We provided 1:1 peer support over 2,000 times, and there were over 600 visits to our Wellington drop in centre. Our website was visited over 101,000 times with 209,000 page views.
Our healthcare referral system was used over 6,000 times, and we received over 1,100 referrals from healthcare providers across the country. Our HRT guide was read over 5,000 times. We also trained over 500 healthcare workers, particularly in mental health and addictions.
Our Rainbow Housing NZ group grew by 500 members to 3,100+, Housing was an area which suffered greatly due to covid 19, so this year much of our work in this area was in supporting individuals to find housing.
We held a successful campaign to pass the BDMRR Bill for self determination/self ID on birth certificates. Our resources were read 15,600+ times, we distributed 100’s of pamphlets and posters, the community turned out amazing submissions, and the law was passed. Our guide to updating your birth certificate sex marker updates was also read 2,000+ times, and a member of our staff became a Justice of the Peace to witness birth certificate documents.
We facilitated connectedness for 2,100+ trans people, whānau, and supporters in our online Transgender and Intersex NZ group, our “trans 101” resource was read more than 42,000 times (15,000 more times than in 2020), and our main parents resource was read more than 1,000 times (double 2020).
We released 6 new healthy relationships and sexual violence prevention resources in 2021. We also began work with Intersex Aotearoa on a joint project – ARC (Anti-violence Resource Centre) which will launch in 2022. We worked on the government’s National strategy to eliminate family violence and sexual violence, together with other members of the Rainbow Violence Prevention Network (RVPN).
We run the national transgender housing support service. This includes support with accessing emergency housing, transitional housing, and council housing. It also includes the national LGBTQI+ Rainbow Housing NZ group online. Our rainbow housing network was established in 2017, and has over 2,800 members in 2021.
If you need support with emergency housing, contact us to discuss your situation and the options available to you in your area.
If you’re looking for a room in an established transgender-friendly home, or if you have a room to offer in yours, visit Rainbow Housing NZ by clicking the image below.
Help transgender people find housing
If you would like to help us support transgender people to find safe housing, you can set up an easy monthly donation using the buttons below, or visit our donations page for more options.
Despite the global pandemic, we had a very successful year across all five of these areas.
We provided 1:1 peer support over 1,300 times, and there were over 500 visits to our Wellington drop in centre. Our website was visited over 61,000 times with 118,000 views.
We made over 4,100 health referrals, and received over 500 referrals from healthcare providers across 9 DHBs. We held a 3DHB community update, and produced 2 health resources.
Our Rainbow Housing NZ group grew to 2,600+ members, we met with the UN Special Rapporteur on Housing, and we published a housing report from our research into homelessness and housing instability in Wellington. We sent Counting Ourselves to key figures at the Ministry of Housing and Urban Development – which then named trans people as a priority group.
Our guide to birth certificate sex marker updates was read over 1,400 times, and we assisted a number of people in making applications. We were also on the BDMRR working group for the Minister of Internal Affairs.
We facilitated connectedness for 1,700 trans people, whānau, and supporters in our online Transgender and Intersex NZ group, we held or significantly participated in 15 community events, our “trans 101” resource was read more than 27,000 times, and our parents resource was read more than 300 times.
Kia ora e te whānau, we hope you are all safe and sound during lockdown (level 4 alert for Covid-19). We have compiled some information to help you get through this difficult time.
Though all our upcoming events, monthly socials, drop in days, and office hours are currently on hold, we are still available by email (cleared daily) and by mobile phone (10am – 6pm weekdays), and you are welcome to join our peer to peer infoshare group on social media Transgender and Intersex NZ – it’s the largest trans forum in Aotearoa with over 1,400 members. Your partner, parents, whanau, and supporters are welcome to join it as well. Please remember to answer all three of the joining questions and read through the kaupapa.
Services are operating slightly differently in different regions, but you can access your medical records, manage clinical appointments, get support, and more by registering for Manage My Health, here.
The government has a website specifically to give you factual information on Covid-19, this is available here.
The Ministry of Health has a website here, with info about the total number of confirmed cases, recovered cases, and more. There is also information and advice specifically for elderly people, disabled people, caregivers, and other specific populations available here.
