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About the service
Gender Affirming (Genital) Surgery Service (the Service) has been established to help more transgender and non-binary people access publicly-funded gender affirming genital surgery in Aotearoa New Zealand.
The Service has been funded with $2.99 million approved in Budget 2019 over four years for the delivery of up to 14 surgeries per year.
The Service is provided through a contractual agreement between Manatū Hauora (Ministry of Health), and a private provider of gender affirming genital surgery in Aotearoa New Zealand. From 1 July 2022, Te Whatu Ora Health New Zealand (HNZ) coordinates the waiting list for a first specialist assessment (FSA) with the surgeon.
The scope of the Service is gender affirming genital surgery for transgender people.
The Service is able to provide the following surgical techniques:
- Vaginoplasty
- Minimal Depth Vaginoplasty
- Metoidioplasty with or without urethral lengthening
- Phalloplasty with or without urethral lengthening
Referrals for other gender affirming surgeries and referrals for people with an intersex variation should be sent to the person’s local hospital network, in accordance with locally agreed pathways.
Further information on the Service can be found at Delivering health services to transgender people.
New referrals to the Service
Referrals to the waiting list need to be made by a hospital specialist unless a hospital network has agreed to allow general practitioners to make referrals on their behalf.
People referred to the Service and accepted, will be placed on the waiting list for a first specialist assessment (FSA).
Read the monthly update on current referrals and the waiting list for a first specialist assessment.
To be considered for a first specialist assessment a person must be at least 18 years of age, and medically fit to have an anaesthetic and complex surgery.
It is important that a person on the waiting list maintain a healthy Body Mass Index (BMI), be a non-smoker (including nicotine-based vapes) and ensure that any physical and/or mental health conditions are managed and stable.
We require people referred for surgery to maintain a healthy BMI. This is for patient safety and the best possible surgical outcome. International evidence shows a significant risk of complications with these highly complex surgeries, when a patient has a high BMI.
The Service is currently accepting new patients with a BMI less than 35.
Patients with BMI 30-35 are advised to see their general practitioner about weight loss management programmes and to ask about their eligibility for a Green Prescription.
This gives patients the opportunity to reduce their weight to a BMI of 30 or less, in a managed and safe way over time, while they wait for their FSA with the surgeon.
Please note that any referral sent directly to the Service’s contracted provider will not be eligible for the publicly-funded Service. Only referrals that are forwarded to the Service by the HNZ wait list coordinator, will be accepted.
Health NZ sends completed referrals with updated health information to the Service provider. Following the review of the submitted referral either:
- Te Whatu Ora Health NZ will contact a patient if the Service requires additional health information before considering them for a first specialist assessment or
- the Service will contact the patient directly with the offer of an appointment for a first specialist assessment.
The waiting list
The waiting list is a list for a first specialist assessment (FSA) with the surgeon. It is not a waiting list for surgery.
The number of people on the waiting list is constantly changing as new referrals are received, and the waiting list is updated following the validation of referrals. Some people cannot be contacted, advise they no longer require surgery, or need to address health issues before they are ready for a first specialist assessment or surgery.
Therefore, attributing a ‘number’ to a referral on the waitlist does not depict the specific order that a patient may be considered for a first specialist assessment, or the length of time someone may be on the waiting list.
The preparation time for surgery can be lengthy as patients may require weight loss, readiness assessment and/or hair removal prior to proceeding to surgery.
There is no reimbursement available to patients who pay for hair removal prior to their first specialist assessment. After the patient has been seen by the Service at the FSA, then the Service will arrange for hair removal procedures and readiness assessments, if these are still required.
Given the number of people on the waiting list, we ask those who have had a referral accepted to notify us promptly by email gender.surgery@health.govt.nz if their contact details or circumstances change. We also encourage people to complete the Gender Affirming Genital Surgery – Patient To Complete Annual Review Form (pdf, 184kb) annually to ensure that we have up to date contact details and relevant information.
