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The Government has lifted the cap on the number of gender affirmation surgeries it will publicly fund. Photo: Lynn Grieveson

Thomas Coughlan worked as a Newsroom reporter based in Wellington.

Gender affirmation surgery cap lifted

The Government plans to dramatically increase the number of gender affirmation surgeries for transgender patients, Newsroom can reveal.

The number of publicly funded surgeries performed, sometimes called gender reassignment surgery, was previously capped at three male-to-female surgeries and one female-to-male surgery every two years.

The Government has flipped the policy on its head. There will now be no cap on the number of surgeries performed, while the previous caps will become a minimum number of surgeries every two years. 

Newsroom understands since the decision was made in June, eight patients have been referred to be “considered” for surgery. That is nearly half of the total 19 surgeries completed since the cap was imposed in 2004.

Documents obtained under the Official Information Act show the Associate Health Minister Julie Anne Genter sought advice on increasing the number of surgeries performed under the public health system. The documents advised the minister she could lift the cap to increase access to surgeries. A spokesperson has since confirmed this decision was taken. 

James Shaw, who is covering Genter’s Associate Health portfolio while she is on maternity leave, told Newsroom the decision was a first step. 

“Our health system has never met the needs of transgender New Zealanders, and that has to change,” Shaw said. 

“I am taking advice on what the next steps are to improve health care for transgender New Zealanders."

A 50-year wait list

There are currently 105 people awaiting surgery in New Zealand. Seventy-nine patients are waiting for male-to-female affirmation and 26 for female-to-male surgery. 

The documents say at the current rate of progress it would take 50 years to work through the waitlist, they also note the number likely underestimates the demand for treatment. 

It's noted that treatment is likely to improve the health and wellbeing of transgender people, which is “markedly worse” than the general population’s.

A 2012 survey of 8500 youth found approximately 40 percent of transgender students had “significant” depressive symptoms and nearly half had self-harmed in the previous 12 months. One in five had attempted suicide in the last year. 

The cost of change

The surgeries are not cheap, and are more expensive in New Zealand. The country has not been able to provide male-to-female surgery since the retirement of the only specialist in 2014. Since then, a small number of publicly funded surgeries have been performed overseas. 

These are paid for from the High Cost Treatment Pool, a fund available for one-off treatments not otherwise funded by the public system. The funding is then used to pay for surgery either in New Zealand’s private system or overseas. 

The funding pool is not capped and its budget fluctuates based on need. 

New Zealand has never had the expertise to perform female-to-male surgeries, which the briefing describes as “more complex”.

Newsroom understands the Government is working to have surgeries performed in New Zealand. The documents note there is now one surgeon with the necessary training here, but they are not currently working. 

Ministry of Health figures put the average cost of male-to-female surgery at $53,382, with individual surgeries costing between $25,587 at their lowest up to $81,975. 

The costs for female-to-male surgery are higher, averaging $218,892, with a range of $45,169 to $525,034.

But these costs also include post-surgery complications. The ministry noted that two of the seven female-to-male surgeries done since 2004 resulted in “significant complications” resulting in bills of over $500,000 each. It is hoped when surgeries are performed here, the likelihood of complications will reduce, reducing the cost. 

The High Cost Treatment Pool budget is set based on the number of surgeries performed and therefore fluctuates from year to year. The ministry confirmed there is no chance of hitting a funding ceiling because the pool itself is not capped.

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The Gender Affirming (Genital) Surgery Service

On this page, about the service, new referrals to the service, the waiting list, referring for masculinising or feminising gender affirming genital surgery, gender affirming (genital) surgery service forms and support documents, revision surgery, national travel assistance .

The Service has been funded with $2.99 million approved in Budget 2019 over four years for the delivery of up to 14 surgeries per year.

The Service is provided through a contractual agreement between Manatū Hauora (Ministry of Health), and a private provider of gender affirming genital surgery in Aotearoa New Zealand. From 1 July 2022, Te Whatu Ora Health New Zealand (HNZ) coordinates the waiting list for a first specialist assessment (FSA) with the surgeon.