You can contact OutLine counseling services if you need to talk with a counselor. You can also contact Healthline here if you have any concerns about your health, or if you symptoms of Covid-19, which include coughing, difficulty breathing, and a temperature over 38 degrees.
You can also see MoH’s Melon website here, with self care and mental health resources and tips for during lockdown.
Just a Thought has info and courses for supporting your mental health.
You can also contact us at GMA for transgender peer support with a professional transgender advocate – we can support you with finding information and connecting you with referrals.
You can apply for a wage subsidy if you are a contractor (including a sex worker), a sole trader, self employed, and under a number of other circumstances. This is a one page form, and asks for contact details, your IRD number, and very little else. You do not have to repay this as long as you meet the requirements. More information about this can be found here.
WINZ payments
WINZ payments will not be stopped during lockdown, regardless of whether you miss an appointment, your medical certificate expires, or any other circumstance.
There is usually a 2 week stand down period for all benefit applications.
Additionally, if you stop working in a job you could technically have kept doing, and apply for a job seekers benefit (rather than a wage subsidy), there is an additional stand down of 12 weeks, unless the job you are stopping is sex work. For sex workers, there is no additional stand down.
You can register for MyMSD here, where you can view your information, see your applications, and update your details.
Trans sex workers and tax
Many sex workers do pay tax and keep records, in which case applying for a job seekers benefit is simple. If you haven’t been paying tax, this guide will provide simple information.
The end of the tax year is March 31st, so the tax you owe for the financial year is due then. However, IRD is very flexible with repayments and is happy to work with you so your repayments are affordable and not stressful.
How it works: If you declare your sex work as, for example, 5 jobs per week at $150 ($750 for the week) for 10 months of the year, that’s $30,000 in a year. But if you spent $250 a week on a work room or hotel, then you minus that expense ($10,000) from your taxable income, and if you also brought sheets, towels, massage oil, lingerie, a heater, a fan, advertising, and travel costs (ideally you should have receipts), you should also minus those costs – let’s say another $5,000. That means you only made $15,000 taxable income. So if the tax and ACC levies you owe come to 20%, that’s $3,000 you would owe.
If you’re applying for a benefit of, for example, $300 a week, it would take you 10 weeks to recover the cost of declaring your income and paying your tax and ACC (bearing in mind that you can pay off tax debts at just a few dollars a week). If you’re likely to need the benefit for longer than 10 weeks, it makes financial sense to pay your taxes. Of course it’s also legally what you’re supposed to do, which can take the stress off as well.
We recommend that everyone stays home and no one continues to do in-person work of any kind, but if you do plan to continue to do sex work at all, you can declare a job per week at $150 with minimal impact on your benefit, as around $80 of additional income doesn’t affect your benefit, and the other $70 only reduces your benefit by about 20 cents per dollar (about $14 in our example). The more you earn the higher the number of cents per dollar your benefit is reduced by.
Decent housing is a human right, and the UN Special Rapporteur on Housing recently said that as such, NZ has not just a housing crisis but a human rights crisis.
The Minister of Finance announced on 23 March 2020 a freeze of rent increases and protections against tenancy terminations. This means that property investors (such as landlords) cannot raise the price of rent during level 4 alert. It also means that you cannot be evicted ‘without cause’, including being up to 59 days in rent arrears. It does not mean that you can stop paying rent – any rent you can’t pay now will likely have to be repaid at a later time. Advice to landlords is to work with tenants so they can be secure during lockdown and into the future. You can find out more information for tenants and landlords on the tenancy services website here.
If you need to relocate to another house because of danger, you cannot be arrested. If this is your situation it may be possible to join an existing bubble.
Leaving the house
During level 4 alert (lockdown) you are required to stay at home with the people you live with and not leave the property except for essential services, or to deliver essential goods to someone who can’t get these for themself, or to go to work if you are an essential service worker. Essential services include supermarkets, doctors, dairies, vets, pet stores, emergency services and Police, rubbish collection, petrol stations, internet services, and pharmacies. You are allowed to go out for a walk in your local area, as long as you keep a 2 meter distance from anyone who is not in your household, and do not visit playgrounds. You are also allowed to leave if you are in danger, including danger of sexual or family violence. You can find more information here.
