In September 2021 we sent Official Information Act requests to all DHBs; asking them whether they provide gender-affirming healthcare currently, whether they use the national guidelines, and whether they provide or promote training and if so who carries this out. Their answers are below.
We also note that GMA delivers training to approximately 500 healthcare workers each year. Some services are available in different regions even if not provided by the DHB. See our database of providers for more info.
Specialist transgender healthcare available in your region
In the charts below, 1 represents yes, and 0 represents no.
Some DHBs told us they needed a time extension due to Covid-19, and some did not respond at all. We understand that the health system is particularly stretched at the moment and we will follow up on the information which is currently missing. We also plan to update this information annually.
Northland
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | Breast clinic referral to plastic surgery unit at Counties Manakau. |
| Breast augmentation for transgender women | 1 | Breast clinic referral to plastic surgery unit at Counties Manakau. |
| Fertility preservation for sperm | 1 | Via Auckland DHB Fertility Services. |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 0 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | Referral through primary care. |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 0 | |
| Who provides training |
Auckland
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | Donated binders pool via plastic surgical service. |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 1 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 1 | |
| Who provides training | Hauora tahine, Ko Awatea, Rainbow Tick. |
Bay of Plenty
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 1 | |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | Pediatric Service |
| Readiness assessment for hormone therapy | 1 | Through Gender Dynamix |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | Adults – Sexual Health Services, adolescents – Pediatric Service. |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 0 | WPATH used. |
| Training provided (Y/N) | 1 | |
| Who provides training | Gender Dynamix, Hauora tahine’s “Working competently with transgender people”. |
Waitemata
Provided through Auckland and Counties-Manakau DHBs – see above and below.
Counties-Manakau
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | Small number of donated binders available. |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 1 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 1 | Also Northern Regional DHB Guidelines for Gender Affirming Healthcare. |
| Training provided (Y/N) | 1 | |
| Who provides training | Counties Manakau health online module. Centre for Youth Health talks. Comprehensive values programme inhouse. |
Waikato
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 1 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | Limited due to few plastic surgeons, covid19, and the 2021 malware attack. |
| Breast augmentation for transgender women | 1 | Limited due to few plastic surgeons, covid19, and the 2021 malware attack. |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 1 | Pre-hysterectomy, not pre-testosterone. |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | If needed to support informed consent model. |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | Health pathways. |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 0 | |
| Who provides training |
Lakes
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 1 | Via Fertility Associates |
| Fertility preservation for eggs | 1 | Via Fertility Associates |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 0 | Guidelines form NZ and International Endocrine Society used. |
| Training provided (Y/N) | 0 | |
| Who provides training |
Tairawhiti
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 Through Paediatrics. | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 0 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | hauoratairawhiti.org.nz. |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 0 | |
| Who provides training | Physicians use the guidelines and self-fund to attend PATHA conferences. |
Hawkes Bay
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | Limited. |
| Breast augmentation for transgender women | 1 | Limited. |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | Limited. |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 1 | |
| Who provides training | Conferences, guidelines, consultations, and general CME (no details provided). |
Wairarapa
| Voice therapy/vocal training | 0 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 0 | |
| Readiness assessment for hormone therapy | 0 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 0 | |
| Hysterectomy and oophorectomy | 0 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 0 | |
| Training provided (Y/N) | 0 | |
| Who provides training |
Hutt Valley
