Health Professionals Concerned At Further Delays To Gender Affirming Healthcare Guidelines
This is clear evidence of ideological interference in an operational, professional frontline medical resource that is being requested by the health sector. We reiterate our call for the Government to allow Te Whatu Ora Health New Zealand to publish these …
The Professional Association for Transgender Health Aotearoa (PATHA) is deeply concerned at further delays to the publication of updated Guidelines for Gender Affirming Healthcare in Aotearoa New Zealand.
PATHA has been informed by Te Whatu Ora | Health New Zealand that the updated Guidelines will not be published until the Minister of Health decides on whether to introduce regulations on the ability of medical professionals to prescribe puberty blockers as part of gender affirming healthcare.
The guideline's advice on prescribing puberty blockers was updated in November 2024 to reflect the Ministry of Health's position statement on the use of these medications. This advice spans just 6 of the total 182 pages of information contained in the guidelines. The guidance is evidence-based, aligns with international best practice and guidelines, and supports a holistic approach to gender affirming medical care for young people who need it.
'Medical professionals working in this area are constantly being asked by colleagues for clinical guidance on gender-affirming healthcare,' says Dr Rona Carroll, a Specialist General Practitioner and Vice-President of PATHA. 'By not publishing the updated guidelines, the government is stopping healthcare providers from being guided by evidence-based, up-to-date New Zealand specific information. We have been given no timeframe for when to expect a decision about the puberty blocker consultation or the updated guidelines. Considering how many other areas of health these guidelines include, and that the advice on prescribing puberty blockers is in line with the Ministry's position statement, the updated guidelines should be published immediately. I think clinicians would be providing safer care if they had access to these guidelines today.'
On Wednesday, 28 May, PATHA published an open letter calling on the Minister of Health, Simeon Brown and the Associate Minister for Health, Matt Doocey, to release the updated guidance.
This letter was signed by over 500 medical bodies, clinicians and community organisations. Signatories include the Royal New Zealand College of General Practitioners, the New Zealand Society of Endocrinology, the College of Child and Youth Nurses, and the Paediatric Society of New Zealand.
The evidence-based guidelines, which have been peer reviewed by clinicians with expertise in this care from within New Zealand and internationally, provide detailed information on a wide range of topics relevant to healthcare for transgender and non-binary people. This includes several revised chapters from the 2018 edition in line with emerging medical research.
'I'm proud of the amount of work the authors have put into these guidelines, bringing their extensive collective expertise into creating guidance that is broad and has a holistic view of transgender health,' says Jennifer Shields, PATHA President. 'These guidelines cover so much more than puberty blocker medication, and this information is important for all healthcare workers to have.'
'It is clear that there is no evidence-based justification for considering restrictions on prescribing puberty blockers to transgender young people,' Shields says. 'These medications continue to be prescribed to children for other indications, and limitations in the quality of the academic evidence are not unique to this care. Healthcare professionals are now left wondering if this government is being pulled into alarming 'culture war' trends away from best practice medical care, and into anti-transgender policies that lead to a reduction in patients' rights and freedoms, and set precedent for making clinical decisions based on political beliefs rather than what's best for patients.'
'This is clear evidence of ideological interference in an operational, professional frontline medical resource that is being requested by the health sector,' Carroll said. 'We reiterate our call for the Government to allow Te Whatu Ora Health New Zealand to publish these updated guidelines immediately.'
Background information
Statement on puberty blockers
On 21st November 2024, the Ministry of Health published a position statement on the use of puberty blockers in gender affirming care, emphasising that puberty blockers could continue to be prescribed when needed as part of interdisciplinary teams. The Government expressed an intention to explore further restrictions on access to this care, and opened public consultation on possible restrictions. This consultation closed on 20th January 2025.
A memo sent to then Minister of Health Shane Reti on 30 April 2024 was released to PATHA under the Official Information Act. In this memo, the Ministry of Health clarified that:
'There is currently no evidence that individual clinicians are prescribing [puberty blockers] outside of an interprofessional team.'
This shows that concerns about individual professionals prescribing puberty blockers inappropriately are unfounded, and current prescribing practices are already in line with the Ministry's position statement.
PATHA previously published a collective statement opposing the restrictions the Government is considering on the prescription of puberty blockers to transgender young people. This statement also received broad support from medical bodies, including the New Zealand Paediatrics Society and the New Zealand Society of Endocrinology. The statement reads [in part]:
'The Ministry of Health Evidence Brief identified that any evidence of harm associated with providing puberty-blocking medication is limited and inconclusive, and withholding this care may exacerbate gender dysphoria and negatively impact mental health. Equitable and non-discriminatory access to this care should be provided and maintained throughout the country.
