19th January 2018, Volume 131 Number 1468

John W Delahunt, Hayley J Denison, Dalice A Sim, Jemima J Bullock, Jeremy D Krebs

The sense of gender identity develops separately to sexual orientation and the external genitalia, and develops to differing degrees between individuals.1–3 Neuroanatomic (nervous system structures including brain anatomy) differences between…

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Before 2000 there were only a few people referred to the Wellington Endocrine clinic for gender reassignment treatment each year. The numbers increased a little in the first decade of this century, but have increased further from 2010 and 2011—from about 20 cases each year to 91 in 2016. As treatment during a change in gender identity involves psychological and counselling support, hormone therapy and possibly reassignment surgery, medical services should plan to provide facilities to meet this increase in need.



Overseas clinics specialising in management of transgender people have noted a marked increase in the numbers of people requesting therapy in the last few years. No data has been presented for New Zealand. We therefore reviewed the number of transgender people seen in the Wellington Endocrine Service to assess if the pattern was similar and assess any potential problems for service delivery.


Using hospital records, we reviewed the new appointments of people who were referred for advice on gender reassignment and seen in the Wellington Endocrine Service from 1990 to 2016.


In total, 438 people who identified as transgender attended the clinic at least once in this period. There has been a progressive increase in number of people identifying as transgender presenting to the clinic, particularly since 2010. In addition to increasing overall numbers, there has been in particular increase in referrals for people under age 30, as well as an increasing proportion of people requesting female-to-male (FtM) therapy so that it is now approaching the number of people requesting male-to-female therapy (MtF).


The pattern observed is comparable to changes reported overseas. These changes have practical consequences for the delivery of both secondary and primary level healthcare, requiring an increased focus on clinical coordination between the relevant medical services and their links to the primary services sector.

Author Information

John W Delahunt, Clinical Lecturer, Department of Medicine, University of Otago, Wellington;
Hayley J Denison, Research Assistant, Department of Medicine, University of Otago, Wellington, Research Fellow, Centre for Public Health Research, Massey University, Wellington, Doctoral Student, School of Biological Sciences, Victoria University of Wellington, Wellington;
Dalice A Sim, Senior Research Fellow/Biostatistician, Dean’s Department, University of Otago, Wellington; Jemima J Bullock, Clinical Psychologist, Endocrine, Diabetes and Research Centre, Capital and Coast District Health Board, Wellington; Jeremy D Krebs, Associate Professor, Department of Medicine, University of Otago, Wellington, Endocrine, Diabetes and Research Centre, Capital and Coast Health, Wellington.


The authors would like to thank Peter Wash, Information Technology at CCH, for assistance accessing and interpreting the current CCDHB Patient Management IT software records.
They also wish to acknowledge their debt to Professor Tony Taylor, Professor of Psychological Medicine at Victoria University, (who consulted in the Transgender Clinic from the 1980s to early 1990s) and Jo Nightingale, Clinical Psychologist, Wellington Hospital (who coordinated the psychological services in the mid-2000s), for their contributions in developing the clinic.


John W Delahunt, Department of Medicine, University of Otago, PO Box 7343, Wellington 6242.

Correspondence Email


Competing Interests



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