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

The Service is able to provide the following surgical techniques:

• 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.

Further information on the Service can be found at Delivering health services to transgender people.

Referrals to the waiting list need to be made by a hospital specialist unless a hospital network has agreed to allow general practitioners to make referrals on their behalf.

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

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

To be considered for a first specialist assessment a person must be at least 18 years of age, and medically fit to have an anaesthetic and complex surgery.

It is important that a person on the waiting list maintain a healthy Body Mass Index (BMI), be a non-smoker (including nicotine-based vapes), ensure that any physical and/or mental health conditions are 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. We require people 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 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.

You can find out more about Body Mass Index (BMI) and how to calculate BMI here:

The Service is currently accepting new 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. 

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 .

Please note: Patients on the waiting list will not be offered surgery unless their BMI is below 30. People who have a BMI of under 30 which makes them  more likely to progress to surgery and had their GP complete and return the GP Completed Health and Wellbeing form (confirming their current health status meets surgery criteria) will be offered an FSA as soon as the service provider is able to do so. There may be some delays in providing an FSA to people whose BMI is currently between 30-35.

Any referral sent directly to the Service’s contracted provider will not be eligible for the publicly-funded Service. Only referrals that are forwarded to the Service by the HNZ wait list coordinator, will be accepted.

The waiting list is a list for a first specialist assessment (FSA) 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 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, 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 FSA, then the Service will arrange for hair removal procedures and readiness assessments, if these are still required.

Given the number of people on the waiting list, we ask those who have had a referral accepted to notify us promptly by email [email protected] if their contact details or circumstances change.

We also encourage people to complete the Patient Completed Gender Affirming Genital Surgery Annual Review form (pdf, 184kb) annually and return it to us at [email protected] to ensure that we have their correct, up to date contact details and relevant information.

It is important that we have 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 either:

• Te Whatu Ora Health NZ will 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 Te Whatu Ora or the Service. Failure to do so will affect their ability to be reviewed with considered for an FSA and/or their waiting list status. 

It is very helpful if during your annual check in with your GP, you ask them to fill in the GP Completed Gender Affirming Genital Surgery Health and Well-Being Form (pdf, 273kb) and have them send it through to us at [email protected] .

Gender affirming genital surgery can be publicly funded and provided in New Zealand in the private sector. 

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.

There is currently a long waiting list for an FSA. From 1 July 2022, Te Whatu Ora Health New Zealand (HNZ) is managing the waiting list for an FSA.

New referrals for gender affirming genital surgery can be made by the person’s transgender health professional (this is normally an endocrinologist or a sexual health physician) or their general practitioner (GP). 

To be considered for surgical assessment, patients need to:

• meet the eligibility criteria set out in the version 7  Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People , published by The World Professional Association for Transgender Health (WPATH) - Version 7 is to be used when assessing patients and not version 8. 
• be  eligible for publicly funded surgery in New Zealand  
• be physically and mentally fit to undertake a complex surgical procedure. This includes being a non-smoker, having a BMI under 35 and good mental health and social support.

Referrals should be made on the Gender Affirming (Genital) Surgery Service referral form (available below), with relevant physical, social and mental health history/clinical reports attached.

Send referrals to:  [email protected] .

Referrals for gender affirming (genital) surgery must be complete by an authorised GP or hospital specialist.

• Referral form – Gender Affirming Genital Surgery (PDF, 213 KB)

People on the waiting list are encouraged to complete the annual review form and to send it to Te Whatu Ora - Health New Zealand every twelve months.

• Patient Completed Gender Affirming Genital Surgery – Annual Review Form (PDF, 200 KB) 

People who are on the waiting list for an FSA and have received an appointment date for an FSA will be sent the health and well-being questionnaire form which must be completed by the patient’s GP.

• GP Completed Gender Affirming Genital Surgery – Health and Well-Being Questionnaire Form (PDF, 280 KB) 

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

• What is Phalloplasty? (PDF, 196 KB)

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

• What is Vaginoplasty? (PDF, 217 KB) 

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

• What is Minimal Depth Vaginoplasty? (PDF, 169 KB)

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

• FAQs Vaginoplasty (frequently asked questions) (PDF, 156 KB)

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

• Choosing Your Caregiver and Support People ( PDF, 205 KB)

This 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.