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 0 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 1 | Also WPATH and Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline (2017). |
| Training provided (Y/N) | 1 | |
| Who provides training | Waitemata DHB’s Rainbow/transgender 101 online course, InsideOUT, 3DHB psychologist and endocrine team. |
Taranaki
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 0 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 1 | Also WPATH. |
| Training provided (Y/N) | 0 | |
| Who provides training |
Whanganui
| Voice therapy/vocal training | 0 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 0 | |
| Readiness assessment for hormone therapy | 0 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 0 | |
| Hysterectomy and oophorectomy | 0 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 0 | |
| Training provided (Y/N) | 0 | |
| Who provides training |
Midcentral
| Voice therapy/vocal training | 1 | Limited – demand exceeds capacity. |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | There are no Plastic Surgeons in this DHB. |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 1 | Through Fertility Associates |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | Through Pediatrics |
| Readiness assessment for hormone therapy | 1 | Informed consent model. Psychologist not required. |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | Through Sexual Health Service. |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 1 | |
| Who provides training | In-house diversity training. Referral to Goodfellow and Gender Minorities Aotearoa. |
Capital and Coast
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 1 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 1 | Also WPATH, and Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline (2017). |
| Training provided (Y/N) | 1 | |
| Who provides training | Waitemata DHB’s Rainbow/transgender 101 online course, InsideOUT, 3DHB psychologist and endocrine team. |
Nelson/Marlborough
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | Delivered by Independent Nursing Practice Medical Clinic |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 0 | Delivered by Independent Nursing Practice Medical Clinic |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 0 | |
| Orchidectomy/orchiectomy | 0 | |
| DHB public pathway to care | 1 | |
| Guidelines used (Y/N) | 0 | Nelson Marlborough Community Health Pathway website used, INP Medical Clinic pathway, and Delivering Health Services for Transgender People by MoH. |
| Training provided (Y/N) | 1 | |
| Who provides training | NMH and NZ College of Clinical Psychologists. |
Canterbury
| Voice therapy/vocal training | 1 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 1 | |
| Fertility preservation for sperm | 1 | |
| Fertility preservation for eggs | 1 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 1 | healthinfo.org.nz |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 1 | planned for 2022 |
| Who provides training | – |
Southern
| Voice therapy/vocal training | 0 | |
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | |
| Chest binding prosthetics | 0 | |
| Chest reconstruction (double mastectomy & contouring for transgender men) | 1 | |
| Breast augmentation for transgender women | 0 | |
| Fertility preservation for sperm | 0 | |
| Fertility preservation for eggs | 0 | |
| GnRH Puberty suppressants (puberty blockade) | 1 | |
| Readiness assessment for hormone therapy | 1 | |
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | |
| Hysterectomy and oophorectomy | 1 | |
| Orchidectomy/orchiectomy | 1 | |
| DHB public pathway to care | 0 | |
| Guidelines used (Y/N) | 1 | |
| Training provided (Y/N) | 0 | |
| Who provides training |
West Coast
| Voice therapy/vocal training | 1 | ||
| Permanent facial hair removal by electrolysis, IPL or laser | 0 | ||
| Chest binding prosthetics | 0 | ||
| Chest reconstruction (double mastectomy & contouring for transgender men) | 0 | ||
| Breast augmentation for transgender women | 0 | ||
| Fertility preservation for sperm | 0 | ||
| Fertility preservation for eggs | 0 | ||
| GnRH Puberty suppressants (puberty blockade) | 0 | ||
| Readiness assessment for hormone therapy | 1 | ||
| Hormone therapy (estrogen, progesterone and testosterone treatment) | 1 | ||
| Hysterectomy and oophorectomy | 1 | ||
| Orchidectomy/orchiectomy | 1 | ||
| DHB public pathway to care | 1 | healthinfo.org.nz | |
| Guidelines used (Y/N) | 1 | ||
| Training provided (Y/N) | 0 | ||
| Who provides training |
Further information
Your GP or other provider may be able to log into the 3D Health Pathways portal to access more detailed information on referral pathways.
Historic official information act requests
In 2018, researcher Gloria Fraser sent Official Information Act (OIA) requests to all DHBs. You can view the data that returned here.
OIA request results from the 20 DHBs – Gloria Fraser (2018).
In 2019, Doctor Jeannie Oliphant contacted all DHBs to request information. Some of them replied. You can see her summary here.
DHB provision of care across Aotearoa, NZ– Dr Jeannie Oliphant (2019).