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Uh uh uh called Burgess, Uh uh called Amanda. Uh, welcome, everyone. Um, I'm Amanda Burgess. Um, my pronouns are she, uh I hail from the beautiful Taranaki. Um, but I've lived in Wellington for more than 20 years, and I currently work in the mental health, uh, policy team here at the ministry. Um, I'm facilitating, uh, this, uh, transgender health panel discussion today. We've [00:00:30] got a fantastic, um, panel of experts in the field. Um, I'm gonna invite them to introduce themselves now, uh, and then I'll just cover a few little stats, but I don't want to take anything away from what they're saying. And then we're gonna the panel are all gonna, um, present, um, sort of the three biggest, um, issues for transgender health that they see. And then we can move into some, um, facilitate questions and questions from the audience. So if you could tell us your name pronounce if you wish to where you're from and where in New Zealand you live now, starting at the [00:01:00] other end. Um, I'm a, um, the national coordinator of Gender Minorities. A, which is the national transgender organisation. Um, and we operate on a, um you know, public health, cup of Maori public health framework. Um, I Where I where I'm from and my pronouns um I was born in the Waikato and I've lived in Wellington for about 14 years. I think, um, and [00:01:30] I use pronouns. OK, my name is Bex Kenner. I am a GP. I work at Evolve Youth Service. Um, I I'm originally from the U. SI came to Wellington a couple of years ago from South Otago, and I use they them pros. I think that's, um my name is Kate. I am the community liaison [00:02:00] at gender minorities of, um and I work with a range of groups and responsibilities there. Um, I am from the hut and have tried living in other cities, but like Wellington better so I always come back. Uh, my name is John. I'm I actually am from, um, originally out on the West Coast. But I now live in Auckland. Um, and I'm at the University of Auckland, [00:02:30] and I'm here with a youth 19 youth, 2000 hat on today. Uh, my name is Jemima Bullock. Um, and I am born and bred Wellington. Um and I use she her pronouns um, and I'm a psychologist here at CC DH B. But cover the the three DH BS. Um, and I'm based in the endocrine department. So I work with young people 16 and up, wanting to go on to hormones. [00:03:00] Um, so right, I'm just gonna traverse a few a few stats about the trans and non-binary population. Um, and then, um, throughout, um, each Panelist's talk. We'll invite them to bring other stats to our attention, Um, in relation to transgender health. Um, so we don't currently know the exact size of the trans and non gender non-binary population in New Zealand. Um, as the data is not collected currently in the census, um, estimates through a variety of, um, uh, research show people with diverse [00:03:30] sexual orientation, gender identity and sex characteristics is between six and 15% of the population of New Zealand. Um, the county survey is quite a defining survey. Um, of this population undertaken in 2018, uh, has a copy over here. Um, so about a third of the survey participants, um, had avoided seeing a doctor because they were worried about disrespect or mistreatment as a trans or non-binary person. Um, two [00:04:00] thirds of the participants had experienced discrimination at some point. Um, and 71% is just as tragic of those surveyed reported high or very high psychological distress, Um, compared to only 8% of the general population in New Zealand. Um, so it's just a little bit of set the scene. Um, stats. I'm gonna ask each panel member now to to talk us through, um, the three biggest, um, issues for trans health that they that they see. So we're going to start with a at the end. Thank you. [00:04:30] Um, I think as a coordinated bunch, hopefully we'll cover. Hopefully, we'll cover those, Um, because the three biggest there, there are so many. There are so many, um, health inequities for trans people. And also lots of them are caused by wider social inequities. Discrimination in housing, um, you know, and education across the board. So many different areas. So, um, it's very hard to have to live a healthy life and to have what you need when, um when you you know, the median income of trans people is [00:05:00] only half the median income of the general population, and one in five are homeless at some point in their life. And that figure is one in two if they're not white. So it's really like it's it's really serious stuff. Um, so what? I want to talk about my my three, my three little points, and I'm gonna try and keep it. Keep it Not too long. Um, the first one is puberty blockers. Um, this is one of the first treatments that lots of trans people are wanting. Um, when they're younger, puberty blockers aren't sex hormones. They just a pause on your puberty. [00:05:30] So they're very much like a contraceptive and that, um if you take a contraceptive, you know, it might pause your periods, and that is quite a big deal. It is something that's really affecting your you know what your hormones would otherwise be doing to your body. But if you, um, and if you stop taking contraceptives, periods come back. So puberty blockers are very safe, they're fully reversible. And if we know that, if, um that if young people can't get access to contraceptives and they don't have very good health outcomes, they really need [00:06:00] to have that. Um it's like really essential that there's not barriers to younger people being able to get contraceptives. And it's very similar with puberty blockers, um, young people who, if they can't get puberty blockers, then they're having to go through really permanent, irreversible changes that their body is taking them through without without their ability to have a say in it. So I think we see puberty blockers as something that really needs to move into a harm reduction framework much like contraception, so [00:06:30] that young people don't have barriers, um, and can access those things. Uh, as soon as they need them. Um, I think the the next thing is a little bit of a smaller thing in