CMDHB Gender Reassignment Health Services Review

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					         CMDHB Gender Reassignment Health Services Review
                        Transgender Community Feedback
Recommendation for next Agenda
Point     Recommended for CMDHB Project Meeting Agenda                                              Date

    1.    Clarification of the Project Plan (timeline, tasks etc) and expectations placed upon the 17/08/10
          trans representatives in the team.

    2.    Ownership of the final guidance document: The ongoing importance of housing the           17/08/10
          document somewhere specific so it will be updated every few years.

    3.    Feedback document from the trans community and discussion of key points                   17/08/10

Collated Feedback by Topic
Point     Diagnosis                                                                                Date

    1.    Recognition of individual’s right to seek treatment without having to be                 20/08/2010
          pathologised. Eg. An adult is capable of deciding they are transgender without
          needing a registered psychiatrist to diagnose them.

    2.    Utilisation of psychiatrists only when dual diagnosis of mental illness or disorder is   20/08/2010

Point     Counselling & Support                                                                    Date

    3.    Counselling should be highly recommended, however it should not be forced upon 20/08/2010
          individuals to achieve a time period to be able to access hormones. Readiness is not
          measured in 3 month increments, but the individual’s decision.

    4.    Real life experience is not always safe for a trans person. If the aim of RLE is to      05/08/2010
          ensure the trans person has relevant support, that can be achieved by a safer
          methods. (E.g asking what support I have during my transition.)

Point     Access to Hormones                                                                       Date

    5.    Weight loss is sometimes required before a trans person can access hormones. This 20/08/2010
          can be a significant hurdle for some trans people, particularly if discomfort with
          their body prior to transitioning inhibits them from exercising.
   6.    Multiple hormone treatment options are available. The guidelines should              21/08/2010
         encourage the medical practitioner to discuss these with their client and let the
         client make an informed decision about what is right for them.

   7.    Respect for the client is paramount. A lot of people find they have to go to          21/08/2010
         seemingly extreme lengths to justify their identity to medical professionals and gain
         access to hormone treatment.

Point    Surgery                                                                              Date

   8.    Can the guidelines include instruction on how to apply to the high cost treatment    21/08/2010
         pool for surgery

Point     Ongoing Wellness                                                                    Date

   9.     If all GP’s have access to these Guidelines it will help to demystify trans issues and 21/08/2010
          they may feel more confident in taking them on as patients to manage their
          general health

   10.    “Te Whare Tapa Wha” is a holistic health and wellness model that could form a       05/08/2010
          good basis for the project. (To complement, replace or relate to the standard
          pakeha notions about health and medicine.)

Point     Uptake of Guidelines                                                                Date

   11.    The resource could be endorsed by Royal Colleges and Associations (of               05/08/2010

   12.    Guidelines should include contacts for clients to make complaints via the Health & 21/08/2010
          Disability commission

   13.    Utilising positive, non-pathological wording will engage the trans individuals and   20/08/2010
          empower them in their utilisation of this resource with their medical practitioners.

   14.    Circulate completed guidelines to ALL General Practitioners in New Zealand          20/08/2010

   15.    Guidelines need to include advise to DHB’s on referring to ensure that people can   21/08/2010
          access treatment even if their DHB does not cater to it locally

Point     Ownership and Future of Guidelines                                                  Date

   16.    Medical ownership of guidelines should be in partnership with one or more trans     20/08/2010
          organisations to ensure continued community input
17.   Handover of ownership to be done with review timeline recommendation. Eg. To 20/08/2010
      be reviewed every 3 years minimum

18.   An outcome of the project needs to be a list of issues arising that have been out of 21/08/2010
      scope which could be handed over to the trans community for further lobbying
General Community Feedback
Point   Community Feedback                                                                   Date

   1.   Feedback from a Trans health professional would like to remind us that the           17/08/2010
        guidelines are not binding and we should not get bogged down in the ownership
        question to the detriment of producing the guidelines.

   2.   We could find useful allies by considering the issue of de-pathologization, because 05/8/2010
        this is a concern for many people, not just trans people.

