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.
A visual guide to intramuscular testosterone injections, and a 101 info sheet on subcutaneous testosterone injections, which is now available in NZ.
Get safe injecting equipment
You can get needles, sharps bins, and alcohol swabs from the Needle Exchange Programme. If you return your used needles they will swap them for new ones free.
Counting Ourselves, a national report on transgender health, has just been released.
The survey had 1,178 participants, from all regions of Aotearoa, ranging from 14 to 83 years old.
The research, funded by the Health Research Council and with support from University of Waikato and Rule Foundation, found that trans people experience discrimination at more than double the rate of the general population, almost half of trans people had someone attempt to have sex with them against their will since age 13, and almost a third reported someone did have sex with them against their will since age 13. Participants reported high or very high levels of psychological distress at a rate nine times that of the general population. In the last 12 months, more than half had seriously considered suicide, and 12% had attempted suicide.
key findings
Medical
In the last 12 months, 13% of participants were asked unnecessary or invasive questions during a health visit
17% reported they had experienced reparative therapy (a professional had tried to stop them from being trans)[note: sometimes called “conversion therapy”]
36% avoided seeing a doctor to avoid being disrespected
Stigma, Discrimination, and Violence
67% had experienced discrimination at some point
44% had experienced discrimination in the last 12 months – this was more than double the rate for the general population (17%)
21% were bullied at school at least once a week, much higher than the general population (5%)
83% did not have the correct gender marker on their New Zealand birth certificate
32% reported someone had had sex with them against their will since they were 13
47% reported someone had attempted to have sex with them against their will since they were 13
Compared to the general population, participants were almost three times more likely to have put up with feeling cold (64%) and gone without fresh fruit or vegetables (51%) in order to reduce costs.
Distress and Suicide
71% reported high or very high psychological distress, compared with only 8% of the general population in Aotearoa New Zealand
56% had seriously thought about attempting suicide in the last 12 months
37% had attempted suicide at some point
12% had made a suicide attempt in the last 12 months
Participants who reported that someone had had sex with them against their will were twice as likely to have attempted suicide in the past year (18%) than participants who did not report this (9%)
Participants who had experienced discrimination for being trans or non-binary were twice as likely to have attempted suicide in the past year (16%) than participants who did not report this discrimination (8%)
Participants’ rate of cannabis use in the last year (38%) was more than three times higher than the general population (12%)
Protective Factors
57% reported that most or all of their family supported them. Respondents supported by at least half of their family were almost half as likely to attempt suicide (9%).
62% were proud to be trans, 58% provided support to other trans people, and 56% felt connected with trans community.
We’re very pleased to announce that the national guidelines for trans healthcare in Aotearoa have been released, and can be found here. We will be updating links across our website to help facilitate their use.
Great work from all involved in their development, we are looking forward to supporting healthcare providers in putting these guidelines into action in their practices. We encourage all transgender, intersex, and takataapui patients to download a copy and pass it along to their healthcare providers.
More information on gender affirming health care can be found in the national database by clicking on the main menu.
March 10th 2018, takataapui, transgender, and intersex people and supporters walked, danced, and rode along in the Wellington International Pride Parade with a clear message: trans health care now!
The float was hosted by Gender Minorities Aotearoa, The Gender Centre, Aunty Dana’s Op Shop, and InsideOUT, with support from NZPC.
Float participants carried a large banner, waved transgender flags, and held placards painted in trans flag colours with slogans such as ”stop non-consensual surgeries on intersex babies”, ”protect trans youths”, ”non-binary not confused”, and ”trans intersex taonga”. One placard posed the question ”40 year wait list?”, another read ”access to health care saves lives”, ”transgender lesbians need HRT too”, ”support sisters, not only cis-ters”.
Behind those walking, Bicycle Junction cycled along playing an upbeat pop play-list compiled by one of the volunteers at Aunty Dana’s Op Shop. Following the music, Aunty Dana’s van ”Pash” carried participants with mobility access needs. A mannequin reclined in a chair on the roof, draped in a huge transgender flag which spread over the sides and back of the van. She wore a trans flag coloured headband and carried a sign that read ”health care for all”.
”Indigenous genders are real” read the final sign in the transgender health care float – strapped to the back of the van.
“The float was FABULOUS and beautiful and fierce and fun! Super amazing. It was such a great combined effort from everyone. From the playlist, to the bike guy, to the van driving, to the snacks! And the face paints! And placard painting! and the folks who coordinated the banner carry! and the waving of that flag in those heels!”
says Gender Minorities Aotearoa’s National Coordinator Ahi Wi-Hongi.
”A huge thank you to Amanduh and the WIPP organisers for all your hard work, to our pals at InsideOUT who we love working with, to NZPC who are strong advocates for trans health, to Jaye, Kerry, Sam, Jess, Ada, Lola, Dan, Dylan, Ella, and everyone who got involved and helped to make this happen. To the beautiful people of all genders who joined the float, and to the folks out there who came to watch and support.
”Nga mihinui ki a koutou katoa, we look forward to appropriate health care in the near future.
Gender Minorities Aotearoa is opening The Gender Centre in Wellington, Transgender Day of Visibility March 31st.
InsideOUT is holding Shift Hui n Wellington, April 20 – 23.
Follow Gender Minorities Aotearoa, The Gender Centre, and InsideOUT on Facebook