Every time someone leaves your property, or ‘quarantine bubble’, there is a risk that if they have Covid-19, they will transmit it to others, or that Covid-19 will be transmitted to them. Even if they maintain a 2 meter distance from others, and everyone wears a face mask and gloves, they might still touch a surface which is contaminated or come into contact with airborne droplets of Corvid-19 and bring that contamination back to their quarantine bubble.
Decontamination protocol
The virus is live for up to 24 hours on paper, cardboard, and soft furnishings, and up to 72 hours on hard surfaces like plastic and metal.
Hand washing: Scrub , rinse, and dry your hands well and often, especially after touching anything outside our quarantine bubble – including your mailbox! Use hot water and soap, wash for 20 seconds, then rinse and dry.
Sanitizing your hands: when you are away from hand washing facilities, use a sanitizer with 70% or higher level of alcohol. You can also carry wet wipes if sanitiser is not available.
Touching your face: do not touch surfaces and then touch your face. Tie long hair back to minimise the risk of touching your face while outside your quarantine bubble. Mucous membranes such as eyes, nose, and mouth are particularly susceptible sites of transmission. Masks: a home made cloth mask should be 2 or 3 layers thick, and can be over 50% as effective as a good commercial mask.
Touching surfaces: what surfaces are you touching? Mailbox, car keys, steering wheel, door handles, ATM, products in the grocery store, shopping trolley, etc. Clean or sanitize your hands frequently.
Decontaminating your clothing and body: Decontaminating when you arrive back to your home or quarantine bubble is important. This includes leaving your shoes outside, changing your clothes, and showering, before touching people or surfaces in your household, to remove any droplets of Covid-19 which you may have come into contact with.
Bringing in items from outside your bubble: If you are bringing home bags or boxes of groceries, either put these in a quarantine area (eg in your laundry) to decontaminate for 72 hours, or alternatively unpack these and wash any washable items – including hard fruit and peelable fruit – in soapy water for 20 seconds. Bags should be put in the trash or paper bags and boxes burned. Frozen items should be washed if possible, or removed from packaging and the packaging discarded, as the virus can survive a much longer time in the freezer.
This booklet is a simple guide to help you get started on gender affirming hormones in the simplest way possible.
It aims to give patients a solid foundation of knowledge, to help you make the best decisions for yourself, and to help you advocate for yourself with your healthcare provider. This guide is read over 10,000 times each year.
Whatever the process in your region, and whatever your age, the first step is usually your GP or sexual health clinic.
Guidelines
At 2023 there are no official national guidelines, however the commonly used guidelines are called the Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People, and Adults in Aotearoa New Zealand (2018).
There is a checklist at the end of this booklet, developed by Gender Minorities Aotearoa, based on international best practice and the best medical frameworks globally.
You can find comprehensive information at genderminorities.com, including clinical guidelines, consent forms, and more.
In New Zealand, gender affirming hormone treatment is usually carried out in alignment with the World Professional Association for Transgender Health (WPATH).
WPATH is a slow moving and somewhat conservative body, which admits that international best practice is often ahead by the time new standards of care are published.
The current WPATH standards of care (v8, published 2022) require the following to initiate hormone treatment.
WPATH standards of care v8 (SoC8)
These are the WPATH SoC8 recommendations for adults, unless ‘suggestion’ is stated.
If your GP is confident, they can give you information at your first visit, assess whether you’ve understood the info and are able to make your own healthcare decisions, and accept your informed consent
They may need to ask some standard health questions and run some blood tests, but should be able to proceed with a prescription at this point.
Medically speaking, they do not typically need to wait for your blood test results as complications are extremely rare. and individual patients can be contacted if they need to discontinue the medication.
Technically they can carry out the checklist at the back of this booklet and prescribe for you at the first visit.
This is international best practice, as provided by Planned Parenthood Great Northwest (USA).
There are consent forms on our website, though these are not technically required..
In reality, many GPs haven’t done this before and don’t feel confident.
They may ask you to see a psychologist to assess whether you can give informed consent, and/or an endocrinologist for blood tests. However, unless there is a reason to believe you are not capable of making your own healthcare decisions, or you have other known health complications, you shouldn’t need to see one of these specialists. Your primary provider (such as your GP) should provide this care.