   3.   I like the primary healthcare focus. It (the guidance) needs to be communicated to 05/8/2010
        all GPs.

   4.   I do not want to be diagnosed with a disorder in order to obtain hormones or         05/8/2010

   5.   Trans people should not have to tell the same story over and over again to           05/8/2010
        convince medical professionals (mental health professionals or other) that they
        deserve medical treatment.

   6.   Some FTMS are barred from hormone therapy because of being overweight. While 17/8/2010
        weight is a health concern for some people, medical professionals need to
        recognize that there are a number of positive effects of hormone therapy for FTMS
        – such as increased energy and usually a happy feeling of motivation – which can
        leader to healthier lifestyles in terms of food and exercise. People are more likely
        to be healthy about their bodies when they are happier or more satisfied. More
        people suffer harm due to lack of access than harm due to accessing hormone
        therapy while overweight.

   7.   I personally think that trans women should undergo extensive counselling to deal     04/08/2010
        with personality issues. It has been my experience that most trans women have a
        number of personality issues that they fail to deal with. Unless these personality
        issues are dealt with they will substantially affect the ability ...of the trans
        community to be treated as equals as the wider society

   8.   (Cerebral Palsy Society of New Zealand Review) I was involved with this study, and 04/08/2010
        the conversation we had was around inclusion and for the health system to
        understand difference. I believe there are many similarities between disability and
        trans communities. I think there's a connection here, and think it's important to
        somehow share the research.

   9.   I am a male to female of some 27 years post surgery that was performed in          04/08/2010
        Brussels in the days when surgery was not undertaken in NZ. I am a Registered
        nurse who has suffered many insults and discrimination within the so-called caring
        profession. However with support of family I have risen to the academic top of my
        profession, holding a doctoral degree, and teaching full time in a Bachelor of
      Nursing programme.

10.   I was disappointed to note in the Minutes that there was no feedback on the     04/08/2010
      Standards of care document produced by the Harry Benjamin Assn. These give us a
      very good outline of what we should be producing (altered of course for NZ

11.   I would hope to see, since the endocrine treatment has seemingly been discussed, 04/08/2010
      is the need for pharmaceutical companies and the medical profession to instigate
      trails of hormones used by the medical profession in treatment of transsexuals. I
      have yet to find one pharmaceutical company who has a recommendation for
      hormone treatment of Transsexuals. I could be wrong.
      But we are just treated as the target gender. It would be nice to see trial data
      showing the good and bad, as it affected us and not just a guess based on the
      target gender trials. At the moment, hormones are merely a dart thrown at the
      wall as far as transsexuals go.

12.   It is essential that the Group produce guidelines that are Best Practice guides for 04/08/2010
      the care of the gender conflicted person. The NET is our greatest misinformation
      source and the bain of my life as I have many gender confused people telling me
      ‘its true cause I read it on the Net!’ One of the participants referred to the horror
      stories (we all can tell) but it is vital that starting with the GP community there are
      Best Practice guidelines so that they do not willy-nilly give out hormones to
      persons who have read the stories, surfed the Net, watched Facebook and got a
      compelling story together.

13.   This resource or guidance should not restrict the freedom of trans people to access 05/8/2010
      a range of medical services and should encourage medical professionals to consult
      their trans clients about their medical care.

14.   A strengths-based approach would be helpful.                                            05/8/2010

15.   Whatever is created needs to be specific and appropriate to Aotearoa New                05/8/2010
      Zealand, which means it needs to take into account the diversity of Maori and
      Pacific Island people not just focus on the American/European medical models.

16.   Weight issues are often as used as a reason for not prescribing hormones. This is       17/8/2010
      seen as quite opaque by many of the Trans community.

17.   How is an application made to the high cost treatment pool for surgery? Could this 17/08/10
      be part of the guidelines?