Decisions about prescribing puberty blockers should continue to be made collaboratively between young people, their families or support people, and the health professionals involved in their care. These decisions are individualised, based on informed consent, and guided by professional training, clinical experience, and the best available evidence. Any move to restrict access to puberty blockers would be a political decision and not one based on clinical guidance from health experts in New Zealand and international best practice. Medical decisions should remain free from political interference.'
Background on puberty blockers
Puberty blockers are a medication called gonadotrophic releasing hormone (GnRH) agonists. They were developed in the 1980s for use in much younger children with precocious (early) puberty, and have been used in gender affirming care for over 20 years. They halt the development of secondary sexual characteristics, such as breast growth or voice deepening, and can relieve distress associated with these bodily changes for transgender young people. Puberty blockers have the benefit of allowing the young person time before making any decisions regarding starting on gender affirming hormone therapy.
The effect puberty blockers have on pausing pubertal changes is reversible. Once the puberty blocker medication has been stopped, puberty will resume as it would have done without medication.
All medications have known or potential risks, but evidence and experience to date does not raise significant concerns about the safety of puberty blockers. As is the case in all medical prescribing, risks, side effects and benefits of medications are discussed with patients as part of the informed consent process before prescribing.
There are also risks to not prescribing medications when they are indicated. Puberty results in irreversible physical changes, which can result in lifelong distress and gender dysphoria for some transgender people.
In every area of healthcare, decisions about treatment and medication prescribing take all of these aspects into account, and health professionals support patients and their families to weigh up the pros and cons for their individual situation. Gender affirming healthcare is no different. Decisions about whether to start puberty blockers are made between health professionals, young people and their whānau. These are healthcare decisions which should remain free from ideological political interference.
Clinicians who initiate puberty blockers should be experienced in providing gender affirming healthcare and working within an interdisciplinary team. It is essential that access to this care and to puberty blocker medication is maintained.
Topics covered by the updated Guidelines
Advice on the prescription of puberty blockers is a small portion of the content covered by the updated guidelines. The updated guidance also includes detailed information on a broad number of other areas of transgender health, including whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
NZ Herald
15 hours ago
- NZ Herald
Middle ground needed in healthcare dispute for the sake of public
Health NZ and the Government are certainly aware of this, but reaching a solution is not as simple as agreeing to the demands of the Association of Salaried Medical Specialists (ASMS) and the New Zealand Nurses Organisation (NZNO). Across the Government's Budget, Health NZ is competing with the funding needs of housing, education, transport and more, all amid a cost-of-living crisis for the average Kiwi. Health NZ offered nurses a 3% pay rise over 27 months, plus two lump sum payments of $325. The NZNO sought a 5% pay rise over two years, along with $2000 flat rate increases for senior positions. The union also sought to restore a tikanga Māori allowance. ASMS executive director Sarah Dalton earlier told the Herald hospital specialists sought a 12% pay rise but were being offered an increase of less than 1% per year. Health NZ has described its offers to nurses and senior medical staff as 'fair'. Dalton acknowledged at the time that 12% may not be achievable but said the dispute may not be settled without a better offer. There is room for Health NZ to manoeuvre between 1% and 12%. Dalton's acknowledgment shows that compromise, at least where ASMS is concerned, is not impossible. Health Minister Simeon Brown estimated 4300 procedures, such as hip and knee operations, were delayed because of the 24-hour strike on May 1. Wait times for elective surgeries have already ballooned since the Covid pandemic, and the wait for specialist appointments and operations has continued to grow in many regions. In February, the Herald reported all of the country's hospital emergency departments were failing to assess patients with 'imminently' or 'potentially' life-threatening conditions on time. Striking doctors and nurses have rightfully pointed out staffing issues, with Health NZ recognising another 4100 nurses were needed in the next decade, on top of 2250 nursing vacancies, despite half of nursing graduates not getting job offers from Health NZ last year. Another 3450 doctors were needed in the next decade to keep up with demand. Concessions are needed from both Health NZ and its striking staff. Sign up to the Daily H, a free newsletter curated by our editors and delivered straight to your inbox every weekday.