Working with your healthcare provider
Gender affirming hormone therapy can be a long-term process, so it’s important to build a healthy relationship with your healthcare provider. Whether you end up working with an experienced provider, or with one who has never met a transgender person before, having rapport with your provider can help you get the best care that is available to you.
Don’t be afraid to ask them to explain things to you, or justify their reasoning, or to ask to try a different medication.
Not all healthcare providers have the knowledge or experience to optimally provide you with hormones, nor are the most common pathways and treatments the best for everyone. Your provider may not know about the availability of certain medications, they may not be aware of publicly funded treatments, or they may not know about the common side effects of the medicines they prescribe.
This may mean that your own personal knowledge of the process and treatments available could be the difference between optimal and non-optimal care.
It is important that both you and your provider work to build a relationship that facilitates open two-way communication. This helps to facilitate addressing any problems that may arise with treatment,.
It is also important that your provider is committed to providing you with the safest and most effective treatment, tailored to your needs.
If your healthcare provider is not open to tailoring your treatment to best benefit you, you may need to provide them with the most up to date Guidelines for Gender Affirming Healthcare in Aotearoa New Zealand, or to seek a different provider.
Youth
After age 16, patients have the right to make healthcare decisions for themselves, and the same right as adults to use informed consent..
People aged under 16 can also give informed consent to the extent that they are able to understand and make healthcare decisions. The Gillick Competency framework is sometimes used to determine their capacity to understand and consent.
“Consent requires the cognitive capacity to understand the risks and benefits of a treatment and the potential negative and positive outcomes. It also requires the ability to retain that information for the purposes of making the decision (using aids as necessary) as well as the cognitive ability to use that understanding to make an informed decision” – WPATH SoC8
For people aged under 16 years, the process is different depending on their age, regional pathways, individual providers, and parental support.
Gender Minorities Aotearoa advocates for a ‘harm reduction’ model that removes barriers to care, but currently it can be challenging.
The current recommendation is to use the Guidelines for Gender Affirming Healthcare. (2018).
Initial discussion with your healthcare provider
First, establish how they can show basic respect for your gender. Be clear with your provider about the sex/gender you were assigned at birth, whether you are intersex (if you know this), and what your actual gender (or ‘gender identity’) is. Tell them how you like to be referred to (she, he, ko ia, they, etc).
Next, it may help if they know it’s not a passing idea – if you’ve felt this way for a long time, tell them.
They may ask about your support system, such as whether you have supportive family or friends, whether you currently present to the world as your gender (or if you are ‘out’), whether you have any history of substance use, or whether you have any mental health issues such as depression or anxiety.
These are all standard lines of questioning. While you can probably guess the ideal answers, none of the less ideal answers should prevent you from being prescribed hormones.
The only “hard nos” are hormone-sensitive cancers (such as testicular cancer).
Your provider is likely to ask for a blood test, check your blood pressure, carry out cardiovascular and respiratory exams, and ask some other physical health questions.
Some providers may recommend weight loss prior to starting treatment. However, no amount of dieting is generally effective long term, with over 90% of diets failing to produce long term weight loss.
Managing other risk factors is a much more attainable goal – consider reducing or stopping smoking, alcohol and other drug use, supporting your health by drinking lots of water every day, getting enough sleep, getting enough food, and managing vitamin and salt intake to support your liver, heart, bone health, and circulation.
It’s all about weighing risks vs. benefits, so lower your risk factors and be sure to tell your healthcare provider how positively hormone treatment will impact your life!
Let your provider know that you understand all the possible effects of hormone treatment. Include your mental health – such as relief of anxiety, feeling more comfortable, reduction in stress – and the physical effects too, discussed later in this booklet.
Include both the positive and possible negative effects. Show them that you have a holistic and realistic understanding.
Discuss with them your intended journey and where you want to be. For example you may want to take hormones and have voice coaching but not have surgeries, or you may only want hormones in order to be allowed Genital Reconstruction Surgery (though this is not technically required).
Fertility preservation should also be discussed.
