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Transgender patients turn to internet to buy hormones, say they lack health system support



One person said she had been using patches (pictured) and pills prescribed by the GP but had not been seeing any body changes (file image). Photo: BMJ
Hormone TherapyInjectable estrogen is legal in New Zealand but very difficult to get prescribed. Photo: 123rf
Some transgender patients are turning to the internet to buy gender-affirming hormones, saying they are not getting the support they believe they need from the health system.

They say taking unprescribed hormone treatment is risky, and they would prefer to receive treatment under medical supervision.

Auckland Sexual Health says demand for its services from trans patients has increased six-fold since 2016.

National guidelines for gender-affirming health care have been rolled out to GPs around the country, but some in the trans health sector say work is still needed to upskill many doctors.

‘I would just like people to listen to their trans patients more’
Aucklander August Ward had hoped to medically transition with her GP’s support but ended up resorting to do-it-yourself hormone treatment.

Ward said she had been using patches and pills prescribed by the GP but had not been seeing any body changes.

She made numerous visits to the GP over a three year period but was still within the acceptable male range for estrogen which was frustrating and she felt desperate, she said.

“So I switched to buying injectable estrogen from the internet, which helped a lot.”

In an attempt to find out why the hormone treatment she was receiving from her doctor was not having the desired outcome, Ward said she did some online research.

Treatment guidelines from other countries were quite different to New Zealand’s, she said.

“Like they recommend that you have higher estrogen levels in order to achieve the changes that you want.”

Ward said her doctor may have been worried about blood clots associated with higher estrogen levels, but she did not believe that was “so much of a risk”.

Ward’s doctor told her that she was already on the highest possible dose of patches and pills and that estrogen injections were not prescribed for trans people in New Zealand – but that turned out not to be true, she said.

Buying estrogen online was straightforward other than needed to use crypto currency to purchase it, she said.

The hardest part was working out what dose to take and self injecting the hormone, she said.

Ward said she informed her GP that she was injecting the estrogen and although the GP was not happy about it and would not aid her in doing it, the GP did inform her what to look out for in terms of side effects and continued to monitor her hormone levels via blood tests.

Ward felt that injecting estrogen was the right decision for her although she said trans people should not have to resort to using the internet to source it.

Asked what changes she would like to see as a result of her experience, Ward said it would be very easy for GPs and Auckland Sexual Health to prescribe estrogen injections.

“I would just like people to listen to their trans patients more.”

‘It’s really difficult to get in NZ’ – Trans on Campus
Avery Zavoda from the University of Auckland group Trans on Campus said it was very common for people not to respond to one or more forms of estrogen that was available to them.

“Because of that they need to resort to injectable estrogen but unfortunately it’s really difficult to get in New Zealand and because of that they have to get it online.”

More than 100 trans people in the wider New Zealand trans community sourced their estrogen online, Zavoda said.

Those who did source injectable estrogen online were encouraged to talk to their GPs by others in the trans community, Zavoda said.

“Where it does fall down is where the GP does deny the monitoring tests and does deny this oversight … and that’s when it can kind of fall apart, when the doctors tend to just deny it because they don’t want to see people doing it.”

Some GPs, particularly in larger organisations, were being held back by those who had shaped New Zealand’s guidelines on injecting estrogen for trans people, with the guidelines in this country differing from those overseas, Zavoda said.

“Injectable estrogen is technically [and legally] available in New Zealand to prescribe, unfortunately that’s not particularly back up, or well resourced within New Zealand, internationally it is.”

Not having that information readily available meant GPs and clinicians often lacked the confidence to do what was right for their patients, Zavoda said.

Funding for the national guidelines sat with Te Whatu Ora, Zavoda said.

It was essential to provide GPs with accessible information about what was available for their patients knowing that it would be backed up nationally, Zavoda said.

Not yet known if injectable estrogen safe enough to include in guidelines – Stephenson
GP Cathy Stephenson, who co-authored the national guidelines around gender-affirming healthcare, said the guidelines were only part of it.