a lot of ways, but it makes a really big deal for lots of people. Um, which is that the small expenses that Trans people need to cover are huge expenses to them. So what I'm actually talking about is, um, binders and facial hair removal. [00:07:00] So binders are like, um, like medical prosthetics that people use to flatten their chest if they have breasts and they don't want to have them and they can't get access to surgeries to, um, fix that so we get gender. Minorities gets about 400 requests a year for free binders from people who can't afford to buy their own. So that's quite you know. That's quite significant. And for them they can't afford it. And and maybe the cost is $60 [00:07:30] or $100. But you know, people are in really desperate situations, and sometimes that's from families who are saying, Look, we've got six kids. We can't afford to buy one of them the $60 item. Um, but they are a medical, you know. They're a medical item, and they should be really covered by DH BS. Or potentially they could be covered centrally by the Ministry in the same way that wigs and hairpieces are covered for cancer patients who need them. Um, yeah, that cost can't be on the individual. And it can't be on the community organisations [00:08:00] because, um, we're not funded for that. Um, and the other thing is facial hair removal, which is probably the most common medical treatment that Trans women need. Uh, and it could be a really big safety issue if they can't get rid of hair on their face. And I think probably most women would, you know, would suffer really greatly. If they had a lot of facial hair growing, that's really, really important. Um, it might cost about $2000 per person to get that done. That's a lot of money for an individual, but it's not a lot of money for a really effective health [00:08:30] treatment that's been proven to work well. So we'd like to see, like, currently no DH BS provide that. But we'd like to see that taken as a, um, as a something that needs to be done. Um, and the last thing nobody's given me a time card, so I'm just gonna keep going. That's the last thing Um, that I will talk about is, um, the genital reconstruction surgeries, which probably is the most kind of common commonly known about one. [00:09:00] there was no surgeon from 2014 to 2018. So we have There was already quite a big backlog. So there's what, A few years ago, the waiting list for those genital reconstruction surgeries was 40 to 50 years. At the rate that they were going, it's now down to about 10 years, so that's like a really good you know, that's a really good progress. But also waiting list shouldn't be longer than six months for any surgeries and which, realistically, sometimes they are about 10 years is ridiculous. Um, so [00:09:30] we do have a a surgeon now, and she's a private surgeon, and she's contracted by the ministry to do about 16 surgeries a year. So, yeah, with a waitlist over 200 patients, it's still quite a big wait. Um, it needs to be funded to actually meet the demand. So that means clearing the waiting list of 200 odd patients and then possibly 16 surgeries a year is adequate. And we don't really know because it's, um, because it's been inaccessible for so long. People haven't been able to apply and that sort of thing. So So there's a little bit of a guess [00:10:00] work there, but it needs to be funded to meet the need. We know that due to covid, lots of people who would otherwise travel overseas for all kinds of different surgeries haven't been able to. So that means they're all in New Zealand getting surgeries done here, which means that the theatres are booked private surgeons, you know, like there is so much surgery that are not related to train stuff necessarily that's being done here. Now there is no theatre time and lots of across the country, so it's quite a, um, it's quite a [00:10:30] big hold up on getting surgeries done. But, um, there needs to be more support around making sure that that can happen. We know that the surgeon is very, very competent, and she's, um, like at the moment. So I'm going, I'm going off track. But there's also, um, people need to have, like, 10 months, maybe of, uh, permanent hair removal done in their genital area if they're gonna get genital reconstruction surgery. So there's a weight on for doing that, and that is funded through the ministry. [00:11:00] So that's awesome. But it doesn't get reimbursed until after the surgery happens, which means that at the moment the surgeon has to pay for that out of her pocket and at 2000 ish, maybe dollars per patient. That's $32,000 that you know, if a surgeon has to pay as an individual $32,000 to get the patient's health care, that system isn't working, so there needs to be like a lot more In-depth thought about how that process works. And [00:11:30] probably the best person to have a, um, to have a clear view of what that looks like as the surgeon. Um, but yeah. So So we we think that that really needs a whole lot more work done on it. Um, yeah, I'll stop there and pass it on to thank you. Um, So, um, first of all, I'd like to say that this should be required reading it is online counting ourselves dot NZ. Um, OK, so, [00:12:00] II, I like stories. Um, it's part of my job as a GP to listen to people's stories. So I've written a little story to hopefully illustrate what I think are the main points. Um, So it's the case of Max. This is a fictional story, but it could be anyone. Max is a teenager who identifies as non binary, neither male or female, but was assigned female at birth. Max has found puberty very distressing, especially breasts and periods, which are constant reminders of their gendered body, which don't doesn't align with their identity. [00:12:30] So, Max ask their parents to take them to the GP to do something about the periods. Max finds this a distressing experience from start to finish. In addition to the misgender and dead naming, they have unfortunately become accustomed to in their daily life. They are surrounded by pamphlets clearly addressed to cisgender and usually heterosexual people. Information about birth control shows pictures of men and women and says