It is important that we have up to date information because if we cannot make contact, patients may be removed from the wait list. It is very helpful if during your annual check in with your GP, you ask them to fill in the Gender Affirming Genital Surgery – GP To Complete Health and Well-Being Questionnaire Form (pdf, 273kb) and have them send it through to us at gender.surgery@health.govt.nz.
Referring for masculinising or feminising gender affirming genital surgery
Gender affirming genital surgery can be publicly funded and provided in New Zealand in the private sector.
People who have been referred for gender affirming genital surgery are on a waiting list for a first specialist assessment (FSA) to see a surgeon and discuss their surgery options.
There is currently a long waiting list for an FSA. From 1 July 2022, Te Whatu Ora Health New Zealand (HNZ) is managing the waiting list for an FSA.
New referrals for gender affirming genital surgery can be made by the person’s transgender health professional. This is normally an endocrinologist or a sexual health physician. In some cases, a referral from a general practitioner with special expertise in transgender care can be accepted.
To be considered for surgical assessment, patients need to:
- meet the eligibility criteria set out in the Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People, published by The World Professional Association for Transgender Health (WPATH)
- be eligible for publicly funded surgery in New Zealand
- be physically and mentally fit to undertake a complex surgical procedure. This includes being a non-smoker, having a BMI under 35 and good mental health and social support.
Referrals should be made on the Gender Affirming (Genital) Surgery Service referral form (available below), with relevant physical, social and mental health history/clinical reports attached.
Send referrals to: gender.surgery@health.govt.nz.
People on the waiting list will be contacted every 12 months to update their contact details and health status.
Gender affirming (genital) surgery service forms and support documents
Referrals for gender affirming (genital) surgery must be complete by an authorised GP or hospital specialist.
People on the waiting list are encouraged to complete the annual review form and to send it to Te Whatu Ora - Health New Zealand every twelve months.
People who are on the waiting list for an FSA and have received an appointment date for an FSA will be sent the health and well-being questionnaire form which must be completed by the patient’s GP.
People who are on the waiting list for an FSA and have received an appointment date for an FSA will be sent the health and well-being questionnaire form which must be completed by the patient’s GP.
This resource is for people wanting to know more about phalloplasty surgery and what is involved.
This resource will help patients choose a caregiver and support people to make the post-surgery recovery process easier.
This resource focuses on helping the patient’s caregiver and support people through the post-surgery recovery process with different ways on how to support the patient.
Email any questions regarding gender affirming (genital) surgery to: gender.surgery@health.govt.nz.
Revision surgery
The focus of the Ministry-funded service is to improve access to gender affirming genital reconstruction for transgender people who have not previously been able to have this surgery.
People who have had or are considering self-funding genital reconstruction surgery in New Zealand or overseas should be aware that the Service will not routinely accept referrals for elective revisions of past surgeries.
People who have or are considering self-funding surgery are advised that their local hospital network is responsible for treating emergency or urgent complications from surgery. Non-emergency / non-urgent complications or sub-optimal outcomes from self-funded surgeries should be referred to the surgical team who provided the patient’s surgery or their GP.
The Service will not reimburse the cost of surgery to patients on the waiting list for publicly funded surgery, who choose to self-fund private surgery in New Zealand or overseas.
National Travel Assistance
A patient offered a first specialist assessment who needs to travel a long distance for the appointment may be eligible for financial assistance under the National Travel Assistance (NTA) Scheme.
A patient may be eligible for the NTA if they can answer yes to one of these questions:
- Do you travel more than 350 km one way per visit for an adult, or
- Will you visit a specialist 22 or more times in two months, or
- Will you visit a specialist six or more times in six months, and travel more than 50 km one way per visit for an adult, or
- Are you a Community Services Card holder and travel more than 80 km one way per visit for an adult?
The Service will assist patients register for NTA. Eligibility for NTA is decided by a patient’s local hospital network, after the hospital network has received a copy of the NTA registration form and appointment letter from Health NZ.
If Health NZ does not approve financial assistance for travel under the NTA Scheme, travel may be an additional expense for the patient. Patients will be advised whether they are eligible for NTA well in advance of their appointment.