GRS can access it easily.

The Ministry of Health resource pages

Gender Reassignment Health Services for Trans People Within New Zealand

High-cost treatment pool


The purpose of Special High Cost Treatment Pool is to

ensure equitable access throughout the country to Special High Cost Treatments

manage the financial risk for certain highly specialised procedures which pose a risk due to their unknown or fluctuating costs

promote the use of cost effective procedures in the public health care system

Special High Cost Treatments include the following

medical treatment overseas

treatment not currently available within the public health system (GRS)

complex cases

Who can apply?

Applications will now be accepted from any GP in NZ, with sign off from a DHB specialist who is supported by the responsible DHB manager/senior medical officer, whose name will be on the contract once application is approved.

Eligibility and criteria:

Access to the Special High Cost Treatment Pool will be determined by the Senior Advisor at the Ministry of Health (MoH), and a panel of relevant Ministry officials in the context of the Ministry’s statutory objectives and functions.

In reaching decisions on access to the Treatment Pool, the Senior Advisor and panel will have regard to the eligibility criteria below, and to the applicant’s individual circumstances.

Special High Cost Treatment

GRS is now available in NZ, and is accepted as a standard treatment for gender incongruence (soon to replace ”gender dysphoria”)

The treatment has proven efficacy when applied in regular practice

The chosen treatment is cost effective which means that:

1. the expected long term savings to the health care system outweigh the initial costs of the treatment; and/or

2. the dollar cost for the expected benefit are acceptable when evaluated against other MoH priorities

3. Failure to receive the treatment could result in serious irreversible deterioration of the patient’s condition or an inability to recover lost function, or significant impairment to normal development of a child; or

4. Failure to receive the treatment could deny an adult with a lifelong disability access to treatment which would lead to a marked improvement in their quality of life,

 

2018 Application Form (if applying for a GRS through the HCTP, because you want a different technique not offered in NZ. This would need to be sent to the new email address though, and may be declined. It’s uncertain whether technique of surgery not offered in NZ counts as a surgery not offered in NZ)