The Gender Affirming (genital) Surgery Service

This service has been established to help more transgender and non-binary people access publicly funded gender affirming genital surgery.

The Service is funded to delivery up to 14 surgeries per year.

The Service is provided through a contractual agreement between Health New Zealand | Te Whatu Ora (Health NZ), and a private provider of gender affirming genital surgery in Aotearoa New Zealand. 

The scope of the Service is gender affirming genital surgery for transgender people. 

The Service is able to provide the following surgical techniques:

• Full Depth 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.

Orchiectomy Incision Placement

When referring locally for orchiectomy please include as an FYI to the surgeon that the procedure ideally should be performed using a short mid-scrotal incision, not the groin or inguinal approach should your patient be wanting either full depth or minimal depth vaginoplasty at some point in the future.

More information

Delivering health services for transgender people

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 referred to the Service and accepted, will be placed on the waiting list for a first specialist assessment (FSA).

Read the quarterly update on current referrals and the waiting list for a first specialist assessment.

Updates from the Gender affirming (genital) surgery service

To be considered for a first specialist assessment a person must be at least 18 years of age, and be eligible for publicly funded surgery and residing in New Zealand and have a current New Zealand residential address. They must be physically and mentally fit to have an anaesthetic and undertake a complex surgical procedure.

It is important that a person referred to the service has a healthy Body Mass Index (BMI), be a non-smoker (including nicotine-based vapes), ensure that any physical and/or mental health conditions are well managed and stable and that their contact details with us remain up to date and are correct.

To be considered a non-smoker, people must be 12 weeks+ completely nicotine free at the time of referral. We require people to continue to be nicotine free when progressing through the pre-surgical pathway.

We require people referred for surgery to maintain a healthy BMI. This is for patient safety and to ensure 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.

Find out more about Body Mass Index (BMI) and how to calculate BMI.

What is body mass index? (BMI) - Heart Foundation (external link)

The Service is currently accepting new patients on to the wait list for a specialist assessment 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 a specialist assessment with the surgeon.

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.

We encourage people with a BMI between 30-35 to speak with their general practitioner about weight loss management programmes and to ask about their eligibility for a Green Prescription (external link).

Please note: Patients on the waiting list will not progress or be offered an FSA or surgery unless their BMI is below 30. 

Referrals must be made on the Gender Affirming (Genital) Surgery Service referral form

Referral form - Gender Affirming Genital Surgery [PDF, 440 KB] and submitted to gender.surgery@tewhatuora.govt.nz once fully completed

The referral form must be fully completed by the Hospital specialists or authorised GP.  The patient referral form must be accompanied with all relevant physical, social and mental health history and clinical reports as outlined in the referral form.

Any referral sent directly to the Service's contracted provider will not be eligible for the publicly funded Service. Only referrals to the Gender Affirming (genital) Surgery Service will be considered.

The waiting list is a list for a specialist assessment appointment 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 or other 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, additional health optimisation, surgical 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 specialist assessment, then the Service will coordinate hair removal funding and readiness assessments, if these are still required.

We ask those who have had a referral accepted to notify us promptly by email gender.surgery@tewhatuora.govt.nz if any of their contact details or circumstances change.

It is important that we have at all times up to date contact information available because if we cannot make contact, patients will be removed from the wait list. Contact information includes a current email address, contact phone number, your home address and your usual GP's details.

Health NZ sends completed referrals with updated health information to the Service provider. Following the review of the submitted referral and information either:

• Health NZ 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.
• it is important that patients on the wait list and progressing through the pre-surgical pathways promptly provide any information requested by Health NZ or the Service. Failure to do so will affect their ability to be reviewed with considered for a specialist assessment and/or their waiting list status. 
• New Zealand citizens are eligible to receive publicly funded services while they live in New Zealand but are not entitled to publicly funded care while residing overseas.

Pre-Referral

Patient Information- Reflection Worksheet
This “Reflection Activities for Surgery Worksheet” resource has been designed as a decision assistance aid for people who are contemplating gender affirming genital surgery. The worksheet should be used prior to any referral submission. It can also be used as a reflective guidance aid at any time by everyone including those currently on the waiting list, GPs, psychologists etc

Reflection Activities for Surgery Worksheet [DOCX, 491 KB]

Referrals

Gender Affirming (genital) Surgery Service referral form

Referrals for gender affirming (genital) surgery must be completed by hospital specialist or an authorised GP (see above for more details).

Referral form – Gender Affirming Genital Surgery [PDF, 440 KB]

Accepted Patients

The following form is for GP use by those who have been accepted and are on the waiting list.

GP to Complete Health and Wellbeing Update

This form is for people who are on the waiting list for specialist assessment when a GP update is requested by the Team and must be completed by the patient's GP.