There is no one right or wrong way to transition, and accessing medical treatments is becoming simpler as more people transition in a variety of ways.
There are two main categories of medicine involved in treatment:.
The first category is “blockers”, which pause puberty, suppress testosterone in adults, or stop certain hormones from affecting your body. Blockers are fully reversible – if a patient stops taking blockers, their natural hormones will begin to affect their body again. These can be prescribed from the start of puberty.
The second category of medicines are often referred to as “gender affirming hormone treatment” or “hormone replacement therapy” (HRT), and consist of various sex hormones which add effects to your body.
Some of these can also do the job of blockers, eliminating the need to take blockers completely.
Sex hormones are usually prescribed from age 14-16, though there is emerging medical evidence which suggests it may be best to begin earlier, as would naturally occur at the onset of puberty.
Forms of administration
Some hormone treatments are available in multiple forms, or can be taken in multiple ways. These different preparations and delivery methods can have an effect on how well the medicine works, its side effects, and its risks. It’s good to be aware of what options are available to you and how one medicine, its preparation, or delivery method might be better for you than another.
Some forms of administration are:
Injection
into either muscle or fat
Pellet implant
usually injected into fat
Patch
stuck to and absorbed through the skin
Pill
swallowed orally, dissolved under the tongue sublingually, or absorbed rectally via suppository
Topical
applied to the skin as a gel or cream
Availability and cost
It may be useful to be aware of which medicines for HRT are available in Aotearoa, and whether or not they’re funded for NZ citizens and permanent residents. Medicines are not usually funded for people visiting NZ on a temporary visa.
Ask your healthcare provider, or check whether a medicine is available using the Medsafe website (medsafe.govt.nz).
You can see whether a medicine is funded using the pharmaceutical schedule website (pharmac.govt.nz/tools-resources/pharmaceutical-schedule).
If you request a particular form of the medicine (for example, you prefer injections rather than pills), these may not be funded. However, your doctor can still prescribe them so long as you are willing to pay for them yourself, and they are available in New Zealand, or you can import them using an international pharmacy which ships to New Zealand.
If a medicine you’ve been prescribed is no longer funded by the government, the funded brand of the medicine may have changed, so your doctor will need to update your prescription accordingly.
If you cannot afford the medicine that has been prescribed to you, you may be able to have it funded through Work and Income NZ (WINZ) on a disability allowance.
You do not have to be unemployed or disabled to do this. It is also possible to get other transition-related treatments such as laser hair removal or electrolysis funded through this pathway (see the health section on our website for more information).
Gonadotropin Releasing Hormone Agonists (GnRH agonists) – or ‘puberty blockers’, suppress or pause puberty changes.
Puberty blockers are safe and fully reversible, and do not affect long term fertility. They have been used for decades to treat Precocious Puberty (early puberty at 6 or 7 years old) in cisgender children.
These are generally Leuprolide (Leucrin, Lucrin, or Lupron) by intramuscular injection (usually every 3 months), or Goserelin (Zoladex) chip implant (usually every 10-12 weeks).
These are prescribed to people who are starting puberty, and are funded up to the age of 16.
“this treatment is fully reversible, it is regarded as an extended time for adolescents to explore their gender identity by means of an early social transition” – WPATH SoC8
Blocking Testosterone in adults
The sex hormone testosterone can be ‘blocked’ or ‘suppressed’ using puberty blockers as above, or by using anti-androgens – sometimes referred to as “T blockers”.
T-blockers should not be taken long term without a replacement sex hormone, as sex hormones are vital for bone health (among other things), and the risk of osteoporosis increases the longer an adult patient is without sex hormones.
T-blockers
Cyproterone Acetate (brand names Androcur, Procur, or Siterone), is a commonly prescribed anti-androgen pill, usually taken orally on a daily basis. Note that while much higher doses are often prescribed, 25mg is usually a sufficient dose and generally shouldn’t be exceeded unless testosterone suppression is insufficient.
Micronised Progesterone (brand names Utrogestan or Prometrium), a pill taken regularly, usually orally, sublingually, or rectally. It can have testosterone suppressing effects but is not commonly prescribed for this sole purpose.
