A 2019 study found 19 percent of trans and non-binary people did not have access to gender affirming hormones. Photo: The Gender Spectrum Collection
A national hub for transgender healthcare is needed to help address the inequities faced by the community, a transgender healthcare advocacy group says.
In an article published in today's New Zealand Medical Journal, the Professional Association for Transgender Health Aotearoa (PATHA) said the current healthcare system was failing trans people.
"In Aotearoa New Zealand, transgender people should have full access to both gender affirming healthcare and routine healthcare," the article said.
"Gender affirming healthcare is care that facilitates people's abilities to embody, express and live in their gender. This includes endocrine and surgical procedures, hair removal, voice therapy and providing social and psychological support.
Not all transgender people require such care, but for those who do it is necessary to ensure their wellbeing.
"Timely access to appropriate gender affirming care reduces health inequities faced by transgender people, which could result in lower health costs for this population across individuals' lifespans."
There was a significant unmet need for gender affirming healthcare with a 2018 survey showing 19 percent did not have access to gender affirming hormones, 67 percent of transgender men having an unmet need for chest reconstruction surgery, 50 percent of transgender woman having an unmet need for voice therapy and 49 percent needing feminising genital reconstruction surgery (GRS).
"There is a growing demand for gender affirming healthcare among transgender people, but often there are barriers to this care, including unavailability," PATHA said.
"Transgender people often have to pay significant individual healthcare costs, as gender affirming healthcare is not always accessible through public healthcare systems. This can result in many people being unable to access the care they need, and some may fundraise for this essential healthcare through donations from friends, whānau and transgender communities.
"Even when services are available in the public healthcare system, they are often not sufficient to meet demand due to funding and capacity limitations or a lack of trained healthcare providers.
"Long waiting lists for public endocrinologists or psychologists can delay access to gender affirming hormones or puberty delaying medications for unacceptable lengths of time, or require individuals to pay for private consultations.
"Gender affirming surgeries in the public sector suffer from chronically under-estimating demand, under-resourcing, lacking training in gender affirming care and having to compete for priorities with other elective surgeries. We are not aware of any plan to address the substantial unmet need."
'People-centred, equitable, accessible and cohesive'
The association said the government's ongoing health reforms were an opportunity to offer better and fairer care in a coordinated way.
"The present healthcare system does not adequately meet the needs of transgender people. With the current health reforms, we need to make healthcare for transgender people more people-centred, equitable, accessible and cohesive.
"We propose that this is done by creating a new transgender health resourcing hub that operates under a Te Tiriti o Waitangi framework, provides national coordination of a distributed model of care, actively works to resource primary care and provides support for gender affirming surgeries.
"For the new resourcing hub to work effectively, it should utilise peer health navigators, education and professional development, healing-focussed care and transgender community leadership and transparency."
Some regions were already providing good transgender healthcare.
The association provided examples such as trans leadership being crucial to the redesign of gender affirming healthcare services in Waitaha Canterbury and, in the Northern Region, Hauora Tāhine providing clear and transparent pathways available online for people, employing a key worker to help people navigate access to gender affirming care, and the service being actively involved in local rainbow community events.
By taking lessons from regions doing well and applying them nationally, the inequities faced by the trans community could be improved.
"Much of what we recommend is already occurring in some regions. Designing a national hub will allow us to take the best practices we are seeing and implement them throughout the whole country."