“What we don’t yet have is the accompanying education and upskilling of the workforce so that all our GPs feel competent and safe to work in this space.”

However, it was coming and Te Whatu Ora was keen and had provided some funding for it, she said.

One of the main points the guidelines outlined was that “the earlier we can provide safe, close to home, gender-affirming care for trans and non-binary people – the better the outcomes”, she said.

“The guidelines also talk about using medication that’s got a long-established evidence base, and that has been used over many years so that we understand the risks and the safety profiles.”

Currently the guidelines did not consider that injectable estrogen fell within that safe level of evidence, she said.

That was probably because injectable estrogen had not been used for many years within the trans community, she said.

“What we do know is that when you first inject estrogen you tend to get very high and often fluctuating levels in the body and they may go well above physiological female levels of estrogen.”

At this stage it was not known whether or not that was safe and it was probably associated with an increased risk of blood clots and even of cancers, she said.

Until more was known it was hard to know whether to put it into the guidelines, but it was a rapidly changing field, she said.

“My hope is that over the coming years we will understand more and more about which medications are best and which ones will get the best outcomes for individuals.”



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Christchurch terror attack inquest: ‘Significant blind spot’ relating to St John’s specialist paramedics – coroner



A woman who was forced to leave the side of her bleeding husband following the terror attack at Christchurch’s Linwood Islamic Centre only discovered he had died the following day after seeking help from then-prime minister Jacinda Ardern.

Saira Patel’s husband Musa Patel was one of seven people who died after being shot at the Linwood Islamic Centre, following the massacre at nearby Al Noor Mosque on 15 March 2019.

Supported by her son, Patel told the inquest into the deaths that she and her husband were praying in separate parts of the mosque on the day of the attack.

Patel said she thought a tyre had blown when she heard a loud bang. A baby began to cry, and she could soon smell gunpowder.

She yelled, “Someone is shooting, someone is shooting” as people ran to escape.

When Patel found her bleeding husband, she told the Coroners Court she could hear him saying his “last prayer” as if he knew he was about to die.

Imam Hafiz Musa Patel

Musa Patel died at Linwood Islamic Centre on 15 March 2019. Photo: Facebook/ US Embassy Suva

She said she was forced to leave when police arrived and started treating Musa Patel, an order that distressed her to this day.

“I think any dying person who is about to leave this world would be very desperately craving and needing to be close to their loved ones. My presence during his final moments would have made a big difference in my life and I think maybe his last moments of departing this world,” she said.

She did not know her husband had died until the following day, when she approached then-prime minister Jacinda Ardern, who led her to a counsellor.

Patel said the counsellor showed her a photo of an unidentified man in hospital who was not her husband.

“I knew then that my husband was dead. There was no-one else who could have identified him, and this last unidentified man was my last hope,” she said.

Patel thanked the doctors and paramedics who did everything they could to console her husband in his final moments.

“I would like to thank them from the bottom of my heart,” she said.

“I was trying to be with him in that last moment but maybe they were chosen to be with him.”

Dr Alison Wooding from nearby Piki Te Ora Medical Centre was one of the doctors who treated Musa Patel when staff went to the mosque to help the injured.

She told the court he was meant to be the first victim taken to hospital but realised he had died after he was moved onto a stretcher.

Wooding said she and others were talking to Musa Patel the entire time they cared for him, but she did not recall him ever responding.

Police officers gave evidence on Tuesday saying Musa Patel had been able to communicate with them at first but his condition deteriorated over time.

Wooding told the court she felt apprehensive and worried about the situation at the mosque, but safe and protected between armed and vigilant police officers.

29th November 2023 Iain McGregor/The Press/Pool Christchurch Masjidain Attack Coronial hearing. Coroner Brigitte Windley.

Deputy chief coroner Brigitte Windley. Photo: The Press / Iain McGregor

‘Significant blind spot’ relating to St John emergency response team – coroner

The coroner has queried a “significant blind spot” in the way St John ambulance officers work with specialist paramedics trained to work in dangerous situations.