18.   How will the guidelines be implemented, will consumers have choice especially           04/08/2010
      those within DHBs that do not provide or embrace services based on the

19.   Flexibility of accessing services supplied from another DHB.                            04/08/2010

20.   Ownership or responsibility of the guidelines, is it a possibility to use an existing   04/08/2010
      organisation (e.g. a society of gender therapists and college of GPs) OR form a new
      organisation, perhaps a NZ instance of WPATH as an example. Trans people would
      like to form part of this ownership.

21.   Guidelines should be encouraged to provide ‘best practice’ in regards to services.    04/08/2010

22.   Creating a degree of uniformity of services across the regions is desirable           04/08/2010

23.   Targeting PHO as the primary health care providers is suggested as a way to gain      04/08/2010
      acceptance of the guidelines.

24.   Not all DHBs will have the required specialist services required; what will the       04/08/2010
      options be for those without local services.

25.   Understanding of what is in scope of the project – suggestion that the Trans reps     04/08/2010
      will provide all comments from the community for consideration by the project
      team on whether they are considered in scope or otherwise.

26.   Re-iterate the requirement for an exit report that highlights services or             04/08/2010
      requirements that are out of scope but require further assessment.

27.   Robust complaint procedures for consumers of services should be set out in the        04/08/2010

28.   Creation of best practice guidelines already seem to be available, perhaps the best 04/08/2010
      approach is to pick an international published document and adapt it where

29.   Privately available medical services for trans services, seem to be readily available 04/08/2010
      for those who are prepared to pay.

30.   General belief in the Trans community that the medical community do not know          04/08/2010
      how to or want to work with Trans people.

31.   Guidelines should not dictate the path Trans people navigate – menu of services       04/08/2010
      should be available. Understanding that not all Trans people are the same.

32.   Do not put checkpoints in place just for the sake of the medical community;           04/08/2010
      consideration of what is right and what is good for Trans people’s well being. E.g.
      creating an absolute requirement to see an endocrinologist for prescribing of

33.   The wellbeing of trans people should be the most important factor in the creation 05/08/2010
      of this resource.

34.   De-pathologizing trans identities may be beyond the scope of this project but we 05/8/2010
      can contribute to a better understanding of why some trans people object to being
      pathologized/labelled with a disorder.
35.   We need to think about accountability: how will health practitioners be            05/8/2010
      accountable for their choice to use or not use this resource?

36.   Inclusion and respect are important goals, not just best practice from a medical   05/8/2010

37.   The phrase “guidance” would be more accurate than “guidelines” for the resource 05/8/2010
      produced by this project because “guidelines” is a specific term that requires prior
      research to have been undertaken and nothing adequate has been produced in NZ
      (or in other parts of the world, as far as we can tell.)

38.   Trans people will need to use the resource we create. By using it we will have     05/8/2010
      ownership of it.

39.   “Te Whare Tapa Wha” is a holistic health and wellness model that could form a      05/8/2010
      good basis for the project. (To complement, replace or relate to the standard
      pakeha notions about health and medicine.)

40.   The resource could be endorsed by Royal Colleges and Associations (of              05/8/2010
      Endocrinologists/Counsellors/GPs etc) even if it is not housed in these specific

41.   Clinical advice should assess a trans person's health needs and the potential      20/08/2010
      benefit a procedure may have on their quality of life. A trans person's personal
      assessment of these health needs and benefits is an important component of any
      such assessment. Where potential health risks are associated with any given
      procedure, these should be clearly explained. These should also be balanced
      against any health risks associated with delaying or not providing such medical
      assistance. Informed consent should be one of the underpinning principles of the

42.   The guidance needs to be updated regularly, should become a growing document, 05/8/2010
      not left to stagnate and become irrelevant. (This could be aided by endorsements
      or, even more effective, ownership by institutions.)

43.   Intersex people wishing to transition have gender reassignment requirements and 23/08/2010
      this somehow needs to be included in the guidelines

44.   Endocrinologists, Sexual Health Clinicians and GP’s are known to prescribe         23/08/2010
      hormones in the Auckland region. Is there a preference to have this limited to
      specialist endocrinologists, particularly for start up treatment and monitoring.