Aim
In Aotearoa New Zealand (NZ), GAHT is commonly started in secondary care settings. However, it is increasingly being initiated in primary care due to increasing demand and greater recognition of the barriers that transgender people face when accessing secondary care services. The use of routine psychological assessments prior to GAHT initiation can be experienced by patients as pathologising, and can result in feeling the need to say the ‘right thing’ to access treatment.1 It can be challenging to find a mental health professional to conduct this assessment at all. An alternative approach (sometimes referred to as the “informed consent model”) is one where the primary care team works in collaboration with patients, provides education about GAHT, and helps to support patients’ understanding of the risks and benefits of GAHT so they can make well-informed decisions about their health. A need was identified for guidelines to assist primary care providers in this work.
Methods
Health professionals from primary and secondary care, were brought together to collaborate on the development of prescribing guidelines. Authors represent a range of professions including general practice, endocrinology, sexual health, adolescent health, psychology and peer support. Feedback was sought from members of RNZCGP and PATHA before release.
Results
The “Aotearoa New Zealand guidelines for commencing gender affirming hormone therapy (GAHT) for adults in primary care” was developed based on international guidelines, but localised to the NZ context, to support GPs to follow a staged process to initiate GAHT in primary care. Common concerns and questions were addressed, and practical tools such as checklists and patient information sheets included.
Conclusion
Supporting primary care clinicians who wish to initiate GAHT, by increasing their knowledge and confidence, and providing them with the tools to do so, has the potential to remove barriers for trans and non-binary people and contribute to improved healthcare experiences and wellbeing.