things like This method prevents pregnancy in 99.9% of women or is especially good for women with heavy periods. Nowhere [00:13:00] does Max find anything about people like them, or what they need to know about birth control or safer sex. If, for example, they started having sex with their girlfriend, Alice, who is a Trans woman, Max is given a prescription for the pill and notices that it is made out in their dead name. If Max were to ask for this to be changed, they might be told it can't be done in the system or they need to legally change it first, neither of which are true. They are also told that the only options for gender are male, female, unknown or indeterminate, [00:13:30] which is true in the MedTech system. Most GPS use Max is 17. They and Alice decide to go to evolve because they're lucky enough to live in Wellington. Max wants top surgery. They're sick of binding their large breasts, and they're having a lot of neck and back pain. They are told that a they have to wait until they're 18 and B for a brief moment in 2020. The surgery was available in the public system in this DHB, but due to a lack of personnel, there is no current capacity. Their GP was told they would be notified [00:14:00] when the service is available again. The GP is sceptical of that actually happening. As it turns out, Alice asks about an orchidectomy, a simple procedure to remove their testicles. She received the same answer. It has been publicly funded, but now the urology department does not have the capacity and procedures are on hold. Max and Alice, of course, do not have the funds to pay privately for these surgeries. Now, let's say Max and Alice, sick of the dismal job prospects and cost of living in Wellington, moved to rural Southland [00:14:30] to work on a dairy farm. The anxiety of even finding a trans friendly GP is enormous, let alone ones who understand. They then pronouns. They travel several hours to Dunedin, where there are at least some GPS who are up to speed. But accessing hormones and surgery is a whole different kettle of fish. The GP doesn't even know what the process is or where to find that information. And to top it off, they find that MedTech is not a national record system, so they have to explain their name, gender and pronouns again. [00:15:00] One time Max sprained their ankle at work and had to go to a local rural health centre, where, trying to explain that their gender and pronouns was met with confusion and basically ignored. The doctor asked irrelevant and probing questions that had nothing to do with their ankle. And they were given information about a medication that said it should be used with caution by pregnant or breastfeeding women. Max and Alice both became very depressed, even suicidal. They have trouble accessing trans affirming mental health services and are faced [00:15:30] with the difficult choice of returning to Wellington, where they have some chance of accessing care that is affirming and inclusive of their genders, but where they cannot afford to live. How are we going to help people like Max and Alice. Well, my three recommendations and there are many more. First, the system needs to be changed. There needs to be clear. Guidelines and pathways across DBS, urban and rural and resources, money and workforce need to be allocated equitably. It systems need [00:16:00] to be changed. Gender options expanded correct naming and gender pronouns and name need to be easily accessed by GPS and hospital systems throughout the country. I forgot to add that the GP system MedTech does not coordinate with any of the hospital systems which are all different, and don't coordinate with any other ones. Either. GPS need to be supported to learn at least the basics of how to make their practises inclusive and where to go for information about referrals and guidelines. And this needs to start at the medical school [00:16:30] level. And actually I think I went to four. Sorry, all health information and communications needs to be written using gender inclusive language IE addressed to all genders and all sexual orientations. So this is just a brief overview of the challenges and inequities trends and non-binary people face in navigating health care in a and from the perspective of someone who has, as we say, been on both sides of the stethoscope. We, uh the system really needs to change. Thank you. Thank [00:17:00] you very much. Great. Cool. So we we spent some time whittling down our collective sex statements between A and I from about 10. Um, and I'm really glad that some of the ones we decided to leave out have just come up in X's statement, Um, and very eloquently expressed. So those are there are some really good and important stuff in there. Um, but for my three things, the first one I'm going to speak to is informed consent, [00:17:30] which is a very important part of what we've got in the, um, the guidelines for gender affirming health care. Um, which is essentially that Trans people should be in a position to make their own decisions about their own health care. Trans people should have access to all of the information they need to make those informed decisions. And then when they make those when they make decisions about what, um, kind of gender affirming healthcare they want to access [00:18:00] the doctors should be should recognise that that intent and that expertise and just give it to them. Essentially. Um, so we've got we We often hear examples of people who are having that informed consent denied to them. Um, so we've heard from transwomen who've been told to go away and learn how to be more feminine before they're allowed to access. Um, H RT. Um it's been very common for a long time [00:18:30] for people to go to to want to access, um, gender affirming surgeries like top surgeries, and be told that they need to take H RT first. And they don't actually want to take H RT. That shouldn't be a decision that's forced on them. Um, what else have we got here? Uh, and also the the endocrine society guidelines say that the the which is a level of oestrogen in your blood for transwomen [00:19:00] should be up to 730. But we've got a system where it