• FAQ Sheet for Caregivers and Main Support People (PDF 174 KB)

Email any questions regarding gender affirming (genital) surgery to:  [email protected] .

The focus of the Ministry-funded 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.

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:

• Do you travel more than 350 km one way per visit for an adult, or
• Will you visit a specialist 22 or more times in two months, or
• 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
• 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 under the NTA Scheme, travel may be an additional expense for the patient. Patients will be advised whether they are eligible for NTA well in advance of their appointment.

Referral for GRS in Aotearoa

Yes! Genital Reconstruction Surgeries (GRS) are available in New Zealand for transgender patients, and may even be covered by public funding.

Changes in recent history

Surgeries available.

As of 2018, there is a surgeon in NZ – Dr Rita Yang, who performs public funded or private (self-funded) surgeries.

These include penectomy (or zero depth vagina), vaginoplasty (penile inversion or Sigmoid colon technique) for trans women and transfem people.

For trans men and transmascs, she preforms metoidioplasty, and phalloplasty, with or without urethral lengthening. She can provide testicle implants and erectile implants as required.

She has trained internationally with top surgeons in several countries, and has very good surgical outcomes.

Dr Yang also performs private top surgeries, breast augmentation, facial feminisation, thyroid cartilage reduction or augmentation, hair transplant, gluteal augmentation, lipofilling, liposuction, and pectoral implants.

Dr Yang is based Wellington at Wakefield Hospital.

The cap on the maximum number of Genital Reconstruction Surgeries per year has been lifted, and is now the minimum number.

$3million was allocated for GRS from the 2019 government budget for the next 3 years (aprox 13 – 15 surgeries per year). This fund is called the Gender Affirming (genital) Surgery Services fund, or GAgSS. It is separate from the  High Cost Treatment Pool (HCTP) .

Waiting time

The waiting list is now much shorter than it used to be – currently around 10 – 12 years. This is still outrageous, but it’s quarter of the 40-50 year wait it was only a few years ago.

At mid 2020, the wait list was around 200 patients, which put the wait time at around 12 years. A year before that, the waiting list was 50+ years. It may significantly reduce again soon if the government puts more funding toward trans health, or becomes more efficient.

We continue to advocate for the list to be cleared, and hope that this will happen in the next few years.

How you can advocate

It is Members of Parliament (MPs), not the Ministry of Health, who decide whether to allocate funding to finance surgeries.

We urge you to meet with your local MP, write letters, and keep pushing until the waiting list meets the national standard – that all surgery waiting lists should be less than 6 months.

Referral criteria and process

As of 2023, the government has taken responsibility for providing information on the process of referral, so we will no longer be maintaining a detailed guide.

You can find the main information you need here.

The Gender Affirming (Genital) Surgery Service

Updates on the current situation, if you have any questions, get in touch.

We usually know what the common patient experience is, what problems people are having, and how they’re solving those problems.

You won’t find that kind of information on the government websites, so do get in touch with us if you want to talk.

Email Address

Privacy Policy Terms of Use © Gender Minorities Aotearoa

Breast reduction

Breast reconstruction, skin cancer surgery, abdominoplasty (tummy tuck), facial cancer surgery, gynaecomastia, scar revision, microsurgery, nerve surgery (carpal tunnel), parotidectomy, acc surgery, gender reassignment, hand surgery, brazilian butt lift, surgical buttock lift, otoplasty (ear reshaping), breast enlargement, breast lift (mastopexy), blepharoplasty (eyelid lift), rhinoplasty (nose job), neck lift surgery, labiaplasty, inverted or large nipples, contouring after weight loss surgery, facial contouring surgery, small volume fat grafting to lips or cheeks, brachioplasty (arm lift), thighplasty (thigh lift), liposuction, learn more about .

The decision to undertake surgery to change body appearance to a gender different from birth gender is important and complex.

