Depo-testosterone (testosterone cipionate) unavailable until September 2022
Due to Covid-19 disruptions, Pfizer, the company that makes the Depo-Testosterone injection, will be unable to supply Depo-Testosterone to New Zealand from late October 2021 until September 2022. This means that Depo-Testosterone will be unavailable in New Zealand during this time.
There are alternatives to the Depo-Testosterone available which are also funded by Pharmac. Pharmac has advised clinicians ahead of time so they know to prescribe alternatives. You can find out more about this issue on the Pharmac website here.
If you are currently taking Depo-Testosterone, we recommend you talk with your prescribing doctor as soon as possible about transitioning onto another form of testosterone. They should be able to advise on the best alternative for you. You can read more about the alternatives in our HRT guide, which you may also wish to share with your prescribing doctor.
The online tool “Manage my health” may be useful for keeping track of changes. Once you register, it will access all the information available which is associated with your NHI number. You will be able to see the results of all your blood tests, your prescriptions, appointments, and other useful information. You need to use your legal name to register.
It can be confusing trying to figure out how to access hormone replacement therapy (HRT) in Aotearoa New Zealand, as practices vary between both regions and individual healthcare providers.
Usually, the first step is to get in contact with your sexual health doctor or general practitioner (GP).
If your GP is clinically competent to treat transgender patients, they will usually carry out the screening as below, and prescribe hormones for you. If they don’t know what to do or don’t feel confident to do this, they might refer you to an endocrinologist, or to a psychologist for a readiness assessment before going to an endocrinologist.
It is a common misconception that a psychological assessment and endocrinologist assessment are mandatory, but this is false. Some GPs will choose to require an endocrinologist assessment, and some GPs or endocrinologists will choose to require a psychological assessment, but these are not required by a regulatory body or by law.
You should not be required to undertake any ‘extra assessment’ unless your healthcare provider has reason to believe that you may not have capacity to give your informed consent.
If you are asked to undertake a psychological readiness assessment, this should never be a “mental health screening”, nor a test of your gender, nor ask you invasive questions relating to partners or sexual activity. It should be a simple assessment of your ability to give informed consent. It should aim to determine:
1. If you have mental capacity to make your own healthcare decisions, and 2. If you understand the effects of hormone therapy.
You must have both 1 and 2 in order to give your ‘Informed Consent’.
An endocrinologist’s job is to test your blood for the levels of certain hormones, and make sure your endocrine system (hormone related system) is safe to receive hormone therapy. A GP can run these tests in most cases, however if you have complex issues or coexisting conditions an endocrinologist may be necessary.
There are also a few general health conditions which may affect treatment – your GP can assess these general risks. Hormone sensitive cancers may be serious contraindications. Other risk factors can usually be managed and should not prevent hormone treatment.
Our guide for patients, Gender affirming hormone treatment, is essential reading for both you and your GP. Other resources are available on our website, such as information on informed consent, recommended doses, and the Guidelines for Gender Affirming Healthcare in Aotearoa (Pages 30 to 37, and appendixes C through F).
You can also download our checklist for clinicians below.
A common question which many trans women ask, is what their estrogen levels should ideally be. They have often asked for a higher dose from their prescribing doctor, and been told no, there are too many risks, and that their current level is within the normal ranges. The maximum pmol/L cited by doctors is often 200 or 250. However, this is against best practise.
If an adult is on a dose resulting in a lower pmol/L than the above, they should be given a higher dose if desired, unless there are sound medical reasons to keep their dose lower.
A sound medical reason may include hormone sensitive cancers or other medical conditions that are not well controlled. If liver and kidney concerns are the reason, these can be minimised by switching from oral estrogen to patches, gel, or cream, as these bypass the liver and kidneys. It is also possible for your prescribing doctor to advocate for estrogen implants (such as those available in Australia) to be made available in NZ through Pharmac.
If a patient is being told no repeatedly without what they consider to be a legitimate medical reason, they have the right ask in writing:
“I am not seeing results and would like to increase my estrogen dose. Please tell me if this is possible, and if not; what is the medical reason?”
They may also wish to add that the national guidelines recommend up to 500 pmol/L, and the endocrinology society guidelines recommend between 367.09 and 734.19 pmol/L.
If there are sound medical reasons for keeping the patients dose lower, the clinician then has the opportunity to write these down in a way that the patient can understand. It also gives them the opportunity to make sure they understand the risks and best practise, before writing it down, to ensure they won’t be found to be wrong later.
GMA would like to acknowledge the enormous amount of work being done by trans people, advocates, and healthcare workers to bring gender affirming healthcare in Aotearoa up to standard. We also wish to acknowledge that there is still bias, negligence, and malpractice from some healthcare providers, and that this can have a devastating impact on their patients’ lives. If you are a trans person struggling to navigate the healthcare system, please get in touch with us as we may be able to assist you in finding out what your options are.