seems that nationwide doctors are keeping transwomen on less than 200. Um, and because the trans women aren't doctors, the doctors aren't respecting their opinion, even though it's perfectly well researched and quite educated. Um, we're coming up against barriers and getting access to the levels we want to have And also, uh, never mind. I'll [00:19:30] finish there. I could go on all day. Um, so the second thing I wanted to speak to was funding for community support. Um So there's an overwhelming tendency for funders, including government funders. To consider trans health care issues is part of rainbow issues, which means that over and over again, we see the funding that is getting put aside to address the really important and massive health inequities that Trans people have is going to sled [00:20:00] rainbow organisations, um and then for what they decide to do with the money. The trans stuff is a really small priority. Often, um so in the northern DH B, there's peer support funding which goes to rainbow organisations which are led. Um, and a peer led organisation would be much better set up to provide that peer support. Um, when counting ourselves was released, the government established the Rainbow Legacy Well-being [00:20:30] Fund. Um, 21% of the people are represented in granting ourselves a youth, and 100% of the people in that study are trans. Yet the Rainbow Legacy Well-being Fund is for young rainbow people, so it's quite misdirected. And where that funding is going and what it's actually being spent on. Um, yeah, And unless the funders are prepared to listen to trans people when we bring this up, then they're not going [00:21:00] to get that information. And we know that when the more broad rainbow orgs apply for funding, they are all and counting ourselves and the inequities that Trans people are facing and yet still very little of the funding goes to peer led trans organisations. It isn't to say that funding for youth and funding for more broad rainbow issues isn't really important because obviously, we acknowledge that those things have real value too. [00:21:30] Um, but unless the funding is going to peer, lead trans orgs, you're not gonna see the same kind of change in the health outcomes. Um, and the final thing I had to talk about, um and I appreciate that I'm speaking to, uh, the the Ministry of Health, which is centralised authority. And the ask is directed at DH BS. Um, so there's a bit of a disconnect there, but [00:22:00] it's a really big issue for for us, um, that we need to see gender affirming surgeries going ahead. Um, we need to see DH BS prioritising them. Um, and this isn't talking about bottom surgery, which does have centralised funding through the Ministry of Health. This is for mastectomies, chest reconstructions, breast augmentations, hysterectomies and orchectomy. Um, which are vital gender affirming health care, um, procedures [00:22:30] that we're just not seeing happening through out most of the country. Um, and the places where it is happening, the capacity is not equal to the demands. And all of these surgeries are surgeries that are accessible to assist people that the pathways are already established. The surgeon. The surgeries are already established. There's people doing the surgeries. Um, there's theatres dedicated to them. Um, but there's just no pathway for trans people [00:23:00] to access them. And we need to see the DH BS establishing those We need to see the DH BS acknowledging the the level of demand and finding the capacity to meet it. Cool. Great. Thank you very much. Kate. John, take it away. Um, So, um, thank you to my fellow panellists. It's really wonderful to be here. Um, I'm going to be presenting some of the data that's in some of the fact [00:23:30] sheets that are moving around. Um just a little plea. Um, please don't share those stats yet. We're doing a media release sometime in the next, um, fortnight after Easter. Um, and so we'd like to, um, kind of really try and make that, um, really pop when we do that. So, uh, my, uh, thanks to you for not sharing that or tweeting or tiktok it, um, whatever you might try and do, um, that would be awesome. But what you'll see there is, um, some of the stats from the latest youth 19, [00:24:00] uh, survey, which is a representative survey of secondary school age students. Um, across a, um, and what that demonstrates is, um, conservatively. 1% of those students say they identify as being trans or non-binary, and 0.6% of them say that they are currently unsure about their gender identity. So that's roughly about, um, 16, Um, about yeah, 11.6%. [00:24:30] Um, in total of those students are identifying in some way around the the transgender non-binary umbrella. Um, what's interesting is that the numbers of those students we asked them about when they started to identify in a way that might be congruent with that identity. And 75% of them said that was before they were 14 years of age. Um, I guess then, um, some of the ask, uh, from my perspective will be around what we're doing [00:25:00] in, um, early care for young people, how we're working with, um, kindergartens, primary schools to create, uh, places that are safe for young trans people Come, what's also interesting, um, in relation to, um, informed consent and, uh, parental consent is that only a third of our participants have disclosed their gender identity to their parents. And, um and that has major implications. [00:25:30] When you think about some of the stuff that's been happening in the UK recently around requirements of parental consent for access to hormone blockers, um, which is something I think is very scary. Um, the findings, um, in the surveys, um, also show, um, that unfortunately, the majority of these students are experiencing unsafe environments in school. Um, nearly five times as many more Trans and non-binary participants reported experiencing weekly bullying [00:26:00] at school compared to cisgender peers. Um, and also, uh, nearly twice as many said that they felt unsafe in their neighbourhoods and that very much talks to those ideas that a he was mentioning about the additional stress and strain that