Mr Adams does not have experience in genital reassignment surgery or any laryngeal procedures and does not offer these procedures. He supports the WPATH principles of multidisciplinary care and the need for psychological and endocrine support. Tauranga and Rotorua-based Mr Adams will consider chest, body and facial contouring surgery in appropriate patients where there is a referral from a general practitioner and support from the patient's psychiatrist.

how long does  the operation take?

Time will depend upon the extent of the procedure.

WHAT DO I GET WHEN I PAY FOR PLASTIC SURGERY?

Plastic and reconstructive surgery is a specialised branch of medicine which requires many years of training. Following medical school, Tauranga hand surgeon Mr Adams undertook an additional 9 years of training and was awarded a Fellowship in Plastic and Reconstructive Surgery. He then undertook 18 months training in Aesthetic (Cosmetic) surgery and complex reconstructive surgery with leading experts.

IMPLANTS AND GARMENTS

If your surgery requires implants or a special post operative garment then these will have a cost associated with them.

Your follow up for 6 weeks, including any wound care and appointments are included in your surgeons’ fees. Costs for revision surgery are not included.

To perform safe surgery a high quality operating facility is required. Extensive surgery requires overnight hospital stays with skilled nurses.

Private hospitals charge for time used in the operating theatre, recovery time and day stay or overnight hospital stays. In addition they charge for all equipment used such as sutures, dressings, disposable instruments and drapes.

Tauranga plastic surgeon Mr Adams only operates at private hosptials with highly trained nursing staff who care for you after your operation in recovery and on the ward if you stay overnight.

SKILLED ANAESTHESIA

Any surgery requring a general anaesthetic (going to sleep for surgery) or sedation requires a skilled anaesthetist. Anaesthetists are skilled doctors who require at least 7 years training after medical school to achive the highest standards of skill and safely.

Your comfort and safety is the result of team work between all of the doctors and nurses who will care for you. If you have complex medical conditions you may need additional assessments prior to surgery.

WHAT IF I NEED REVISION SURGERY OR HAVE A COMPLICATION?

Most of the time surgery goes well and wounds heal without problems. However, no surgical treatment is completely risk free - if you are having elective or cosmetic surgery it is especially important that you understand this. The general complications of surgery which occur with some regularity include:

• Infection Delayed healing
• Bruising Problematic or unsightly scars
• Infection Injury to nerves, blood vessels, or surrounding structures
• Pain Distortion of surrounding skin or other structures
• Allergic reactions Poor cosmetic result
• Complications of sedation or general anaesthetic Further surgery or other treatments

If there is a complication that requires further surgery – you or your insurer will be responsible for any further costs.

FINANCIAL CONSENT

The estimates of cost provided are estimates only and are not based on what is needed by any particular patient. If surgery is unexpectedly complex it may take longer then hospital and anaesthetic costs will increase. If a complication occurs and requires surgery there will be costs associated with repeat surgery. Mr Adams does not control the hospital or anaesthetic costs

How much will this procedure cost?

Private hospital, the estimated costs of having, with mr adams at grace hospital is approximately, individualised estimates required.

* In addition to surgical fees, these figures include an estimate of hospital and anaesthetic costs.

private clinic

With mr adams at the da vinci clinic is approximately, just a thought.

"We can't direct the wind but we can adjust the sails"

"Life isn't about finding yourself, it's about creating yourself"

"Just remember that you're never to old to be young"

start your journey today

Tick the boxes of the procedures that you are interested in., reconstructive surgery, cosmetic surgery, appearance medicine, i'm here to help.

Before committing to any form of reconstructive or cosmetic surgery it’s important to understand the whole process. If you’re thinking about plastic surgery but don’t know where to start or what questions to ask, Brandon Adams is here to help you.    Working privately at Da Vinci Clinic or publicly at Grace Hospital in Tauranga, as well as at Central Health in Rotorua, Brandon is a trusted professional who prides himself on offering considered consultations. He will listen carefully to your goals and explain what cosmetic or plastic or cosmetic surgery procedures will help you achieve them.

