Bridging the information gap in gender-affirming healthcare

5 January 2021

As a passionate advocate for the gender diverse community, GP and College Clinical Lead Cathy Stephenson wants to provide GPs with the information they need to provide gender affirming healthcare.

Cathy is the co-author of a recent New Zealand Doctor course which aims to give GPs a better understanding of the issues the gender diverse community face when accessing primary health care.

“There is a perception that gender-diverse people need specialist help, or that their needs fall outside what general practice can provide, but this is not always the case,” she explains. “For many gender-diverse patients, they just need to talk things through, or need help to find a local support group. There is a lot their GP can do to improve their wellbeing.

“Like any patient, a gender-diverse person wants to be heard, and knowing that they will be listened to with compassion and empathy is huge.”

Cathy became involved in this rapidly growing area of medicine eight years ago, when the Capital and Coast DHB facilitated some collaboratives to get a better picture of what health care provision looked like in the region, and to identify where the biggest gaps were.

 “Just asking someone what their preferred pronouns are goes a long way to letting them know they are acknowledged, respected and understood.”

Wearing her youth-health hat (Cathy is part of the Mauri Ora Student Health Service at Victoria University), she quickly discovered that the provision of gender-affirming healthcare was inconsistent and patients relied on the luck of the draw to find a doctor who could help them.

“There were some truly heartbreaking stories of people knocking on so many different doors, trying to find support services, and being sent away disappointed,” says Cathy.

“These are people who already feel marginalised and discriminated against, who are often struggling with their feelings and mental health and experiencing a significant level of trauma.”

She was one of the founding members of a gender-diverse working group which brought together health care service providers and transgender community organisations to identify what was needed and how it could be facilitated.

“Ensuring community representation was essential for the kaupapa of the group and we were able to ensure that services were designed by them, for them. It was a highly effective approach.”

This area of health care has long been struggling for funding, in part because the gender-diverse community are seen as a minority amongst minorities. But statistics show that this is not the case.

A survey carried out as part of the Youth 2000 project conducted by Auckland University found that 1.6% of New Zealand high school students identify as gender diverse with further 2.5% questioning their gender.

“That’s more than 1 in 100 Kiwis who are going through this, which is certainly not a minority,” asserts Cathy. “And when you take into consideration that a large proportion of this community are simply looking for support for a social transition and do not need the expense of hormone therapy or full gender re-assignment surgery, the amount of funding required should be manageable.

“Like any patient, a gender-diverse person wants to be heard, and knowing that they will be listened to with compassion and empathy is huge.”

“Furthermore, this group are highly-over represented when it comes to mental health issues and the huge costs we are experiencing in this area – early intervention and support is not only vital but cost-effective.”

And even when services are available, many doctors do not have the information they need to access them. There is a huge inconsistency in local information across the regions with Northland, Auckland, 3D (Wellington/Hutt/Wairarapa), Canterbury and West Coast only having reasonably up-to-date pathways.

She hopes that the information in the article will go some way to addressing these inequities and help educate and enable GPs to take a more proactive role when it comes to helping gender-diverse patients.

“I can honestly say that this work is amongst the most satisfying I have ever done,” says Cathy. “Affirming and validating someone’s gender can make such a difference to their lives because you are giving them the freedom to be who they are, and that is a truly joyous thing.”

“For many clinics, merely ensuring clear guidelines and policies around the provision of gender affirming health care are in place will make a huge difference to individuals who identify as gender diverse.

 “Just asking someone what their preferred pronouns are goes a long way to letting them know they are acknowledged, respected and understood.”


The article published in NZ Doctor can be found here (use the code 'gender'). A College audit to help you establish great gender-affirming healthcare protocols in your practice can be accessed here.