faces transgender non-binary young people as per se. Um, and what that means is that, um, we're seeing incredibly high rates of, um of symptoms of depression, um, and self-harm and [00:26:30] suicide attempts. Um, in terms of depression and self-harm, those are both over 50% for the trans and non-binary young people in our study. And, um, the the a quarter of the participants reported a suicide attempt in the past year, Um, which compared to just 6% for the cisgender peer group. So we are seeing that real sharp end coming in around, um the the results of, uh, a sort of oppressive environment for these young [00:27:00] people, I guess what that means, then, is that, um, from a health ask talks to the fact that we need, um to improve mental health services for trans and non-binary young people. Um, and there's a really serious urgent need, uh, to do that. Finally, unfortunately, the survey Sorry. It's such a bad news story, this this, um, this particular fact sheet. But it also showed there's a massive disparity which is apparent in in the we're having here about [00:27:30] the ability for these young people to access health care. Um, we asked young people about their ability to do this. And, um, the the numbers were, um, significantly lower for trans and non-binary young people compared to their cisgender peers. Which means that we also need to do more work to enable young people to access, uh, trans and non-binary affirming healthcare services. Thanks. Lovely. Thank you. John. Jemima. Um, again, [00:28:00] um, I forgot to mention that I think we're all members of P A, which stands for the Professional Association for Transgender Health at, um, and myself and I here on the, um, executive committee for that as well. So speaking from, um, a more national perspective, I fully support everything that has been said before me, Um, and particularly do want to reiterate the importance of mental health support particularly for our younger people. And, um, we do know, uh, there's [00:28:30] there's some really good research to show that if young people are supported with a social transition accepted by their friends and family that their mental health outcomes are absolutely equal to their cisgender. Um uh, peers. So So really really, really key. Um, and and also where we have had, um, you know, we have some gender minorities, you know, nationally and here in Wellington provide an absolutely amazing, uh, service that that isn't funded. So so again, really looking at having those [00:29:00] support services either in mental health or to walk alongside, um, young people and and adults to navigate the system. I think there's one of the DH BS up north in Auckland have successfully done that with a trans peer health navigator. And it's just been so incredibly helpful to have that, um, really up to date information source where they not only advise, uh, clients, young people, but also health professionals That may not necessarily know what they're doing, which is OK, um, but but [00:29:30] to be able to have have somebody that can tell them um, my other point, uh, again, probably, you know, supporting again. What you talk about working in in primary health care. Uh, really, really wanting that support and funding and knowledge for GPS, particularly in our rural communities where where it might be, you know, the one GP, um, available where where there is support, uh, education and confidence uh, for those in primary health care to do the informed consent [00:30:00] where a young person comes in seeking medication to either block puberty or to, um, develop the sex characteristics so that they can be more congruent with with their identity. Uh, finally working in, uh, one of the DH BS again that access to, um, gender affirming surgeries. Pointing out that these are not cosmetic surgeries, they are essential health care. Um, and I work on a team that prescribe hormones, but for our trans masculine, uh, people, um, it can be very, um, difficult [00:30:30] to step out in public where where people often assume that because you have a have breasts or a large chest that you are female and treated as such. So I work with so many clients that simply do not leave the home literally. Don't don't leave the house or only, uh, leave with a binder. But that's very limiting. Um, so So yes, really, uh, recognising that that these services are not well funded and certainly wanting them to be so nationally with DB will meet a certain standard would be [00:31:00] ideal. I'll stop there. Brilliant. Um, thank you all for those um fantastic. Um, insights and comments. Um, I thought we might turn to the audience to see, um if there are any questions, I've got a few questions I'd like to ask you as well, but I thought I would hand over to the audience. Um, So can you introduce yourself and either ask one panel member or direct it at all and we can go? Freya, Hello? Um, yes, I am Freya, uh, for people online. If you cannot, uh, comment. Feel free [00:31:30] to message me as well. I'm the only prayer at the minister of health. So you'll find me, um the question I have, which is actually, um from, uh, who's in Christchurch at the moment. Um, with the UK order of blocking hormones to young people, can you please explain why it is important that young people have access to hormone blockers and the safety element of being able to have self determination for young people to ask for human hormone blockers? Yeah, There's a really good statement, actually, that was written by, [00:32:00] um, the World Professional Association for Transgender Health. Um, along with the, uh, European Association for Parish Association for Transgender Health in the Asia, the equivalent same association in Asia. Um, the one, I think there are maybe seven or eight of them. And they wrote a really good statement in response specifically to that case. Um, so we're essentially what they're saying is the [00:32:30] issue is always access to the right health care. Um, so if you if somebody has so puberty blockers don't change your sex characteristics. So that's the first thing. That's one separate thing over here. Hormones change your sex characteristics. Yes, you