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.

Waiting Time and Funding

  • 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 High Cost Treatment Pool (HCTP).
  • At mid 2020, the waitlist was around 200 patients, which put the wait time at around 12 years.
  • A year before that, the waiting list was 50+ years.
  • It may significantly reduce again soon if the government puts more funding toward trans health.
  • It is Members of Parliament (MPs), not the Ministry of Health, who decide whether to allocate funding to finance surgeries.
  • We urge you to meet with your local MP, write letters, and keep pushing until the waiting list meets the national standard – that all surgery waiting lists should be less than 6 months.

Surgeries Available

  • 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.
  • She has trained internationally with top surgeons in several countries, and has very good surgical outcomes.
  • 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 operates in Auckland and Wellington.

Referral

  • Referral is no longer to the waiting list for surgery, but now to a waiting list for surgical assessment.
  • A patient needs to be referred by a DHB specialist or private specialist – for example a sexual health specialist, or an endocrinologist.
  • In Wellington only, the DHB has agreed that GPs can refer, with specialist sign off.
  • Once on the waiting list, the patient will be sent a form by the MoH every 12 months, to confirm their contact details and that they still wish to have GRS. They will receive this by post or email, so it is important to keep contact details up to date with their local DHB. When they are near the top of the waiting list, they will be sent a more comprehensive form with health questions including their smoking status, BMI, and other related information.
  • The Ministry of Health provides advice for healthcare providers here.
  • Ideally a patient should only need a GP – not a specialist – to refer. GMA advocates for this across all DHBs.

Referral Forms

The 2019 referral form asks for the ‘Readiness Assessment’ date and name of assessor. The Readiness Assessment (usually done by a psychologist) is an assessment of whether 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.

A Readiness Assessment is not a mental health screening! It is only to assess informed consent.

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 readiness assessment before being referred.

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

Completing the Form

  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: contradicted 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 and those who do not desire it.]
    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

Ministry of Health Updates