Updates from the Gender affirming (genital) surgery service

Current status

As at 30 September 2024, there were 326 people on the active wait list for their first specialist assessment (FSA) as part of the Gender Affirming (Genital) Surgery Service (the Service). Of those 326 people, 101 have had an FSA.

Seven surgeries have been performed so far in 2024 with one surgery planned for October.  

The Service continues to review the wait list to ensure patients meet the current service referral criteria for acceptance onto the waitlist and to give us a better and more informed picture of everyone’s overall current health status.

As part of our ongoing waitlist review and validation process, patients referred during 2021 have been contacted to provide updated health and wellbeing questionnaires. Each patient’s General Practitioner (GP) needs to complete the health and wellbeing questionnaire. Patients who do not meet the service’s referral acceptance criteria, do not respond to communication or who do not provide the GP completed information within required timeframes will not be considered and will be removed from the wait list as part of the review process, with patients and their GP's or referrers are being advised of these requirements.

This is consistent with the regional hospitals’ current pathways of accessing elective reconstructive surgeries, including top (chest reconstruction/breast removal) surgeries, breast reconstructions and breast reductions.

It is important that you contact us immediately if you decide you no longer want to be considered for an FSA/no longer want surgery, or if your contact details, home address, or GP has changed. Email us at gender.surgery@tewhatuora.govt.nz to let us know about any changes.

Wrap around health and wellbeing support for the Service

Health New Zealand | Te Whatu Ora is working to improve and increase wrap around services. 

The wrap around services will include the establishment of several new roles to provide more intensive health and wellbeing support for patients on the waiting list for an FSA and/or preparing for surgery. 

One of these support roles is Pathways Health. Pathways is a leading national provider of community-based mental health and addiction services operating across Aotearoa New Zealand. Pathways was formed in 1989 and is currently operating in fifteen regions across the country contracted to Health New Zealand and Oranga Tamariki-Ministry for Children. 

Pathways provides via the GAgSS Gender Affirming Package of Care a number of individualised patient centred services to patients receiving surgery to help meet their needs. This include providing patients with some mental health and wellbeing support during the immediate post operative recovery phase, use of sensory modulation kits specially developed to assist patients, transportation assistance for post-surgical appointments and at times assisting with collection of essential medications and food. 

New referrals to the service

New referrals for gender affirming genital surgery can be made by the person’s public hospital transgender health specialist(this is normally an endocrinologist or a sexual health physician) or for those in Wellington and Christchurch districts only, this may be done by their general practitioner (GP).

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. Please note: it is not a waiting list for surgery.

To be considered for first specialist surgical assessment (FSA), patients need to meet the Gender Affirming (genital) Surgery Service eligibility criteria:

• be eligible for publicly funded surgery and residing in New Zealand and have a current New Zealand address.
• be at least 18 years of age
• be physically and mentally fit to have an anaesthetic and undertake a complex surgical procedure.
• Be a non-smoker (including nicotine based vapes and recreational drugs). To be considered a non-smoker people must be 12+ weeks completely nicotine free.  
• Have a BMI under 35. Referrals are currently accepted for patients on to the wait list for a first specialist assessment (FSA) with a BMI less than 35, with the expectation that patients with a BMI between 30 and 35 will be working with their general practitioners (GP) on a healthy weight management programme while they are waiting to be offered an FSA with the surgeon. Patients on the waiting list will not be progressed or offered surgery unless their BMI is below 30that patients have a minimum of 12 continuous months of gender affirming hormone therapy as appropriate to their patient gender affirmation goals.
• that patients have a minimum of 12 continuous months of gender affirming hormone therapy as appropriate to their patient gender affirmation goals.
• and good mental health and social support.

The chart below sets out the number of new referrals received by quarter between January 2013 and  June 2024. Overall, 78 percent of the referrals are for feminising surgery and 22 percent are for masculinising surgery.