do have to be a little bit older to get those, um, and the requirements are a little bit different. You should. You shouldn't need any barriers whatsoever to get puberty blockers. Hormones are slightly different. Um, but they [00:33:00] Yeah, it's It's important that if you've had those sex hormones or you have had any sort of gender affirming surgeries, I think the the rate is there is a study. There was a study of like 22,000 people who had had gender affirming treatments, and only of those 22,000 only 22 had had regret about having had those treatments because of their gender identity had changed again. So there are some [00:33:30] people Very, very, very tiny numbers of people, though, but But, you know, there are some people who've had those treatments, and then they actually my gender journey has moved on. I want to You know what feels right for me is actually this gender, and I'm gonna do that. What those people need is the same sort of care that trans people need. Like they need to have access to gender affirming, um, health treatments if they if they are a woman and they thought they were a trans man and they had a a ectomy, they had their ovaries taken out. [00:34:00] They're gonna need oestrogen based hormone therapy. Um, so if they're going to being, you know, a cisgender woman after having had trans affirming surgeries, they're gonna probably need, you know, further hormone treatments. They might need other surgeries and as a very small number of people, but they need the same sort of human rights based, proper affirming health care that trans people need. And it's the same with things like identity documents. You know, if you can only change your birth certificate once, then what happens if your gender changes again and [00:34:30] you know, you need to have. You need to have, um, the same sort of access to correct proper, good, supportive, gender affirming medical care and, um, identity documents and things. I think with the UK as well, if we're looking at it from a human rights perspective, is that New Zealand takes in, has granted asylum seekers from the UK refugee status in a [00:35:00] because they are transgender. And the UK is a fundamentally unsafe environment for trans people. Um, and that is the the background towards To all those court cases, it's ideologically driven. They don't like trans people. Um, and well, there's a massive, powerful section of people within the UK who don't like trans people. And they control the narrative and have created, uh, like a fundamentally [00:35:30] unsafe country for for the trans people there. And the legal decisions that come out of that are not, uh, internationally valid, I would say nice. Um, so, um, just just speaking, from the perspective of the GP. First of all, there I've run across a lot of things in my career where policies are made by people who aren't doctors and don't have medical information. As he [00:36:00] has said, there is There's actually nothing harmful about puberty blockers when given at the right time in puberty, best sort of early on, so that it just puts a pause. Eventually, at some stage, a person will need to have make a decision. Medically speaking, sex hormones of one sort or the other are necessary, but it puts a pause on that. Testosterone, in particular, is a very strong hormone, and if you're a trans woman and you [00:36:30] that testosterone runs rampant in your body, it's very difficult to reverse those changes. The other thing, I just wanted to, you know, my math brain just calculated what he said, and it's about one in 1000 people who det transition. That's the same as the rate of getting pregnant on most of our most effective birth control methods. So if we're willing to take that risk, um, that should be a no brainer, in my opinion, um, [00:37:00] so that's that's kind of a little bit more about the medical perspective. It really pissed me off when I saw those news reports, because any time policy makers are making decisions that should be made by doctors and are uninformed by the medical evidence, it just It's like practising medicine without a licence, it shouldn't be happening. OK, can I? Um Mike, one of the things that I, um, forgot to mention, too, was that we also asked [00:37:30] young people about how supported they felt at home. And unfortunately, only two thirds of Trans and Non-binary young people said that they had a parent, at least one parent who can about them a lot. So this idea that, you know, expecting trans and non young people to come out to parents, a third of whom say their parents actually don't care about them a lot to then get the health care that they need is is is incredibly problematic. And I really appreciate the human rights and and vocation there around what that means in terms of [00:38:00] the United, the UN Convention on the rights of the child and their access to health care. So it's a it's a major issue, and it's something I'm, you know, really passionate about it, obviously. So, yeah, can I just add one more thing to that about the de transition, um, or ret transition narrative? Because de transition is usually used by people who want to stop people from getting gender affirming health care, whether that's for a transgender identity or after having had a transgender identity to have a CIS gender identity again, Um, [00:38:30] I think it's about 64% of people who who de transition for any reason. Um, they do that temporarily, and and most commonly it's because of pressure from a parent. So, you know, we we need to also, if we're looking at, you know, people having to give up a transgender identity does. Is that because of, um, you know, is that because of actually, my gender journey has moved on and I'm not that anymore? Or is it just going back in the closet? And we know the harms of going [00:39:00] back of having to be in the closet of not being able to be out, Um, especially on mental health. But yeah, um, any other burning questions? I've got a couple. I have another follow up. Um, this one is from Clare Ryan from our Disability Directorate. Um, she just wanted to ask if any of our panel can comment on how issues for access to