Spironolactone (brand name Spiractin), is a pill taken orally daily. Much like Cyproterone, Spiro is also commonly prescribed. Some studies have linked taking Spironolactone with a higher likelihood of seeking breast augmentation surgery.
Bicalutamide (brand names Binarex, Bicalox, or Cosudex), is a pill taken daily orally. Bicalutamide has fewer side effects compared to other anti-androgens.
The Monotherapy Method (oestrogen-only therapy) is another option for blocking testosterone. With a pmol/L of 367.09 (the minimum level recommended by The Endocrine Society), many trans women do not need blockers. With a pmol/L level of 734.19 (the high end of the range recommended by The Endocrine Society) most trans women do not need blockers.
To gain these levels of oestrogen through oral administration, a patient would need to take a dose that would likely present risks for their liver function. However, other methods (such as injections) bypass the liver.
Many healthcare providers in NZ are unaware that injectable oestrogen can be obtained by prescription from compounding pharmacies, and that bioidentical oestrogens do not pose the same health risks as synthetic oestrogens. Therefore they are often unwilling to prescribe for the recommended pmol/L levels, or use the monotherapy method.
5alpha-reductase inhibitors – or ‘DHT blockers’, prevent testosterone from being converted into the more powerful androgen dihydrotestosterone. DHT causes scalp hair loss, and preventing its production can help regrow a receding hairline. These include:
Finasteride (brand names Propecia, Ricit, or Finpro), is a pill taken daily orally. Some people have reported strong negative side effects on mental health.
Progesterone (brand names Utrogestan or Prometrium), is a pill taken daily, usually orally, sublingually, or rectally. Progesterone is also available in a cream which can be bought from compounding pharmacies, and administered to the hairline.
Blocking Oestrogen and menstruation in adults
The sex hormone oestrogen can be ‘blocked’ or ‘suppressed’ using puberty blockers, as discussed. For adults, sex hormones are necessary, so continued use of blockers long term without taking testosterone is not advised.
If a patient is taking testosterone (discussed overleaf), they no longer need to take (GnRH) agonists as the testosterone will suppress their natural oestrogen.
However, birth control is still necessary. Progesterone based Long Acting Reversible Contraceptives (LARCs) such as Depo provera, Jadelle, or an IUD or IUCD are suitable forms of contraception.
Sex hormones
Taking Oestrogen & Progesterone
The sex hormone oestrogen (also known as estrogen or “E”) is a primary sex hormone. Progesterone is sometimes taken in addition to oestrogen, to enhance breast development and assist in regrowing hair.
These hormones are available in the following forms:
Oestradiol Valerate (brand name Progynova), is available as a pill, usually taken orally or sublingually, and can be taken rectally. This is usually taken daily. It is also available as an injection taken every 3-7 days in either gluteus muscle or subcutaneous tummy fat, that can be ordered from a compounding pharmacy with a prescription.
Micronised Oestradiol Hemihydrate (brand name Estrofem), is available as a pill taken daily, usually orally or sublingually. Because it is micronised, Estrofem is especially good for sublingual delivery.
17beta-oestradiol (brand name Estradot), is available as a patch, usually re-applied twice a week.
Progesterone is a secondary sex hormone which some people take in addition to oestrogen. Progesterone enhances breast development in cisgender women and causes “gynocomastia” (breast development) in cisgender men. However, due to a lack of trans-specific research, there is currently no medical indication for progesterone in treating trans women. As a result, most healthcare providers in NZ will not prescribe progesterone.
Progesterone is available in NZ as micronised Progesterone (brand names Utrogestan or Prometrium), a capsule pill which can be taken orally, sublingually, or rectally. Progesterone is also available in a cream which can be bought from compounding pharmacies. Oral delivery is not recommended as it can have a greater chance of causing side effects such as drowsiness, and sublingual delivery can be hard due to the bad taste of the oil in the capsule.
Progesterone is sometimes taken cyclically (referred to as “cycling”) i.e. for a set duration of days every month, in combination with lowering the dose of oestrogen during this period, in order to mimic the ovarian secretion of the hormone as seen in menstruating people. Some endocrinologists have indicated that this method is very effective, however some people find that cycling can cause side effects such as mood swings.