GP Completed Gender Affirming Genital Surgery – Health and Well-Being Questionnaire Form [PDF, 280 KB]

First Specialist Assessment

What to expect

On the day of their first specialist assessment appointment, patients will be invited to attend a closed, small, patient only group education session occurring that same morning.

The Group Education Session is presented by members of the Gender Affirming (genital) Surgery Service team.

Purpose of the Group Education Session

We provide these patients-only small, closed group session to increase access and reduce waiting times for patients on the waiting list for a Gender Affirming (genital) Surgery First Specialist assessment appointment. These group education sessions enable us to better utilize patients’ one-on-one appointment with the surgeon afterwards, see more patients, and therefore to be able to potentially provide more surgeries.

Confidentiality is outlined to all participants and agreed upon prior to attendance. Note: Patients’ private personal information is not discussed during the group session, although patients can ask questions at the end if they wish.

Patients are expected to attend the group session education session as the information presented at the group session is vital for surgery considerations. The education session provides details about the surgery procedures and requirements, preparation, post operative care and recovery. If group sessions are not attended, this may impact on when you can be assessed by the surgeon

Note: Patients’ private personal information is not discussed during the group session, although patients can ask 

The one – to-one specialist assessment appointment

Following on from the group education session, each attendee will be given a private one-to- one appointment latter that day with the surgeon. This private appointment is where you will be able to raise and discuss in more detail any questions you may have regarding your own specific surgery options, concerns, personal goals and circumstances with the surgeon. 

Phalloplasty

What is Phalloplasty? [PDF, 195 KB]

This information resource is for people wanting to know more about phalloplasty surgery and what is involved.

What is Phalloplasty without Urethral Lengthening [PDF, 168 KB]

This information resource is for people wanting to know more about phalloplasty without urethral lengthening surgery and what is involved.

FAQs Phalloplasty (Frequently Asked Questions) [PDF, 205 KB]

This information resource focuses on helping patients with answering frequently asked questions regarding phalloplasty surgery.

Full Depth Vaginoplasty

What is Vaginoplasty? [PDF, 188 KB]

This information resource is for people wanting to know more about full depth vaginoplasty surgery and what is involved.

Minimal Depth Vaginoplasty

What is Minimal Depth Vaginoplasty? [PDF, 168 KB]

This information resource is for people wanting to know more about minimal depth vaginoplasty and what is involved.

Vaginoplasty FAQs

FAQs Vaginoplasty (frequently asked questions) [PDF, 278 KB]

This information resource focuses on helping patients with answering frequently asked questions regarding vaginoplasty surgery. 

Metoidioplasty

What is Metoidioplasty? [PDF, 219 KB]

This information resource is for people wanting to know more about metoidioplasty and what is involved. 

FAQs Metoidioplasty [PDF, 269 KB]

This information resource focuses on helping patients with answering frequently asked questions regarding metoidioplasty surgery. 

Caregiver and Support Person Information Resources

Choosing Your Caregiver and Support People [PDF, 205 KB]

This information resource will help patients choose a caregiver and support people to make the post-surgery recovery process easier.

FAQ Sheet for Caregivers and Main Support People [PDF, 174 KB]

This information 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.

Post Operative Patient Resources

Re-learning your Body - Vaginoplasty

The Re-learning your Body -Vaginoplasty patient resource is designed to assist and support post operative people who have very recently undergone gender affirming vaginoplasty surgery by providing a set of exercises.

The exercises are designed to help re-train the brain to relearn sensitivity to touch, improve sensation and to help with patients’ genital sensation reaching its full potential.

Re-learning your Body - Vaginoplasty [DOCX, 447 KB]

Re-learning your Body - Phalloplasty

The Re-learning your Body -Phalloplasty patient resource is designed to assist and support post operative people who have very recently undergone gender affirming phalloplasty surgery by providing a set of exercises.

The exercises are designed to help re-train the brain to relearn sensitivity to touch, improve sensation and to help with patients’ genital sensation reaching its full potential.

Re-learning your Body - Phalloplasty [DOCX, 441 KB]

How to contact us

Email any questions regarding gender affirming (genital) surgery to: 

gender.surgery@tewhatuora.govt.nz

The focus of the 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. If you are considering self-funding genital reconstruction surgery overseas, please consider the information provided by SafeTravel here:

Medical tourism - SafeTravel (external link)

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.

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:

1. Do you travel more than 350 km one way per visit for an adult, or
2. Will you visit a specialist 22 or more times in two months, or
3. 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
4. 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 and post operative accommodation under the NTA Scheme, travel and post operative accommodation until medically discharged to return home may be an additional expense for the patient. Patients will be advised whether they are eligible for NTA well in advance of their appointment.

More information

National Travel Assistance - Health Information and Services (external link)