Scoop
3 days ago
- Scoop
Patient-Focused New Zealand Health Plan Tabled
Minister of Health Health New Zealand's New Zealand Health Plan was tabled in Parliament this afternoon. Developed by Health New Zealand, the plan is a requirement under the Pae Ora (Healthy Futures) Act 2022. 'The plan outlines how Health New Zealand will deliver on the Government's health priorities over the period 2024–2027,' Health Minister Simeon Brown says. 'It sets the direction for how we will improve health outcomes and ensure all New Zealanders can access the care they need, where and when they need it. 'It gives effect to the Government Policy Statement on Health 2024–2027, with a clear focus on the Government's five health targets and five mental health targets: Health targets: faster cancer treatment improved childhood immunisation shorter stays in emergency departments shorter wait times for first specialist assessments shorter wait times for elective treatment. Mental health and addiction targets: faster access to specialist mental health and addiction services faster access to primary mental health and addiction services shorter mental health and addiction related stays in emergency departments increased mental health and addiction workforce development strengthened focus on prevention and early intervention. 'The plan is focused on achieving the Government's health targets, ensuring the health system delivers real results for patients and communities. These targets are backed by clear accountability and transparent reporting, so the public can track progress on a regular basis. 'Reducing wait times is a key priority for the Government. Too many New Zealanders have been left waiting far too long for the care they need. Under the last Government, waitlists ballooned – with the number of Kiwis waiting more than four months for elective procedures like hip, knee, or cataract surgeries increasing by over 2,500 per cent. 'Health New Zealand is focussed on delivering the Elective Boost programme, which will deliver 21,000 additional procedures over the 2025/2026 year to help clear the backlog of patients needing care.' The plan also sets out how the Government will grow and support the health workforce; improve clinical leadership with continuous quality improvement and innovation; invest in essential hospital infrastructure; ensure services are delivered more consistently across the country; and strengthen primary care across New Zealand so that people can receive timely, quality care in the community. 'Our focus is clear: putting patients back at the centre of the health system. We're building a system that delivers real results, and this plan is a key part of that,' Mr Brown says. Note:
NZ Herald
3 days ago
- NZ Herald
Gisborne targets youth vaping with CBD smoke-free policy
However, some councillors questioned whether it was a matter for the council or a public health issue for the central Government to address. 'It's a health problem. I worry we're dipping into things that we shouldn't be,' said councillor Debbie Gregory. Councillor Rawinia Parata responded that policies like these only made kids hide their smoking. In contrast, councillor Colin Alder said central Government had let them down. As an ex-smoker who battled an addiction for most of his life, Alder said he would love all the money he spent on smoking back 'with interest'. 'The companies that have been peddling this addiction are rubbing their hands together.' According to the meeting's report, Tairāwhiti continued to have the highest smoking rates in the country. However, data showed it was decreasing, with the rate of smoking dropping from 22% to 12% between 2018 and 2023, the report said. Action for Smokefree 2025 (Ash NZ) surveys thousands of Year 10 students every year on smoking and vaping behaviour habits. In 2023, the National Public Health Services prepared a report for the Gisborne District Council using Ash NZ data to understand the extent of vaping in the region. The percentage of participating Gisborne students who regularly vape soared from 1.6% in 2015 to 36% in 2022, but had decreased to 26.6% in 2023. The number of students who had tried vaping at least once had increased from a quarter in 2015 to just over half (54.7%) in 2023. The Māori rate of regular vaping (37.0%) was significantly higher than the rate for European/other (14.4%), according to the report. Councillor Nick Tupara agreed it was a government responsibility and a public health issue, particularly for Māori. However, the council could not expect national change if there was no voice locally. 'Looking at the data, it is epidemic, and it was during my mother's time and my grandmother's time.' Councillor Teddy Thompson said New Zealand was behind the eight ball, noting that in Australia, vape flavours were limited and people could only buy vapes from pharmacies. He and Gregory asked for the cost of updating signage, while councillor Larry Foster wanted to expand the policy area to include the central business district. The policy's designated smoke-free areas are playgrounds, parks, sports grounds, beaches, and outdoor public areas around council buildings and facilities, as well as any events run or funded by the council. Strategic planning manager Charlotte Knight said that as the policy was a position statement rather than an enforceable rule, it did not require consultation. After the majority of councillors voted in favour of Foster's suggestion, Knight said the council would include the CBD, and the area would be the same as the Local Alcohol Policy definition. A council spokeswoman said the cost to update the policy was minimal. There might be some funding from the Ministry of Health and other stakeholders to help with updating signage, she said. Mayor Rehette Stoltz recalled how, in 2018, the council questioned how it would enforce its initial smoking policy. 'The community self-police. At the end of the day, people slowly stop smoking in places that they used to, and now people just don't.' Stoltz said the policy was 'more a signal from the council to the community on what we value in our open spaces for our children'. 'Let's send that message and make it supportive. It is a health issue, there is help available, and not to shame people,' she said. According to the council report, no council in New Zealand had a smoke-free/vape-free bylaw. The Whanganui District Council did adopt a bylaw. However, it revoked it because of enforcement issues and now used a voluntary policy, the report said. The council will update its website by September 1 to communicate the policy changes.
