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.

Surgeries available in NZ

  • As of 2018, there is a surgeon in NZ – Dr Rita Yang, who performs public funded or private (self-funded) penectomy, vaginoplasty (penile inversion or sigmoid colon technique), metoidioplasty, and  phalloplasty; including testicle implants, erectile implants, and urethral lengthening as required.
  • Dr Yang also performs private top surgeries, breast augmentation, facial feminisation, thyroid cartilage reduction or augmentation, hair transplant, gluteal augmentation, lipofilling, liposuction, pectoral implants.
  • Dr Yang is based in Auckland and also operates in Wellington at Wakefield hospital.
  • Find general surgery info (techniques etc) here.

Funding and waiting list

  • The cap on the maximum number of Genital Reconstruction 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). This fund is called the Gender Affirming (genital) Surgery Services fund, or GAgSS. It is separate from the HCTP or High Cost Treatment Pool.

At mid 2020, the waitlist was around 200, 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 meets the national standard – that all surgery waiting lists should be less than 6 months.

Referral

  • Referral is no longer to the waiting list for surgery, but now to a waiting list for assessment.
  • The pathway for referrals is currently a DHB or private specialist – this could be a sexual health specialist, or an endocrinologist, for example.
  • In Wellington only, the DHB has agreed that GPs can refer with specialist sign off.
  • We advocate for primary care (GP) led in all matters across all regions.
  • The Ministry of Health provides advice for healthcare providers here.
  • Once on the waiting list, you will be sent a form by the MoH every 12 months, to confirm your contact details and that you still wish to have GRS. You will receive this by post or email, so keep your contact details up to date with your local DHB. When you near the top of the waiting list, you will be sent a more comprehensive form with health questions including your smoking status, BMI, and other related information.

Referral Forms and How to Fill Them In

The 2019 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 must also demonstrate the 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 assessment waiting list.

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.

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 required if it is not ”clinically 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

Updates

2018 Update.

2019 Update.

2020 Update.