trans health options are being supported for disabled people. Um, in particular for people with maybe cognitive learning impairment. Thank you. [00:39:30] You got any on that? Well, I can say some things about, um because a lot of I think I think it's, um it's around, like, 24%. Maybe of the trans people who answered the counting ourselves are are disabled. Um, and we sort of put disabled and neuro diverse somewhat together because, you know, they're not always the same thing, but there are a lot of the same issues, a lot of the same things that disabled people and society are disabling. You know, for a lot [00:40:00] of a lot of people, um, we know that the the health outcomes for disabled trans people are much worse than for trans people who aren't disabled. Um, I forget the exact question. I can repeat it if you'd like. Ok, um, where did I put it? Accessing, um, in particular for people with co. Yeah, right. I suppose that there just needs to be a lot [00:40:30] more focus in that area. Um, one of the actually G MA has just applied for some funding to try and be able to focus on, like, disabled trans people. Um, and in particular, I mean there are. There are lots of groups within that catchment who have especially, um, a special, especially, um, inequitable access. Um, we know that around the country, so gender minorities has about 3000 contacts a year. [00:41:00] Not all of them are trans people, Some of them are, or people working in services that support trans people. But a lot of them are trans people, um, needing support and and heaps of that as health system navigation. Um, we know that a lot of people are turned away or told that they don't really know what they're asking for or that sort of thing, depending on the healthcare providers read on their level of not not necessarily capacity but like capability. And [00:41:30] I think that that's one of the and and, you know, I think I think it's about 13% of Is it 13%? We have really, really high numbers of trans people who are autistic. It's really common that if you, um, think about things in a slightly different way and are less concerned about fitting into social norms than the general population, that's more likely that you explore your gender in a different way as Well, um, and I know that lots of us at our organisation are autistic. It's really, really common. [00:42:00] Um, and we come across that all the time with the people we support as well. And a lot of the time people have been told, Oh, I think you're just trying to fit in. You know, maybe you're just weird in some way. Essentially, of course, the health care provider doesn't say you're just weird. But what the patient is hearing is you're just a bit weird. And maybe you're just trying to fit in. Um, and so you think this will help you fit in and I don't think anyone thinks Maybe I'll try being transgender, and that will help you fit in. Yeah, There's a lot of work to be done in that area. [00:42:30] Thank you. May I add to that, um, with with regards to people that maybe have a cognitive impairment, Um, you know, consenting to any medical treatment is about about understanding it and and giving that consent. So it might just be that that person needs some additional support either from more specialist services that specialise in that area. Um, and also some people on the autism spectrum again. It's a social communication difficulty, so so it doesn't mean the person is any less trans. [00:43:00] It just means they might need some more support to to make sure that they do understand the information and that they're able to articulate that in some way. Um, and And we do know that out of the the trans population, including transgender non-binary the continuum, um, your three, that population is 3 to 6 times more likely to also have autism spectrum disorder, whether it's diagnosed or not. So that's 3 to 6 times not too sure why. It's a correlation, but but so we often [00:43:30] do work with people that that express themselves in different ways. Yeah, just add, um, from a funding perspective, the youth one Stop shop network. We provide holistic wraparound care, including mental health services, and it's very empowering for young people to be able to come and access their services. They're all free, but they need more funding and we don't. We have a lack of funding for providing some of [00:44:00] these services to trans and non binary young people, which really needs to be rectified. So I just OK any other questions question over here. Do you think that there's enough legislation in New Zealand to protect trans people not only in terms of their experience but also, um, their choices? Good. No. I think [00:44:30] that, um, amending the Human Rights Act to include sex characteristics and gender identity is very, very necessary. Um, and it it's certainly on the table, but it's not been prioritised. Um, I think lots of the issues, uh, like a lot of the issues with trans people, are based on discrimination. Um or, you know, come from discrimination happening. And in a lot of cases like anti [00:45:00] discrimination legislation gives you a way to hold people accountable after the discrimination has happened. If you can show that that is why the discrimination has happened. So overall it definitely has an effect and like makes things better. But it also doesn't you know, murder is illegal. It still happens. So it's kind of there's a whole lot of, um, there's a There's a lot of policy things that could be improved across, you know, every every sector. Um, and we know that one of the biggest issues for trans [00:45:30] people was housing. And if you can't get housing. How can you have a GP? You know you can't even get a food parcel if you don't have an address. So it's it's It's quite dire. Um, and I think that, like protecting trans rights better like in some ways, um, that won't solve that problem. That problem is something that needs to be tackled on its own, Um, and then also that can be supported by things that do support trans people, like having emergency housing that's accessible for trans people. Um, you know, prioritising trans [00:46:00] people. And I think, um, I