Transgender surgery and therapy

The word ‘transgender’ or ‘trans’ covers a wide variety of genders. For this content, we use the word transgender — but we acknowledge people may identify a different way. 

Some other words that people might use, including Māori and Pacific terms include:

• aikāne
• akava’ine
• fa’afafine
• fa’atama
• fakafifine
• gender diverse
• genderqueer
• māhū
• non-binary
• palopa
• takatāpui
• tangata ira tāne
• trans
• transsexual
• vakasalewalewa
• whakawahine.

Other people may have another gender not included in this list. This may be another term in English, Te Reo Māori, or may be specific to another language or culture.

Transgender people may be:

• binary — their personal sense of their gender is male or female
• non-binary — their gender is neither male or female, or strictly male/boy or female/girl.

Gender affirmation (transition) is an umbrella term for a range of actions and possibilities that are unique to each person. 

Some transgender people choose a form of medical affirmation, such as gender affirming hormone therapy or surgery.

Both the steps people choose to affirm themselves (transition goals), and when they choose to do so, will be unique to each person. Each person will have their own personal goals. This will depend on what feels personally affirming, what feels safe to do, and what is accessible and available. These individual goals may include different aspects of social, medical, or surgical care.

The way people express their gender is up to each individual, and may or may not conform to social expectations of:

• behaviour
• dress
• mannerisms typically associated with being either solely male or female. 

Some, but not all, transgender people experience distress from the differences between their gender, and the sex they were assigned at birth. This is known as gender dysphoria. Timely access to gender-affirming healthcare can help this distress.

Some transgender people — generally those aged 16 years and older — use hormone therapy. Hormones can cause many physical changes to a transgender person's body. This helps align their bodies more closely with their identity. Some changes are reversible, and some are permanent. 

Health professionals with transgender healthcare knowledge support people when they start on hormone therapy. If you are less than 18 years old, a specialist healthcare team across different areas of healthcare may be involved.

Some transgender people use speech language therapy to help them use their voice in a way that more closely matches the way they want to talk. 

Publicly funded availability of this service depends on:

• the capacity within your local hospital
• the clinical priority given to your referral.

Some transgender people want to have gender affirming surgery. Surgeries can include:

• removal of testes (orchiectomy)
• chest reconstruction surgery — often called 'top surgery' — which involves subcutaneous mastectomy, creating a more masculine chest appearance
• removal of the uterus (hysterectomy)
• removal of the ovaries and fallopian tubes (salpingo-oophorectomy)
• a broad range of procedures to give the face a more traditionally feminine appearance (facial feminisation surgery)
• surgery to change the pitch and tone of voice — or both — to more typically feminine (laryngoplasty or vocal fold surgery)
• surgery to increase breast size (breast augmentation)
• a broad range of procedures to change the appearance and function of genitals, or both (vaginoplasty, minimal depth vaginoplasty, phaolloplasty, or metoidioplasty)

Publicly funded availability of these surgeries, except for genital surgery, depends on:

• the surgical expertise and capacity within your regional hospital
• the clinical priority given to your surgery.

You may need an assessment by a mental health professional of your readiness before you can be referred for consultation with a surgeon. 

Guidance on eligibility for all gender affirming surgery is in the Standards of Care for the Health of Transexual, Transgender and Gender Nonconforming People. This is published by the World Professional Association for Transgender Health (WPATH).

Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People — WPATH (external link)↗

Gender affirming genital surgery is publicly funded and provided in Aotearoa New Zealand. It includes:

• vaginoplasty
• minimal depth vaginoplasty
• phalloplasty with or without urethral lengthening
• metoidioplasty with or without urethral lengthening.

Referral to the waiting list

Referrals to the waiting list need to be made by a hospital specialist, or your usual health professional. This is normally an endocrinologist or sexual health physician, unless a hospital network has agreed to allow general practitioners to make referrals on their behalf. 

People whose referral for gender affirming genital surgery has been accepted are on a waiting list for a first specialist assessment (FSA). This is with the surgeon to discuss their surgery options. It is not a waiting list for surgery.

There is currently a long waiting list. Regular updates are provided on the Health New Zealand website. You may be asked to see your healthcare provider, regular doctor, or Nurse Practitioner to complete health updates while you are on the waiting list.

Eligibility for referral

To be considered for surgical assessment, you need to meet the eligibility criteria. To find out more information about the surgeries, visit the Health New Zealand website. 

The Gender Affirming (Genital) Surgery Service — Health New Zealand (external link)↗