Gender-affirming healthcare The Transgender Health Research Lab at the University of Waikato defines gender-affirming healthcare as: “Healthcare that is respectful and affirming of a person’s unique sense of gender and provides support to identify and facilitate gender healthcare goals. These goals may include supporting exploration of gender expression, support around social transition, hormone and/ or surgical interventions. This may also involve providing support to whānau, caregivers or other significant supporting people.”xxvi In Aotearoa, patients have the right “to services of an appropriate standard”.xxvii This means that all people seeking gender affirming healthcare should be able to access it. Guidelines for gender affirming healthcare in Aotearoa,xxviii and internationally,xxix show that timeliness is vital and deliberate delays such as the ‘watchful waiting’ approach exacerbate gender dysphoria, mental health problems and other negative and avoidable outcomes.xxx Principles of providing gender-affirming healthcare include: Te mana whakahaere: autonomy which is the right of transgender people to make informed decisions about their care, and to be free from discrimination, including conversion practices while receiving that care. Ngā manukura: community leadership is the need for the transgender community to provide leadership in the development and provision of healthcare for transgender people.xxxi To learn more about providing gender affirming health care in Aotearoa see: 77 • Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealandxxxii. • Guidelines for GPs providing gender-affirming carexxxiii • World Professional Association for Transgender Healthcare Standards of Care, v.8.xxxiv • Professional Association for Transgender Healthcare Aotearoa Vision for Healthcare 2022xxxv • Gender Minorities Aotearoa website • Gender Minorities Aotearoa’s A third opinion: Transgender healthcare tips for providersxxxvi Young people, gender-affirming care, and informed consent In Aotearoa the Code of Health and Disability Services Consumersxxxvii Rights mandates an informed consent model for healthcare. Informed consent requires a readiness assessment to ensure a person is aware of expected risks, side effects, and benefits of any medical procedure. People aged 16 and over are considered old enough to provide medical consent for themselves under the Care of Children Act 2004.xxxviii With children and people under the age of 16, the Medical Council of New Zealand recognises their consent may not be viewed in the same way as that of an adult.xxxix Capacity to consent for those under 16 will be assessed case-by-case under the Gillick competency test. This provides a sliding scale of ability to consent based on the age, maturity and intelligence of the child.xl Under the Care of Children Act the child’s welfare and best interests are paramount.xli The Act also provides that as guardians, parents have the duties, powers, rights, and responsibilities for:xlii • contributing to the child’s intellectual, emotional, physical, social, cultural and other personal development • determining for or with the child, or helping the child to determine, questions about important matters affecting the child. Where consent cannot be obtained, best practice would be to obtain the views of the child and to consider whether a proposed course of action will be in the best interests of the child. The views of guardians and others involved in the child’s care may also be relevant in this respect. It is recommended that a multi-disciplinary team assists in the informed consent process for young people and gender affirming healthcare. Conversion Practices Guidance for medical healthcare professionals