DA VINCI CLINIC Ground Floor Vantage Building 359 Cameron Road  Tauranga 3110 P +647 578 5350 F +647 578 5354 www.davinciclinic.co.nz

CENTRAL HEALTH 1181 Amohia Steet  Rotorua 3010 P +64 7 578 5350 F +64 7 578 5354 www.rotoruamedical.co.nz

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New Zealand reduces 30-year wait for gender reassignment surgery

Relief for trans community after country fell behind in offering the procedure

The New Zealand government has lifted a cap on gender reassignment surgery to address a 30-year plus waiting list.

Under the previous government the state funded three male-to-female surgeries and one female-to-male every two years. The waiting list for around 100 people stretched into the decades.

Under the new Labour coalition government the old cap will become the new minimum number of surgeries to be performed every two years.

The news was greeted with elation by the trans community, who said they felt they were finally being respected and acknowledged by the government.

“It is going to make such a lot of different to a lot of people, and there is great relief and excitement in the trans community,” said Lynda Whitehead, an advocate for Tranzaction Aoteroa.

“It gives people hope, and before there was very little or no hope. As a community we have been ignored and put on the back burner for a long time. But it feels like our concerns have finally fallen on sympathetic ears.”

In the 1990s New Zealand was a world leader in reassignment surgery, with the comparatively low cost of the operation and progressive attitude towards the delicate procedure attracting patients from around the globe.

But when the country’s only specialist surgeon retired in 2014, the waiting list for the complex and costly procedure ballooned, with advocates saying trans people were getting “desperate” and “frustrated” with the situation and taking risks with cut-rate surgeries overseas.

Vic Roper told the Guardian in 2016 that he saw “no point” in joining the waiting list for surgery as “by the time I got to the top of the list, I would be too old to appreciate it”.

“Trans people have an incredibly high suicide rate and this is practical action that will help people have an improved sense of mental health and wellbeing,” said Roper, who is scheduled for surgery in November.

“It was not a waiting list before, it was a ‘We’ll put your name here and never think about it again’ list. I feel the Labour government has a really different perspective on the country and who gets priority. They are really thinking about minority groups and trying to give them more of an even playing field.”

Dr Andy Simpson, New Zealand’s chief medical officer, said there were 111 people waiting for surgery: 84 male to female, and 27 female to male. It was unclear how long it would take to address the backlog but there was an interim arrangement of referring patients at the top of the list to a surgeon in the private sector. “So far, eight patients have been referred to this private sector surgeon for consultation.”

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A transition with a never-ending cost.

For trans* youth, finding support is hard and getting funding for surgery is even harder.

Oliver Rabbett was born with a female parts but began telling people he identified as a male when he was 16.

His family were supportive, he says, but for a while stumbled over the little things like pronouns and his new name.

Oliver’s face turns grim for a moment as he explains that his best friend couldn’t come to terms with his plan to transition and is no longer a part of his life.

“There are always going to be people that don’t understand, but if they don’t respect you then you don’t need them in your life.”

This story is true to the terms used by the people interviewed to describe themselves. Others may describe themselves using different language .

Oliver and his mum were going for a walk when he decided to tell her he no longer identified as a girl. “I turned to her and said, ‘Mum, I feel like a boy’.”

She began telling him stories from when he was a child, how he would scream and cry when she put him into a dress. T he stories proved to them both that he should have been born male. His mum wasn’t surprised and said “it all made sense”.

Oliver has since been diagnosed with gender dysphoria, a term used to explain that he doesn’t identify with the biological sex he was born with.

Support for trans* youth isn’t always easy to come by in New Zealand and funding for surgeries is even harder.

Surgeries like mastectomies are available for those transitioning from female to male but the cost is restrictive, but there is currently no one in New Zealand capable of performing sex reassignment surgery.

Oliver’s grandma took a little time to come to terms with his transition, but once she did she has provided unwavering emotional and financial support. She paid $13,000 for him to have his breasts removed by a private surgeon in Christchurch three years ago.

The surgery involved cutting into his chest and removing the breast tissue. His nipples were cut off, resized and then stitched back into place.