think the Ministry of Housing and Urban Development last year, 2019, we sent them this great this great County House report. You know, there's been a lot of work that's gone on there to get Trans people named as a priority and, um, in the national housing strategy and things like that. So it's kind of yes, across the board, a lot more needs to be done. Some of its legislation, probably most of its policy. And then there's a lot of how do people enact their rights. Do we have the right mechanisms for holding? Um, [00:46:30] you know, like like like in the case of a doctor continually says to patients, You need to go away, learn how to wear a dress and high heels before you're allowed to come back and get hormones should you be practising. If that's what you expect women to do to get health care from you. I don't know. I I'm not a medical medical regulatory body, but you know, it's Yeah, it's making sure that we have the right mechanisms. I wanna tell you particularly address, particularly the non binary aspect of things. [00:47:00] Um, in the 2018 census I had, I had read something about how they were going to be more than male and female as gender, um, options. And then when I got my census, I was really pissed off and there was there was an article from Stats New Zealand basically said, It's just too hard. I come from a family full of statisticians. Um, it's not too hard. Um, I think they're working on it for the next time around. When my partner and I got married applying online, we're both [00:47:30] non binary. We only had male and females options. There was somebody in the DIA who championed our cause. and we actually got a marriage licence with X or something. Yeah, something that wasn't male or female. Um, you know, because as of 2013, gender is irrelevant in marriage. So, um, there's all sorts of policies like that. And if we find that we're not included or invisible, that has a huge effect on mental health. I mean, the number [00:48:00] of times I myself just feel completely deflated when somebody misgender me or I'm not included in some something, you know, and then this this legislation about that, I think I don't know what happened to it about being able to self declare your gender for your birth certificate. Turns out I can now that I'm a New Zealand citizen. Self declare my gender for my passport, but not my birth certificate and just all of those things that completely [00:48:30] invalidate our existence. So, yeah, that would be helpful. OK, I think we're just about, um, just about time to wrap up. But I've got one question, um, for each of you for the panel, I think you've touched on this in all of your conversations, but I think we'll, um just, uh, lay it down as a challenge. Um, what is your top priority for the Ministry of Health to work on for transgender health? Um, I think competent care across all areas would be great. Just a just a small one. [00:49:00] We could get that by 3 p.m. gosh, um, my top priority, I think, um, as a health professional, um, having really clear guidelines that are consistent across all the DH BS and funding that's consistent, and if possible, workforce availability. That's consistent. Um, I mean, I found this in multiple [00:49:30] areas, not just trans care. Um, coming from the southern DH B to this DB, um, so some kind of cohesive system and also empowering the GPS to be able to access those guidelines and feel comfortable if they don't feel comfortable providing the service themselves, which there are probably many areas that I don't feel comfortable with in other spheres to [00:50:00] know where to refer people and funding for that. You know, if I'm a GP with a special interest in trans care, what funding am I going to get to be able to provide that service that 16 other GPs in my area don't feel comfortable with and want to refer to me. Um, so one that I think is arguably the most important, but also one that the Ministry of Health has a lot of control over is clear. [00:50:30] The backlog for genital reconstruction surgeries. Um, all it needs is funding. And it's a concentrated pathway and like a good system, all of which is well within the Ministry of Health's capacity to do, um, people have been waiting for 10 years already. There are There are plenty of people who have told us that the reason they haven't tried to get it is because they don't believe that it's ever going to happen. Um, [00:51:00] the system has left us with so little hope. Um, it just needs to happen. I. I think I just have to reiterate that point. It's just such a no brainer that we need to address that massive backlog and also provide, um, funding for binders and a range of other scenarios and especially clearly, um, quality mental health, um, support for young people. Ultimately, it would be lovely to live in [00:51:30] a society that wasn't easily transphobic all the time. And so it would be nice if we could start to think from a public health perspective What that might mean and how we might address that as well. Right? Thank you. Um, a again. I agree with all of those things and and probably, um, really wanting to de pathologize trans affirming health care. Um, so if a young person or an adult you know, needs or wants medication, we all go to our GP and speak to our GP and our GP Usually, you know, helps us out by prescribing [00:52:00] something. Um, is that that Trans people have exactly the same rights that that myself and other cisgender people have, Um, and to have funding to support, uh, the training and competency of our primary health care professionals. Um, I'd just like to thank all the panellists for sharing those amazing insights. I think it's given us all, uh, a wider and deeper view of, um, issues, um, for trans gender health care. Um, I think, uh, we have to finish up by one, but I think there'll be, um, an opportunity to stay around for the next, um, few minutes. If anyone's [00:52:30] got any questions, they want to ask the panellists or anyone that's happy to stay around. Um, so thank you very much for coming. Um, and, uh, i'll just, um, close off the panel there, Kilda.
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