Sharing some joy: my job, the next four years.

Coming up on 12 years ago, a very nervous 17-year old went to see her GP about hormones. In Tāmaki, this meant then going to Auckland Sexual Health to see an endocrinologist and a psychologist.

My GP was helpful, if a little lost. I think I might have been her first - she was new to me, too, and the practice had just moved to a flash new building. Lots of firsts all round.

I knew, also, that the endocrinologist she would refer me to was old school. He was expecting a feminine, heterosexual woman - for a long time, around the world, that expectation was enshrined in clinical pathways and guidelines.

The psychologist felt a little more friendly, like I could be more myself with him. In my memory, I spent fifteen minutes with him sharing about who I was and my journey - that I didn’t quite know where I was going, or how feminine I was, but that I’d like to be less masculine and see how it went. This felt like enough for him - I remember him telling me that I knew who I was.

I think, unfortunately, that the endocrinologist didn’t just want a feminine, heterosexual woman - he wanted an adult feminine, heterosexual woman. He disagreed with the psych, and told me to come back in six months, once I had turned 18.

I have no idea whether this age requirement was codified in the pathways at the time. I didn’t even know pathways were a thing. It didn’t matter - it was out of my hands. I waited.

It’s hard to feel like what’s happening to your body is out of your control, in the hands of someone else entirely. Years later, two GPs I work with now would enshrine the phrase “do no harm doesn’t mean do nothing” in my mind.

I turned 18. I got back in touch with the clinic. Their books were closed. That was that. It was another three months before I went back to my GP, when the feeling of being stranded got too much.

I was living on Queen St at the time, and remember taking the bus out to New Lynn, white dress, thin braided leather belt, squares of tissue paper stuffed down my chest. Doing everything I could to play the part

I told her what had happened, that the clinic couldn’t see me. I told her I had seen the psych, that he had given his okay. I was lucky - because despite the psychologist’s letter not being on file, that seemed to be enough for her. I went away with a script, and my life changed.

As messy as that whole process felt to me, I know it’s not unusual - and that compared to so many, I got relatively lucky. Gender affirming care has been a postcode lottery throughout Aotearoa for generations now, that’s well-established. I hear from so many who have faced barrier after barrier at each step of the way - referrals going nowhere, waitlists untenably long, outright prejudice experienced by many.

I’ve been blessed to see how things are improving, too - to get to work alongside some incredible clinicians and cisgender allies and champions within the system who have recognised the severe inequities and worked to make things better, easier.

I have friends who looked into transitioning decades ago, when pathways for hormone therapy required one year of what they called “real life experience”. Living as your affirmed gender for a year with no medical interventions whatsoever was an impossibility for so, so many. It meant uprooting their whole lives, moving to a new town and starting fresh. Even after this one year of RLE, it required both a psychiatrist and psychologist’s approval. So many went back into the closet, instead.

These friends have now been able to come out - for a number of reasons. The increase in visibility and acceptance - how much we talk - is a big one. The move to informed consent is another. They heard that now, they could just go see their GP - no “real life experience”, no psychiatrist, no psychologist, no endocrinologists, no waiting lists, no pathologisation. Just a conversation about where they’re at, what their goals are, how they’re doing and what other support they might need.

I’m not meant to have favourites, but these are some of my favourite stories. I’m not meant to have favourites, but these are some of my favourite people to be able to watch grow and come into themselves. To witness someone else’s gender euphoria, to see them find and create community - it’s like nothing else.

A few months ago, I had the opportunity to reflect on this part of my journey, and on how I ended up where I am now, doing the work I do today. At the University of Canterbury, in the human services programme, is a class taught by the quietly radical Cindy Zeiher. She invites people working in and for and with communities to talk about what they do, how they got there, and what’s important for those beginning similar mahi to know.

My lectures are so often about building inclusion, improving wellbeing, working towards specific outcomes for who I’m talking to - I’m so grateful to get to speak to so many people working in so many different areas. This was something different entirely.