Oliver shortly after having his breasts removed. Photo: Supplied

The surgery was followed by two months of recuperation during which he couldn’t move his arms above his head due to pain and stiffness.

Having his breasts removed went a long way for Oliver’s confidence. He becomes animated as he describes being able to wear tight t-shirts and wear what he wants.

For this, Oliver considers himself one of the lucky ones but he is aware the process isn’t so easy for other trans* people in New Zealand due to the cost of surgery.

Oliver began taking testosterone treatments three years ago. The hormone comes in vials and is injected into the top of his hip every two weeks.

To start hormone therapy he needed a letter from a psychiatrist saying that his biological gender was impacting his mental health and clearly doesn’t match how the gender he identifies with.

Before he was given his first injection of testosterone, Oliver was assessed by two hospital psychiatrists, who he describes as intimidating and scary.

“They’d only seen about two other trans people in their whole career. I felt like I was trying to prove myself, which was not a nice feeling.”

They’d only seen about two other trans people in their whole career. I felt like I was trying to prove myself, which was not a nice feeling.

The cost of transitioning gender is never-ending. Trans* people wanting hormone treatment are required to see a specialist at least once a year for the rest of their lives and each appointment costs up to $200.

Earlier this year, Oliver had his ovaries and uterus removed at the Christchurch Women’s Hospital. Gas used in the surgery escaped to under his lungs, leading to days of pain.

Despite going through two invasive surgeries and so far paying over $13,000, Oliver is considering getting genital reassignment surgery in the future.

There are currently 72 people on the waiting list for genital reassignment surgery. Only three surgeries for male to female reassignment and one female to male are funded by the Health Ministry every two years. There is currently no doctor qualified to do the operation in New Zealand.

The best someone wanting gender reassignment surgery can hope for right now is that they’ll be placed on the waiting list to have the operation done overseas.

To get on the list they must provide two psychiatric reports by senior psychiatrists and one report from a psychologist or social worker with experience in transgender people. They also have to prove they have undergone more than 12 months of continuous hormonal treatments, and document that they have been living and working fulltime for at least two years as a man/woman.

Four people are almost there, but the Health Ministry still needs to approve a surgeon overseas.

The Health Ministry says the male to female surgeries will continue to be provided overseas until a surgical team is able to provide the procedure in New Zealand.

Oliver was diagnosed with gender dysphoria, a term used to explain that he doesn’t identify with the biological sex he was born with. Photo: Supplied

One of the people on the waiting list is 20-year-old Katelyn Thomas.

Katelyn was born with a male parts but has lived as a woman for the past two years. She lives in Tauranga where she is studying to become a nurse.

Katelyn says there is no trans* community in Tauranga and has to rely solely on mutual friends to find other trans* people.

“If you know someone that knows someone who is trans it’s just like, ‘hook a sister up, let’s be friends’.”

Katelyn takes oestrogen pills and has had Botox and lip fillers in order to look more feminine, but she wishes to take her transition the whole way, including having genital reassignment surgery.

For people with male parts, this surgery means using the skin from their penis and scrotum to form a vaginal lining and labia. Surgeons can also create a fully functioning and sensitive clitoris from the penis glans.The surgery can cost up to $30,000.

Katelyn believes she is about number 60 on the waiting list.

“It’s so frustrating because you get so far in your transition and then hit a wall.”

It’s so frustrating because you get so far in your transition and then hit a wall.

Katelyn has been on hormones for two years. The oestrogen she takes causes her body fat to redistribute, giving her breasts and curves.

Hormones don’t have the magic effect that trans* people want, but they go a long way to help her look like a female, she says.

It wasn’t until she was standing in her underwear with a male friend in a full length mirror at Farmers that Katelyn realised what a difference the hormones had made to her body.

“I thought ‘that’s what my body would have looked like without the hormones’.”

Katelyn began her transition while she was still attending an all-male boarding school in Tauranga. She had to drive four hours to New Plymouth to see a hormone specialist.

Her high school’s dean drove her to the appointments and he advised her to freeze some of her sperm before she started taking oestrogen.

