Gender affirming healthcare services — Wellington, Hutt and Kapiti

Affirming gender with hormones, also known as gender affirming hormone therapy (GAHT), involves using hormone therapy (oestrogen or testosterone) to alter physical characteristics and help align the body more closely to a person's own sense of their gender. For transgender and nonbinary people, GAHT can be a way to alleviate distress (gender dysphoria) and improve mental and physical wellbeing.

The effects of hormone therapy can vary greatly from person to person — some changes may be reversible, while others are permanent. It is crucial to discuss the potential benefits and risks of GAHT with a qualified healthcare provider to determine if it is the right choice for you.

Not all transgender or non-binary people want or decide to choose GAHT to affirm their gender.

Getting started 

First steps

If you are a transgender or non-binary person aged 18 years or over and want to start gender affirming hormone therapy (GAHT), you should make an appointment with your usual healthcare provider and start discussing this with them.

For those under 18, see the section For youth and adolescents aged under 18 years.

Assessment and referral

Your healthcare provider may have specialty expertise and training in gender affirming healthcare and, if appropriate, may be able to conduct an assessment and initiate GAHT themselves. Please ask them if they can access primary care funding to cover any extended and additional appointments for gender affirming care.

Baseline blood tests

Your healthcare provider may order baseline blood tests before starting hormone therapy.

Fertility preservation

Fertility preservation will be discussed with you before any commencement of GAHT. We suggest looking at the links below in preparation and speaking with your healthcare provider regarding criteria, eligibility for public funding and for a referral to Fertility Associates for fertility preservation if this is something you would like.

Transgender fertility — Fertility Associates (external link)

Wellington — Fertility Associates (external link)

Referrals to specialists

In most cases, your healthcare provider will refer you to the specialists at your local endocrine department. The endocrine department provides specialist secondary health care services, which include supporting transgender and non-binary people who require gender affirming hormone therapy.

All referrals to the endocrine service must come from a healthcare provider such as your usual GP. To process your referral, they also need you to provide the patient self-assessment 'gender diverse' form, which you complete yourself and give to your healthcare provider to send with your referral. 

Ask your healthcare provider to go to HealthPathways, to give you the patient self-assessment 'gender diverse' form to complete, which is in the referral criteria section.

The endocrine department provides services for GAHT only. 

They are unable to: 

• accept enquiries or referrals for gender affirming surgeries
• offer a counselling service, ongoing therapy or psychological intervention
• provide support for people who are questioning their gender and do not currently want gender affirming hormone therapy.

What to expect at appointments 

At your first appointment, you will meet with the team's clinical psychologist for a psychosocial assessment. The psychologist is based at Wellington Regional Hospital. 

For most people, this will be a single 90-minute-long appointment. However, sometimes people may require an additional 90-minute appointment to complete the psychosocial assessment.

There is a significant waiting list to be seen by the psychologist, up to 12 months.

The purpose of the psychology assessment appointment(s)

The psychological readiness assessment for GAHT aims to determine a patient's capacity to make an informed decision about their healthcare, including hormone therapy for gender affirmation. It is not a test of 'transness' or a barrier to accessing treatment, but rather an opportunity to discuss the process, potential side effects, and available support.

The primary goal is to ensure the patient understands the risks, benefits, and the potential reversible and irreversible effects associated with hormone therapy including the impacts on fertility, addressing mental health concerns, and providing education about the process, allowing them to make an informed decision, considering their mental health and understanding of the process.

A more detailed breakdown of what happens during the psychosocial assessment:

• Exploring goals and expectations — the psychologist will discuss the person's reasons for seeking hormone therapy, what they hope to achieve, their goals, expectations and concerns regarding hormone therapy and understanding of the potential outcomes. 
• Understanding the process — they will provide information about the different types of hormone therapy available, the potential side effects, and the importance of regular monitoring. 
• assessing mental health — the psychologist will inquire about any existing mental health concerns or challenges that may be relevant to the decision to start hormone therapy. This includes identifying any existing mental health concerns or conditions that may need to be addressed before or during hormone therapy. The psychologist will explore with you how you manage stress, your social support networks, and your ability to cope with the potential emotional and physical changes of hormone therapy. 
• referring for further support — if necessary, the psychologist may refer the person to other mental health professionals for specialised therapy or support. 
• reproductive options — discussions will cover the potential impact on fertility and other reproductive options. 

Summarising the assessment findings

The psychologist will document their observations, recommendations, and any concerns regarding your readiness for hormone therapy. The report guides the decision-making process and ensures appropriate care for you.  

It is crucial to understand that the assessment is not a test of a person's gender or a way to 'screen' for mental health issues. It is a process to ensure the person is well-supported and understands their choices.   

What happens next

You will be given an appointment to see the endocrinologist. This is usually about 6 to 8 weeks after your appointment(s) with the psychologist, and the appointment will be 40 to 60 minutes long.

The endocrinologist will focus on your physical health and will ensure you understand the irreversible and reversible effects of hormone therapy from a medical perspective. In most cases, you will be prescribed hormone therapy and given a script at this appointment. In some cases, further medical investigations may be required before this is possible, such as when awaiting blood test results. 