Due to the current difficulty of obtaining a prescription for progesterone, some patients import it without a prescription and self-medicate, however this is not recommended. If a patient does do this, they are still entitled to have their hormone levels monitored by a healthcare provider, and it is recommended to have regular blood tests.
“Previously used conjugated estrogens have been abandoned in favor of bioidentical estrogens.” – WPATH SoC8
Tests for people taking estrogen or progesterone
Annual blood tests: Electrolytes – monitor more frequently if on spironolactone, LFT HbA1c – if risk factors suggest indicated, Lipids – if risk factors suggest indicated, Oestradiol – aim for normal female range (The Endocrine Society recommends target 367.09 pmol/L to 734.19 pmol/L), Testosterone (aim for level < 2 nmol/L).
Taking testosterone
The sex hormone testosterone (also known as “T”) is a primary sex hormone. Adequate levels of testosterone also usually suppress oestrogen and prevent monthly bleeding, however there is still a possibility of becoming pregnant while on this treatment.
Testosterone is available in the following forms:
Testosterone (brand name Androderm), is available as a patch re-applied daily. It’s common for the skin around the patch to feel irritated.
Testosterone is also available as a non-branded injection into muscle or subcutaneous fat (SubQ) from compounding pharmacies such as Optimus Health and CompoundLabs. The advantage of this option is higher concentrations can be ordered than those that are fully funded, meaning that the volume of liquid injected is much smaller.
Testosterone esters (brand name Sustanon), are available in combination as an injection into muscle or subcutaneous fat, usually administered every 2-3 weeks.
Testosterone cipionate (brand name Depo-Testosterone), is available as an injection into muscle or subcutaneous fat, usually every two weeks. Subcutaneous injections are often easier and less risky to administer than intramuscular.
Testosterone undecylate (brand name Reandron), is available as an injection into muscle every 10-12 weeks. This is usually administered by a healthcare provider, and patients are not permitted to self-administer.
Dihydrotestosterone – or ‘DHT’, is a more powerful androgen than testosterone. It can be topically applied directly to the genitals to increase growth. However, the cream is not available in Aotearoa and should not be used without the supervision of a qualified professional.
Tests for people taking testosterone
FBC – every 3 months in first year, then 1-2 times yearly, LFT HbA1c – if risk factors are indicated, Lipids, Testosterone (aim for normal male range).
Overleaf are the main physical and physiological changes which you need to be aware of before discussing with your provider. The lists are not exhaustive.
There are also psychological, emotional, spiritual, and social changes to consider.
The charts of changes and times which you may have read online are always somewhat inaccurate, as the effects of hormone treatment are very different from person to person, and the time at which different changes may occur or complete are even more so.
For example, many charts will say breast growth on oestrogen will stop after 2 years, but many transfeminine people report breast growth happening up to 10 years after starting, sometimes with changes in medications or doses..
Because of the variability from person to person, we have not included expected time frames.
Managing your expectations is important. Transition looks different for every patient, and it’s important to remember that puberty takes time – usually around 7 years to completely finish. However, if you’re getting notably unsatisfactory results from your treatment, making changes to your lifestyle, medication, delivery method, or dosage amount may improve your results.
Estrogen based treatment
Change in body scent and sweat smell
More fat in lips
Decreased production of sperm and ejaculatory fluid
Slower growing and finer face and body hair
Decreased libido and ability to have erections, though erectile function can usually be maintained if desired
Decrease in muscle and redistribution of body fat to hips, thighs, buttocks, and breasts
Breast growth
Slowed or stopped scalp hair loss
Softer skin
Change in genitals – erections may become less firm, decrease in testes size, penis may become smaller and change shape, becoming more like a clitoris
Testosterone based treatment
Change in body scent and sweat smell
Deeper sleep and increased snoring (heightened risk of sleep aponea)
Increased libido
Facial and body hair growth – thicker, darker, and more
Increase skin oil and acne
Scalp hair loss
Increased ejaculatory fluid
Increase in muscle, and redistribution of fat from buttocks, hips, and thighs to tummy
Lighter or absent menstruation
Decreased vaginal lubrication, thinning of vaginal tissues, vaginal canal may shorten
Voice cracking and dropping
Genitals change – clitoris may become larger and change shape becoming more like a penis
Most providers will want to be supportive, even if they’re not sure how to support you. In these cases, providing information to them can help.
