Some people need surgery or medical treatment to affirm their gender or sex. Some gender-affirming healthcare is available for free through the public health system, other gender-affirming treatments are only available self-funded, and some are not available in New Zealand.
Funding for genital reconstruction surgery
The Ministry of Health recently created the “Gender Affirming (Genital) Surgery Service” to help trans people access publicly funded gender affirming genital reconstruction surgery. There is only one surgeon in New Zealand who can perform these surgeries, and the funding is limited. The average wait time for publicly funded surgery is 10-13 years.
The specific types of reconstruction surgery available include surgery to construct a penis (metoidioplasty or phalloplasty) and surgery to construct a vagina and vulva (vaginoplasty).
How do I start the process to get gender-affirming genital reconstruction surgery?
Getting a referral for a First Surgical Assessment (“FSA”)
First, talk to your usual GP. In some regions, your GP can refer you to the waiting list for a “first surgical assessment” (FSA).
If your GP cannot do this, they can refer you to a specialist who can, and ask them to refer you to a transgender health professional. This is usually a sexual health physician or a specialist in hormone-related treatments. In some cases, your GP might be a transgender health professional themselves.
To be eligible for a FSA referral, you will need to have a psychological appointment. If you have already had one in relation to starting hormones, you won’t need another one until you reach the top of the FSA waitlist.
The transgender health professional will give you more information about the options available for gender-affirming surgery, and what the eligibility requirements are. If you both agree, they will refer you to see a surgeon for an FSA.
Waiting and preparing for your FSA
There are currently long wait times for an FSA. You’ll be asked to complete a review form once every 12 months while you are waiting for an appointment date to be set.
When you are near the top of the FSA waiting list, you’ll be sent additional forms, which will ask for specific health information, including your BMI and questions about smoking and vaping. If you don’t meet the eligibility requirements at this stage (for example, if you were required to stop smoking but you didn’t), you will be removed from the waiting list.
When the appointment date is set, you’ll be asked to complete some further forms. You’ll also be given more information about what to expect in the assessment.
At your FSA
At your FSA, you’ll meet with a surgeon and discuss the surgery in more detail. The surgeon will give you information about the surgical techniques they can offer, and answer any questions you have.
If you want to go ahead with the surgery, the surgeon will give you information about the timeframe for receiving the surgery and any steps you need to take next.
Funding for top surgery and other gender-affirming surgeries
Other types of surgery are sometimes available through public funding. These include:
- top surgery (removing or constructing breasts)
- uterus removal (hysterectomy)
- ovary removal (oophorectomy)
- testicle removal (orchidectomy)
If you are interested in any of these treatments, you can talk to your GP about your next steps.
Funding for non-surgical gender-affirming treatments
Public funding is also available for some non-surgical gender-affirming treatments. These include:
- Hormone therapy
- Your GP can prescribe you hormones as part of your gender-affirming care. To do so, they just need to complete a screening with you. If they don’t feel confident doing this, they might refer you to an endocrinologist or a psychologist first.
- Hair removal and voice therapy
Gender Minorities Aotearoa has free and low-cost hair removal clinics for trans people in Wellington, Tauranga, Whangārei, and Auckland. You don’t need a medical certificate to access these clinics. To find out more, see: “Where to go for more support” at the bottom of this page.
You can get funding for voice therapy or permanent facial hair removal through Work & Income if you meet the financial requirements for a “disability allowance”. You don’t have to be on a benefit to access this funding. In most cases, if you are a single adult, you just need to earn less than $786.69 per week before tax.
You will need a medical certificate from a doctor or specialist to access this funding from Work & Income, which says this is an “essential medical treatment” for a medical condition you are diagnosed with. The “medical condition” can include gender dysphoria.
Self-funding your gender-affirming healthcare
If you are denied public finding, you may still be able to get your healthcare if you fund it yourself.
In some circumstances, it is possible to withdraw funding for surgeries from your KiwiSaver, if you have one. This is done on a case-by-case basis. You will need to talk with your KiwiSaver provider to find out their policies.
Some surgeries and hormone medications are not publicly funded, but are available in Aotearoa if you can self-fund. You can find information about these treatments on the Gender Minorities Aotearoa website, here (or go to genderminorities.com and search: “Gender affirming hormone treatment – a guide for patients”).
You can also talk with your GP or specialist about the treatments available through self-funding.