I got to reflect and talk about my pathway through lived experience, activism, into advocacy. The tension and symbiosis between the two - activism and advocacy, those working inside the system and those working without - has been cropping up a bit in my life lately. I read How to Blow Up a Pipeline and was thoroughly convinced less than halfway through. Those pushing for change from inside the system couldn’t do what they do without that radical flank on the outside keeping the pressure on.

I started this work outside of the system. I did it for myself, at first, because I needed it. We used Official Information Act requests to try push for change, to try bring light to this inequitable system. We sat down with the university to talk about their preferred name systems, their lack of gender neutral bathrooms. We went to the press. We caused a fuss.

When I moved back to Ōtautahi, I was invited to consult on Pegasus Health’s first gender diversity education module. And then, almost overnight, I found myself working from within. I was sat next to the person at the Ministry who answered all my OIAs.

The last OIA I ever sent around gender affirming care somehow found its way into my own inbox to answer.

This reflection is especially critical for me at the moment because - like I’ve mentioned as an aside a couple of times now - we’ve landed a huge contract. It’s so exciting and so important and so almost overwhelmingly important that even though it’s been public information for over a month now, I’ve been feeling anxious talking about it.

I’ve dropped it here and there, shared with friends, testing the waters - mentioned it at the Nelson Arts Festival, mentioned it offhand in that post.

In Budget 2022, Labour announced just over $2 million over four years support to gender diversity and gender affirming care in primary care. Part of that funding was for a national training programme, supporting GPs, NPs, and our primary care workforce around Aotearoa to better support trans and non-binary folks, no matter where they live.

A couple of months ago, Qtopia and PATHA were awarded that contract. I’m leading it.

We’ve been running professional development workshops for five or so years now, and in the last two or three I’ve been able to really specialise them for the health workforce here in Waitaha. The list of GP practices who have had trainings, the number of GPs on our peer group, the number who have put up their hands to start prescribing GAHT through informed consent, it keeps growing. To have that work acknowledged, to be able to take them around the country, to be well-resourced to do so - it still doesn’t feel real.

I have to mihi to one of our GPs here, Dr Rebecca Nicholls. She’s one I mentioned earlier - do no harm doesn’t mean do nothing. She’s the clinical lead for trans health in Waitaha Canterbury, on the project team for this piece of work, and has been so instrumental in making change within Canterbury’s healthcare system. So many people do this work quietly, because it’s the right thing to do, never seeking recognition, all the while doing incredible things. I’m so, so pleased to have her on this piece of work.

I’m thrilled, I’m excited, I can’t wait to be able to really sharpen up the programme and to start taking it around the motu. I’m so looking forward to getting to meet so many people working across this area, and so many others who aren’t yet, but want to know how. That’s been the best part of my job for years, now - the people.

It’s a four year contract. I’ve got some of the most hard-working people alongside me on the project team. We had nearly 30 inquiries to join a steering group with a membership of 8.

We have an incoming right-wing government for the next three years, but this is a four year contract. By the end of these four years, my dream is for that postcode lottery to be no more. For anyone wanting to access gender-affirming hormone therapy to just be able to go and see their regular GP - no referrals to closed clinics, no obfuscated pathways and no one really knowing how to get it done.

I want our primary care workforce to be able to feel so confident that they’re doing the right thing, that they know how to best support our trans whānau around Aotearoa.

By the end of these four years, I think we’ll be there.

Thanks for reading - if you’d like to know more about this mahi, want to contribute, or would like to come to a training - send me a message at primarycare@qtopia.org.nz. We’re in the process of synthesising everything that currently exists (there’s actually a whole lot!) and making sure we’re covering some key gaps for Māori, Pasifika, and disabled community members and primary care workforce. It’s looking like we’ll be booking workshops around Aotearoa first thing next year - not just Tāmaki, Pōneke, Ōtautahi, but everywhere. We’ll have some e-learning up and available in the near future, too.

For posterity, and because I think I’m very funny, this post was very nearly titled Taking it on the road, baby.