Gender affirming surgery and speech language therapy

Speech language or voice therapy can help people adjust how they use their voice and communicate. Some transgender and gender diverse people use this therapy to explore changes to pitch, resonance, tone, pace, gestures or other communication features that feel more aligned with their gender.

Availability of this service in the public system funded availability of this service depends on the: 

• capacity within your local hospital
• clinical priority given to your referral.

Some people want to seek gender affirming surgery as part of their gender affirming healthcare. Surgeries can include:

• removal of testes (orchiectomy)
• chest reconstruction surgery — often called 'top surgery' — which involves subcutaneous mastectomy, creating a more masculine chest appearance
• removal of the uterus (hysterectomy)
• removal of the ovaries and fallopian tubes (salpingo-oophorectomy)
• a broad range of procedures to give the face a more traditionally feminine appearance (facial feminisation surgery)
• surgery to change the pitch and tone of voice — or both — to more typically feminine (laryngoplasty or vocal fold surgery)
• surgery to increase breast size (breast augmentation)
• a broad range of procedures to change the appearance and function of genitals, or both (vaginoplasty, minimal depth vaginoplasty, phalloplasty, or metoidioplasty).

Publicly funded availability of these surgeries, except for genital surgery, depends on the:

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

You may need an assessment by a mental health professional of your readiness before you can be referred for consultation with a surgeon.

Guidance on eligibility for all gender affirming surgery is in the 'Standards of Care for the Health of Transexual, Transgender and Gender Nonconforming People'. This is published by the World Professional Association for Transgender Health (WPATH).

Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People — WPATHexternal link

Gender affirming genital surgery is publicly funded and provided in Aotearoa New Zealand. It includes:

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

Referral to the waiting list

Referrals to the waiting list need to be made by a hospital specialist, or your usual health professional. This is normally an endocrinologist or sexual health physician, unless a hospital network has agreed to allow general practitioners to make referrals on their behalf. 

People whose referral for gender affirming genital surgery has been accepted are on a waiting list for a first specialist assessment (FSA). This is with the surgeon to discuss their surgery options. It is not a waiting list for surgery.

There is currently a long waiting list. Regular updates are provided on the Health New Zealand website. You may be asked to see your healthcare provider, regular doctor, or nurse practitioner to complete health updates while you are on the waiting list.

Eligibility for referral

To be considered for surgical assessment, you need to meet the eligibility criteria. To find out more information about the surgeries, visit the Health New Zealand website. 

Gender Affirming (Genital) Surgery Service — Health New Zealandexternal link