Gender Minorities Aotearoa has a web page of comprehensive healthcare resources, research reports, and information at genderminorities.com. There is also a database of trans-friendly healthcare providers by region.
Remember that even if it’s frustrating, unfair, discriminatory, or takes a long time, you will have an easier time in the long run if you keep your cool. If something needs to change, making a complaint is better done in writing than in the heat of the moment.
You are also entitled to a second opinion. This isn’t always easy to get, you may live rurally, have limited time or other resources, and yes, you shouldn’t have to. However, if you’re not getting anywhere, a well written formal complaint can be effective, and if your complaint is not addressed, it can be used to make a complaint to an external body such as the Health and Disability Commissioner.
For a faster solution in some cases, a change of provider may be the simplest course of action. A supportive healthcare provider is everything.
Appropriate health care is a human right, and you are legally entitled to get the right health care. Don’t give up! It may take time but you will get there.
For more in depth information, ideal doses, friendly doctors in your area, or to talk with us, please see our website genderminorities.com or get in touch.
Guidelines for Gender Affirming Healthcare (2018)., Jeannie Oliphant, Jaimie Veale, Joe Macdonald, Richard Carroll, Rachel Johnson, Mo Harte, Cathy Stephenson, Jemima Bullock, David Cole, Patrick Manning.
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, (2022) International Journal of Transgender Health, 23:sup1, S1-S259, DOI: 10.1080/26895269.2022.2100644 E. Coleman, A. E. Radix, W. P. Bouman, G. R. Brown, A. L. C. de Vries, M. B. Deutsch, R. Ettner, L. Fraser, M. Goodman, J. Green, A. B. Hancock, T. W. Johnson, D. H. Karasic, G. A. Knudson, S. F. Leibowitz, H. F. L. Meyer-Bahlburg, S. J. Monstrey, J. Motmans, L. Nahata, T. O. Nieder, S. L. Reisner, C. Richards, L. S. Schechter, V. Tangpricha, A. C. Tishelman, M. A. A. Van Trotsenburg, S. Winter, K. Ducheny, N. J. Adams, T. M. Adrián, L. R. Allen, D. Azul, H. Bagga, K. Başar, D. S. Bathory, J. J. Belinky, D. R. Berg, J. U. Berli, R. O. Bluebond-Langner, M.-B. Bouman, M. L. Bowers, P. J. Brassard, J. Byrne, L. Capitán, C. J. Cargill, J. M. Carswell, S. C. Chang, G. Chelvakumar, T. Corneil, K. B. Dalke, G. De Cuypere, E. de Vries, M. Den Heijer, A. H. Devor, C. Dhejne, A. D’Marco, E. K. Edmiston, L. Edwards-Leeper, R. Ehrbar, D. Ehrensaft, J. Eisfeld, E. Elaut, L. Erickson-Schroth, J. L. Feldman, A. D. Fisher, M. M. Garcia, L. Gijs, S. E. Green, B. P. Hall, T. L. D. Hardy, M. S. Irwig, L. A. Jacobs, A. C. Janssen, K. Johnson, D. T. Klink, B. P. C. Kreukels, L. E. Kuper, E. J. Kvach, M. A. Malouf, R. Massey, T. Mazur, C. McLachlan, S. D. Morrison, S. W. Mosser, P. M. Neira, U. Nygren, J. M. Oates, J. Obedin-Maliver, G. Pagkalos, J. Patton, N. Phanuphak, K. Rachlin, T. Reed, G. N. Rider, J. Ristori, S. Robbins-Cherry, S. A. Roberts, K. A. Rodriguez-Wallberg, S. M. Rosenthal, K. Sabir, J. D. Safer, A. I. Scheim, L. J. Seal, T. J. Sehoole, K. Spencer, C. St. Amand, T. D. Steensma, J. F. Strang, G. B. Taylor, K. Tilleman, G. G. T’Sjoen, L. N. Vala, N. M. Van Mello, J. F. Veale, J. A. Vencill, B. Vincent, L. M. Wesp, M. A. West & J. Arcelus.