After each appointment, the endocrinologist sends clinical letters to your healthcare provider outlining your management plan. They support your healthcare provider in providing ongoing maintenance once established. Please see your healthcare provider for repeat prescriptions between appointments with the endocrinologist.

You may receive a few additional appointments with the endocrinologist as they review your progress during the first year, before discharge back to your healthcare provider.

Depending on your residential address, Health New Zealand | Te Whatu Ora will offer the appointment with the endocrinologist at: 

• Wellington Regional Hospital
• Hutt Hospital
• Kenepuru Community Hospital
• Kāpiti Health Centre.

Some transgender people want to have gender affirming surgery. Publicly funded availability of these surgeries, except for genital surgery, depends on:

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

Gender affirming surgeries can include:

• chest masculinisation or reconstruction — different surgical techniques that remove breast tissue and reshape the chest to create a more masculine appearance, often including common mastectomy techniques
• breast augmentation — surgery to increase breast size.

Both of these surgeries are often called 'top surgery'.

These services are not currently available in Wellington, Hutt and Kapiti and referrals are not accepted.

Surgery on reproductive organs

Removal of testes (orchiectomy)

Health New Zealand | Te Whatu Ora Urology services in Wellington, Hutt or Kapiti do not have the capacity to offer gender affirming orchiectomy. Referrals are not accepted. 

Removal of the uterus (hysterectomy) and removal of the ovaries and fallopian tubes (salpingo-oophorectomy)

Hysterectomy and salpingo-oophorectomy are both offered by the 'Women's Health Service' at Wellington Regional Hospital to those residing in Wellington. Hutt and Kapiti. Speak to your healthcare provider to discuss referral criteria and for a referral.

Facial feminisation surgery (often referred to as “FFS”)

This term covers many procedures to give the face a more traditionally feminine appearance.

This service is not currently available in Wellington, Hutt and Kapiti and referrals are not accepted.

Tracheal/ laryngeal shave (chondrolaryngoplasty)

Surgery to reduce laryngeal prominence (often known as the Adam's apple).

Tracheal shave and other facial feminisation surgeries are not provided by Health New Zealand | Te Whatu Ora in Wellington, Hutt or Kapiti regions and referrals are not accepted.

Vocal cord surgery

Surgery to change the pitch and tone of voice — or both — to more typically feminine (laryngoplasty or vocal fold surgery).

This service is not currently available in Wellington, Hutt and Kapiti and referrals are not accepted.

Gender affirming genital surgery

The term gender affirming genital surgery covers a broad range of procedures to change the appearance and function of genitals and is publicly funded and provided in Aotearoa New Zealand.

The procedures available are:

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

More information on surgeries, patient information resources and referral criteria is on our Gender Affirming (genital) Surgery Service page.

The Gender Affirming (genital) Surgery Service — Health New Zealand | Te Whatu Ora (external link)

For people whose referrals are accepted and are placed on the waiting list, it is a waiting list for a first specialist assessment (FSA) and to discuss options with the service provider. It is not a waiting list for surgery.

Self-funded or private surgery

To make a private surgery referral in Aotearoa New Zealand or to an overseas provider, you usually require an in-depth referral from your healthcare provider. You can then choose to see a specialist privately, which means you'll pay for the appointment and treatment, and pay for the surgery directly yourself. You should talk to your healthcare provider to discuss your options and get their recommendations based on your needs and circumstances.   

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 or 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 healthcare provider. 

Medical tourism — Safe Travel (external link)

Voice and speech-language therapy

The speech and language services in Wellington can provide outpatient gender affirming voice therapy through speech-language services at Wellington Regional Hospital or Hutt Hospital.

Gender affirming voice therapy works to achieve the goals you have for your voice and communication. Your results will depend heavily on how regularly you practice the techniques you learn in sessions.

To access these services, you need a referral from either a healthcare provider or an endocrinologist and to fit the eligibility criteria.

The eligibility criteria include:

• you need to be experiencing voice dysphoria
• you should be in a position to use your new way of voicing full-time.

The purpose of this access criteria is to make sure people significantly impacted by voice dysphoria have access to a public service and that they can regularly use a new way of voicing. This gives the best chance to habitualise voicing and carry it over to everyday life.

Wait times for speech and voice therapy in the public system can be up to 10 months. To make sure as many people as possible have the opportunity to access services, the number of sessions is limited to 4 to 6 per person. Your speech-language therapist will work with you to figure out how to make the most of these sessions based on your goals and how you like to learn.

Private speech therapy is an option for people who do not have voice dysphoria or are interested in using a new way of voicing part-time. A list of private providers can be found on the New Zealand Speech-language Therapists' Association website.

Find a therapist — New Zealand Speech-language Therapists' Association (external link)

Health New Zealand | Te Whatu Ora in Wellington, Hutt and Kapiti provides gender affirming medical healthcare for transgender and non-binary young people under 18. 

Referral information

A referral for this service must come from a healthcare provider.

Ask your healthcare provider to check HealthPathways for referral criteria for to refer to the appropriate service.

For those aged under 16 years, referrals must be made to the child health service at either Wellington Regional Hospital or Hutt Hospital.