Despite having support from her dean, Katelyn’s school friends quickly became distant and stopped talking to her.“I would walk down the hall with another friend and people would yell names and throw fruit at us.”

Katelyn eventually left the boarding school after she attempted suicide. Despite all this, she is adamant that she will get the reassignment surgery.

“A lot of people think that being transgender is just playing dress up, but for many trans people the surgery is a key part of our transition.”

Katelyn believes that getting the surgery will change her life for the better. She says that people generally lose interest in her after she explains she is trans*. She believes this will change once she has had the reassignment surgery.

A lot of people think that being transgender is just playing dress up, but for many trans people the surgery is a key part of our transition.

“I get rejected by guys all the time. Trans or not, if I just had a vagina then it would be none of their business - they would never know.”

Dr Sue Bagshaw says everyone is waiting for a surgeon capable of performing the operation. As a doctor at the 198 Youth Clinic in Christchurch, she has seen first-hand the effects of the lack of funding and support going into trans* health care.

The clinic is one of the few places in New Zealand that trans* youth can go to for  counselling and medical help.

Dr Bagshaw says she believes the cost is one of the main things preventing trans* youth from having surgery. She believes surgeries such as mastectomies and hysterectomies can make a huge difference to people’s lives and should be cheaper. 

“It’s touch and go as to what’s cheaper: going overseas and paying for both the travel and the operation, or getting it done here.”

She explains that suicide, anxiety, social phobias and depression are among the effects of trans* youth not getting the support that they need. “Some of them won’t face people because they just can’t face living a lie.”

There needs to be a “one-stop” clinic where people can come for their counselling, medical advice, hormone treatments and surgeries, Dr Bagshaw says.

“It just makes their lives turn around and be so much better if they can get these things done.”

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GENDER REASSIGNMENT SURGERY Overseas

Also commonly called Sex Reassignment Surgery (SRS), this procedure helps individuals become the person they want to be by transitioning them into the gender they associate with. It is becoming a very common procedure with more and more individuals taking the next step in their transition. At the moment we offer male to female transition only.

INDIVIDUAL HOSPITAL PRICING IS LISTED FURTHER DOWN THE PAGE

If you would like to obtain a personalised quote for Gender Reassignment Surgery Overseas, please refer to our Enquiry page.

Procedure Pricing

Beverly Wilshire Medical Centre +

Phuket Plastic Surgery Institute (PPSI) +

Phyathai 2 Hospital +

Yanhee International Hospital +

What you need to know

BEST CANDIDATES +

The best candidate for Gender Reassignment Surgery (GRS) is someone who is:

• unhappy with the gender they are and wish to become the gender they associate with
• fully aware that this is a permanent procedure
• aware of all of the steps involved
• aware of any legalities that are required in their country for changing their name, gender etc

Because this is significant, life-changing surgery, it is important that you are physically, mentally and emotionally ready. As with any cosmetic surgery procedure, it is imperative you speak to someone you trust, are happy in your life and are psychologically ready.

PREPARING FOR YOUR PROCEDURE +

It is important to discuss with your doctors and with us any:

• Medical conditions you have
• Any medication you are taking - prescription, herbal and non-prescription

Once you arrive at your destination you will have a physical evaluation with your surgeon, where you will discuss your goals and concerns and finalise the plan for surgery. At this examination your surgeon will determine the best procedure for you and explain it to you in detail, including any limitations. It is important that you head into surgery with realistic goals. It is during this examination that your surgeon may also make recommendations for other procedures. 

In the lead-up to your surgery, it is important you do the following:

Stop smoking. Smoking can cause problems with circulation and increase the possibility of complications.

What does gender reassignment surgery include?

The process of sex reassignment surgery (SRS) is to help people transition into the gender they align themselves with. There are various procedures, some of which can be done at the same time and some that must be staggered for medical purposes. There is female to male transitioning, but we currently only offer male-to-female transitioning. The five common procedures Beautiful You Holidays offers are; Orchiectomy, Penectomy, Vaginoplasty, Facial Feminisation and Body Contouring (including breast augmentation). 

At what age can you change your gender?

