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Around 1000 delegates, speakers and exhibitors gathered last month for the first in-person Goodfellow Symposium since 2019. New Zealand Doctor Rata Aotearoa reporters continue their coverage started in the last issue
GPs should take a bigger role in managing and repeat-prescribing gender-affirming hormone therapy in primary care, transgender health expert Rona Carroll says.
A Wellington specialist GP with an extended role in transgender healthcare, Dr Carroll spoke at the Goodfellow Symposium last month, hoping to empower primary care professionals to feel confident in supporting their trans and non-binary patients.
Over a third of gender-diverse young people, who answered the Counting Ourselves transgender survey in 2018, have avoided seeing their doctor at some point, Dr Carroll says. “All of us, regardless of how many trans patients we have, have got a role to play in improving that.”
As waitlists for gender-affirming care in Aotearoa New Zealand are so long, GPs and nurse practitioners can take some of that burden off secondary care by managing repeat hormone prescriptions, she says.
Patients will usually see a clinician in secondary care to get hormones initially prescribed, either an endocrinologist or a sexual health doctor, and then the GP should take over the hormone management, Dr Carroll says.
Dr Carroll, who uses the pronouns she/her, worked alongside other experts in February 2023 to create the latest Primary Care Gender Affirming Hormone Therapy Initiation Guidelines, which have been endorsed by the RNZCGP.
The guidelines explain everything from terminology to clinical hormone levels, and how to work with patients to provide them the best possible care.
There is still a lack of research around hormone therapy but if their GP knows the basics in hormone prescribing, patient and provider can work together in general practice to figure out the best plan for the individual, Dr Carroll says.
Dr Carroll spoke alongside three other trans health experts at the Goodfellow Symposium; Te Whatu Ora gender surgery health navigator Jove Horton, Auckland general paediatrician Rachel Johnson and Auckland Sexual Health Service clinical director Jeannie Oliphant.
Mr Horton works in the genderaffirming surgical service, and offers advice to GPs when referring patients for gender-affirming surgeries.
Mr Horton, a transgender man who uses the pronouns he/him, spoke to GPs at the conference about gendered language and how to create an affirming and inclusive environment at your clinic.
At least 1.2 per cent of New Zealanders are trans and/or non-binary, Mr Horton says. While this figure appears to be increasing, this is not actually the case, he says. More have just learnt language to express their identity.
“People are talking more about it. Visibility has increased. Gender-affirming care is improving, and people feel safer being themselves.”
He says language to explain people’s gender is constantly evolving, and not to worry about memorising all the terms. “Just use the language that your patient uses for themselves.”
He says language to explain people’s gender is constantly evolving, and not to worry about memorising all the terms. “Just use the language that your patient uses for themselves.”
It’s a very new service, with only 26 surgeries completed since its opening in 2020. Regardless of this, plenty are seeking it out: 410 referrals were made in the month of March, he says.
But not all transgender people want gender-affirming surgery or hormone therapy, he says. Trans-inclusive healthcare also incorporates correct pronoun use, and being aware of microaggressions which trans people often face in healthcare spaces.
While some trans people experience gender dysphoria, they also know what it’s like to feel “euphoric”, and an inclusive space can help to give trans people that experience, Mr Horton says.
Tips from Jove Horton
Jove Horton is a gender surgery health navigator for Te Whatu Ora
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