Te Whatu Ora was due to release the guidelines in March. Photo: RNZ / Angus Dreaver
Prominent medical bodies are calling on the government to allow the release of updated gender affirming healthcare guidelines after a small section on puberty blockers caused it to be delayed.
The guidelines were due to be released at the end of March but it's is now unclear when they will be.
The Professional Association for Transgender Health Aotearoa, who was asked by Te Whatu Ora to update the guidelines, believes the delay is "due to unprecedented and inappropriate political interference".
Te Whatu Ora says it'll publish the guidelines "once decisions are made by the government following the ministry's consultation process".
Public submissions on the matter closed 20 January.
But PATHA says the advice on puberty blockers in the guidelines was updated in November to reflect the Ministry of Health's new position and this was approved by Te Whatu Ora's National Clinical Governance Group.
It says this advice makes up only six pages out of the total 182 pages of the document.
The guidelines cover all aspects of gender-affirming care to support trans and non-binary people and their families to navigate healthcare.
This includes whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people, PATHA said.
More than 300 medical bodies, community organisations, and individual healthcare professionals have signed an open letter calling for the government to allow Te Whatu Ora to release the guidelines.
These include General Practice New Zealand (GPNZ), Royal New Zealand College of General Practitioners, The Paediatric Society of NZ, New Zealand College of Clinical Psychologists, New Zealand College of Primary Health Care Nurses, College of Child and Youth Nurses and New Zealand Nurses Organisation.
PATHA president Jennifer Shields said delaying the release impacts on the ability to improve healthcare delivery and health outcomes for the transgender and non-binary population.
"Less than 24 hours before the date of publication, there was an unnecessary, indefinite and unexplained delay in the publication of these clinical guidelines, we believe due to unprecedented and inappropriate political interference."
'The need for this updated guidance is clear'
In November, the government released its evidence brief on puberty blockers and a position statement which sets out its expectations for their use.
It signalled its intention to consider regulating them in gender affirming care and tasked the ministry with consultation, opening up public submissions.
Regulatory measures could include restricting prescribing puberty blockers in the context of gender affirming care for young people but not its use in other contexts, the ministry said.
Further measures being considered by the ministry included updating clinical guidance and increasing monitoring of prescriptions.
The Green Party has denounced the signalled change of approach.
Medical practitioners are currently working with guidelines published in 2018. PATHA said Te Whatu Ora contacted it in 2023 to update these.
"It is standard practice for guidelines to be periodically updated to ensure their content is kept up to date. PATHA submitted the updated guidelines in October 2024 and they followed the standard process for publication of a clinical guideline, and were approved by Te Whatu Ora's National Clinical Governance Group."
Vice president Dr Rona Carroll said clinicians are asking for up-to-date guidance to provide appropriate and safe healthcare.
"The need for this updated guidance is clear and something I hear from health professionals on a daily basis. We just want to be able to publish these guidelines so the clinicians who need them can use them."
Health NZ Te Whatu Ora national clinical director primary and community care Dr Sarah Clarke said it acknowledges the guidelines currently being used are from 2018 and that the evidence base in this area continues to evolve.
"In the interim, and ahead of the updated guidelines being published, our advice is that health professionals continue to provide effective care based on the best available evidence and consult and take advice from colleagues more experienced in this care when appropriate."
Puberty blockers can be used as part of gender affirming care to delay the onset of puberty by suppressing oestrogen and testosterone.
They are also used for precocious puberty in children, and the ministry says the same medications can be used in adults to treat endometriosis, breast and prostate cancer, and polycystic ovary syndrome.
The evidence brief released in November and subsequent public consultation only looked at the use of blockers specifically as they related to gender affirming care.
The ministry says overall, the evidence brief found "significant limitations in the quality of evidence for either the benefits or risks (or lack thereof) of the use of puberty blockers".
Following the release of the evidence brief, the ministry directed clinicians to exercise caution in prescribing puberty blockers.
At the time Shields said this was already in line with New Zealand best practice and it was reassuring to see the ministry recognise this.