In New Zealand, the minimum age for considering gender reassignment surgery is currently adults over 18 years of age. Anyone under this minimum age is not legally entitled to undergo any of the procedures above, even with the consent of an adult.

Can you reverse gender reassignment surgery?

The decision to undergo SRS isn’t one to be taken lightly. We ensure candidates understand the steps and legalities involved, and that patients understand that this is a permanent procedure. In the extremely rare case that someone who has undergone gender reassignment surgery wants to reverse the surgery, please consult a doctor. 

WHAT TO EXPECT +

Surgical Procedures:

There are several procedures involved with a male to female gender reassignment, some of which can be performed at the same time. How many procedures you have done at the same time will depend on your own wishes along with the recommendations of your surgeon.

Orchiectomy (removal of the testicles)

An orchiectomy is a quick procedure and is often performed as part of a more comprehensive reassignment process. It is imperative to understand that without testicles the male hormone testosterone will not be produced. 

Penectomy (removal of the penis)

This procedure can be performed as a single procedure or as part of the gender reassignment process should you want to create female genitals. During the penectomy, the urethra will be shortened and redirected. 

Vaginoplasty (creating a vagina)

A vaginoplasty is used to create a vagina and is often done by using the skin of the penis and turning it inside out to create the walls of the vagina. The specifics depend on the size of the penis and the surgeon's techniques. During this procedure, it is also common to alter the urethra by is shortening and repositioning it so that it functions as it would in a female body.

A vaginoplasty is done to improve the function of the body part and should not be confused with labiaplasty, which is more of an aesthetic change. While performing a vaginoplasty, it is common to include a labiaplasty and clitoroplasty to create female genitals that are aesthetic, minimally scarred, and sensitive to sexual arousal.

Facial Feminisation  

The techniques used to feminise a face vary based on the client’s facial structure and features, with the following procedures used:

• Face lift 
• Otoplasty (ear pinning)
• Rhinoplasty (nose surgery)
• Tracheal shave (reducing the size of the Adam’s Apple)

Body Contouring

The techniques used vary from client to client, with the following procedures used:

• Tummy tuck 
• Breast augmentation
• Buttock implant 

LENGTH OF SURGERY +

The length of surgery depends on the procedures performed, your body and your surgeon’s recommendations. It is common to stay in the hospital for 14 nights. 

Recovery and post-op care:

While your recovery will depend on the procedures performed, it is common to experience pain and discomfort following the surgery, which will be managed by painkillers prescribed by your surgeon.

Your surgeon will give you instructions on how to perform periodic dilation (stretching the vagina walls). You will be given a dilator to wear inside the vagina to ensure it does not close over or change in shape. It is common to do this for eight weeks following your vaginoplasty, with the frequency gradually reducing. The vagina should be cleaned regularly as per your surgeon’s specific instructions.

You will be able to return to light work 4 to 6 weeks after surgery, and slowly being more strenuous work and exercise around 6 to 8 weeks after surgery.

Length of stay:

Most surgeons recommend staying on holiday for at least 21 days, during which time you will have regular follow-up appointments with your surgeon. To get the most out of your recovery time we suggest you partake in gentle exercise, yoga classes and treat yourself to some pampering. If you are feeling up to it, there is plenty to see and do in Phuket, Bangkok and Kuala Lumpur.

PRECONDITIONS AND RISKS +

Risks and complications are minimised by using the care and services of our highly-skilled, trusted doctors and nurses. However, with every precaution taken complications can still occur. These are rare and few patients experience any issues. If you have any concerns about your procedure and the possible preconditions and risks, please discuss them with your doctor and nurses.

Potential risks include:

• Hematoma (which can be treated either through puncture or surgery, depending on the size)
• Nipple necrosis (which can be corrected with aesthetic procedures to reconstruct the nipples should this happen)

OTHER PROCEDURES TO CONSIDER +

If you would like to take advantage of your time away, there are other non-surgical procedures you can add so you return home feeling refreshed. These include cosmetic fillers, laser resurfacing and chemical peels.

Got a question? Talk to our friendly team

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