Dr Rona Carroll has developed national guidelines to support healthcare practitioners in enabling their patients seeking gender affirming hormone therapy to make well-informed decisions about their care.
The Primary Care Gender Affirming Hormone Therapy Initiation Guidelines are the first of their kind to be developed in New Zealand.
The new national guidelines support community GPs and nurse practitioners to prescribe gender affirming hormone therapy to transgender adults.
They have been developed by Dr Rona Carroll, a GP specialising in gender affirming healthcare and a senior lecturer in the Department of Primary Health Care and General Practice (Wellington), in collaboration with colleagues working in primary care, endocrinology, paediatrics, psychology and sexual health.
Dr Carroll hopes the guidelines will contribute towards removing barriers to accessing gender affirming hormone therapy and in turn improve health outcomes for transgender people.
“Many trans people will come to their health provider with a really strong base of knowledge and experience of their own needs. The aim of the guidelines is to support healthcare practitioners to work with their patients to ensure they understand the risks and benefits of gender affirming hormone therapy and can make an informed decision about starting therapy.
“The prescriber's role is to ensure therapy is safe. This is done by following prescribing and dosing guidelines, assessing medical risk, providing education about expected outcomes and monitoring treatment, in collaboration with their patient.”
Dr Carroll says transgender people face many barriers to accessing appropriate health care in a timely way.
“In a 2018 'Counting Ourselves' transgender health survey, 19 per cent of respondents reported an unmet need for gender affirming hormone therapy. The most commonly reported barriers were not knowing where to go (40 per cent), cost (28 per cent) and fear (26 per cent).”
Dr Carroll says using a primary care-based approach means not all transgender patients will need to have a specialist mental health assessment before gaining access to the therapy.
“The requirement to have a psychosocial assessment from a mental health professional resulted in long wait times for therapy in the public system, or high costs through the private sector. And many transgender people found this process pathologising. Some worried about having to prove they were 'transgender enough' or that they needed to 'say the right thing' in order to access the treatment needed to affirm their gender.”
Dr Carroll says the guidelines make clear it is not the role of a health professional to make a judgement on whether a patient's gender is valid, and instead recognises the patient as the expert in who they are.
The guidelines are based on an informed consent approach to help patients make well-informed decisions about their health.
“The primary healthcare team works in collaboration with patients to meet their gender goals, provides education about gender affirming hormone therapy and general health, and helps to support patients' understanding of the risks and benefits of therapy.
“Gender affirming care, including hormone therapy, is a key part of many transgender people's lives and should be considered holistically in the context of their social and whānau relationships and spiritual wellbeing.”
Dr Carroll cautions though that the guidelines can only do so much, and says general practices need support for training and better funding in order to provide care for their transgender patients.
“Primary care has the skills and expertise to provide a holistic approach which considers all of a patient's needs, but it is essential that this be supported with adequate funding and time for this work.”
The guidelines have been welcomed by the primary healthcare sector.
A GP working in student health, Dr Ellen Miller, says they have given her the information she needs to prescribe hormone medications confidently and safely.
“Trans people are able to get the care they need from a doctor they know and trust and are saved from months-long hospital waiting lists.”
The comprehensive national guidelines were launched in February and include protocols for starting hormone therapy, patient information sheets and consent forms.
The Primary Care Gender Affirming Hormone Therapy Initiation Guidelines are endorsed by the Royal New Zealand College of General Practitioners.
Dr Carroll developed the guidelines with co-authors Rebecca Nicholls from Te Whatu Ora Waitaha Canterbury and Pegasus Health, Christchurch; Richard W. Carroll and Jemima Bullock from the Endocrine, Diabetes and Research Centre, Te Whatu Ora Capital, Coast and Hutt Valley; Dion Reid from Te Mata Peak Practice in Havelock North; Jennifer Shields from Pegasus Health and Qtopia, Christchurch; Rachel Johnson from Kidz First Centre for Youth Health, Te Whatu Ora Counties Manukau; Jeannie Oliphant from Auckland Sexual Health Regional Service at Te Whatu Ora Te Toka Tumai Auckland; Elizabeth McElrea from Gender Care, Tamatea Medical Centre, Napier; Patricia Whitfield from the Endocrine, Diabetes and Research Centre, Te Whatu Ora Capital, Coast and Hutt Valley and the Department of Medicine at the University of Otago, Wellington; and Jaimie Veale from the Trans Health Research Lab at the School of Psychology at the University of Waikato.
Kōrero by Cheryl Norrie, Communications Adviser, Wellington