While mental health referrals are good and can sit alongside an informed consent process, they should be offered as additional support, and should not be part of getting informed consent.
‘Health Pathway’ is a generic term referring to the pathway from first contact with a health care provider – usually a GP – through the health care system to meet a patient’s medical needs.
For irawhiti takatāpui, transgender, and intersex people, this may include “gender affirming healthcare” – such as puberty blockers, hormone replacement therapies, affirmation or transition related surgeries, and other medical treatments, the pathways are often unclear – even to health care providers.
Read our Health Pathways 101 to find out what we think health pathways should look like, and click the buttons below for more information.
Where can I get gender affirming healthcare, ideally?
All DHBs should provide gender affirming surgical interventions, and Genital Reconstruction Surgeries should be adequately funded to meet the need at a national level – clearing the waiting list and ensuring a future wait time that aligns with the national standard of less than 6 months.
Binders are medical aides/prosthetics which should be provided by DHBs or centrally through the Ministry of Health. This should be temporary until the patient is old enough to have top surgery, or reaches the top of the waiting list (in under 6 months).
Permanent facial hair removal by electrolysis, laser, or IPL is an essential medical treatment and should be provided by DHBs. Facial hair, as well as the act of shaving, are key aggravating factors in triggering dysphoria, and the prescribed treatment is permanent facial hair removal (alongside testosterone blockers in adults).
Gender affirming healthcare should ideally be primary health led, with all GPs competent to prescribe hormone treatments and make referrals for surgeries. This should be complemented by gender affirming healthcare being available through sexual and reproductive health clinics.
It is not “extra training” for a GP, it is part of being competent. It is as much a part of competency as training to prescribe birth control. A GP should be competent and willing to assess a patient using the Informed Consent Model, carry out routine physical tests, and prescribe if there are no complications present or refer to a specialist if needed.
Informed Consent means that if a patient can demonstrate that they are well informed, and have the intellectual capacity to make their own healthcare decisions, then they should have the freedom to choose the medical treatments they are seeking. The Health and Disability Commissioner’s Code of Rights, enshrines this right (right 7).
Initiation of hormone therapies should be on the basis of Informed Consent, or Assumed Competence.
There are some health concerns which need to be managed alongside hormone treatments, but very few conditions which ultimately contraindicate hormone therapy – hormone sensitive cancers are the main concerns.
Gender Minorities Aotearoa advocates for the placement of puberty blockers within a similar Harm Reduction framework as contraceptives – that young trans people must be able to access these completely reversible medical treatments without barriers.
This should sit within a wider context of bodily autonomy, protecting intersex infants from non-essential surgical interventions.
Gender Minorities Aotearoa advocates for DHBs to provide gender affirming healthcare as part of their standard service provision. Transgender-specific funding is not necessary as trans people are part of the population in any given area. A practice with just 100 patients is statistically likely to have at least 1 – 2 transgender patients, alongside 1 – 2 intersex patients.
We also advocate for the inclusion of comprehensive training in medical school curriculum, to ensure a consistent and evaluated approach to competency. Continuing medical education after initial training should be provided by both the medical sector and expert transgender led organisations.
In some regions, health pathways are being developed by interdisciplinary health teams or working groups. These teams or groups may include representatives from District Health Boards, Sexual Health teams, Endocrinology, General Practice, Mental Health, and Youth Services, as well as Transgender, Irawhiti Takatāpui, and Intersex Community experts.
Health teams often prefer this approach, however a patient should be able to access appropriate healthcare whether or not these exist in their region. Much of Aotearoa is small towns and rural areas without significant likelihood of of capacity for interdisciplinary teams, and this must not systematically prevent transgender people from accessing healthcare.
A patient is entitled to a second opinion, or to change healthcare providers. There are consent forms, as well as extensive information, available here. GMA provides health navigation and peer support to transgender patients who are experiencing difficulties accessing gender affirming healthcare, and if all else fails can talk with you about how to make a formal complaint.