Deputy chief coroner Brigitte Windley questioned St John duty manager Bruce Chubb about the organisation’s response massacre.

Two Special Emergency Response Team (SERT) paramedics were among ambulance officers who went to the scene of the shooting in Linwood Avenue.

No-one from St John attended the Al Noor scene in a SERT capacity.

Chubb told the Coroners Court that SERT teams worked under police and it was not uncommon for St John not to know when they had been requested, where they were, or what they were doing.

In response, coroner Windley said: “My concern is that that creates a significant blind spot for St John, doesn’t it?”

“Isn’t it that these are critical resources in terms of closing that care gap for people who are dying and injured and being able to get a response in, and you’ve got no visibility about where they are and even if in fact they’ve been deployed?”

041223 CHRIS SKELTON Witness, Bruce Chubb from St John command and control during the Christchurch terror attack inquest held at the Christchurch Justice precinct.

St John’s Bruce Chubb. Photo: Stuff / Chris Skelton

Chubb said he was not suggesting it was “okay” that St John did not know where SERT officers were but said it was the practice at the time.

He was not aware of any changes to the SERT policy since the terror attack.

Chubb told the coroner he thought it was “always nice to know” where resources were, to which she replied, “I would suggest it’s more than nice to know. I would suggest that St John needs to know”.

Chubb earlier told the inquest that he believed general ambulance officers should not have entered either mosque immediately after the shootings because of the safety risk.

Windley said the court was concerned St John ambulance officers had to breach the organisation’s policy in order to get an emergency response in place.

“Do you agree that that’s fundamentally a problem?” she asked.

“Yes,” Chubb replied.

Earlier on Tuesday, Chubb told counsel for families Kathryn Dalziel that the terror attack was a catastrophic event that he did not expect and was never prepared for.

“I don’t believe any of my colleagues were either, so it was fundamentally overwhelming,” he said.

The inquest will examine the following 10 issues over seven weeks:

  • Events of 15 March 2019 from the commencement of the attack until the terrorist’s formal interview by police
  • Response times and entry processes of police and ambulance officers at each mosque
  • Triage and medical response at each mosque
  • The steps that were taken to apprehend the offender
  • The role of, and processes undertaken by, Christchurch Hospital in responding to the attack
  • Coordination between emergency services and first responders
  • Whether the terrorist had any direct assistance from any other person on 15 March 2019
  • If raised by immediate family, and to the extent it can be ascertained, the final movements and time of death for each of the deceased
  • The cause of death for each of the victims and whether any deaths could have been avoided
  • Whether Al Noor Mosque emergency exit door in the southeast corner of the main prayer room failed to function during the attack and, if so, why?

The inquest continues.


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Protests raise questions about next year’s Waitangi day



In the wake of protests over the new government’s policies on co-governance and the Treaty, the head of the Waitangi National Trust Board says it is important Treaty partners front up and have a conversation on 6 February.

Prime Minister Christopher Luxon says he intends to visit for Waitangi Day, as does ACT’s David Seymour.

The protests taking place across New Zealand on Tuesday were part of a “National Māori Action Day”, led by Te Pāti Māori and iwi, to challenge the government over its policies on the Treaty of Waitangi, and other policies affecting Māori.

Waitangi National Trust Board chairperson Pita Tipene expected for that sentiment to flow through on Waitangi Day.

“Clearly, the Māori people see it as an attack on the Treaty of Waitangi and the constitutional basis of this country,” Tipene said.

These include switching from Māori to English names on various government departments, rewriting legislation to make mentions of the principles of the Treaty more specific, and progressing an ACT bill calling for the principles to be set down under its own prescription, rather than decades of jurisprudence.


Ngāti Hine leader Pita Tipene

Ngāti Hine leader Pita Tipene Photo: RNZ

Tipene told Checkpoint there was no invite list for politicians per se, and the doors of the Trust were open for all to come along.

“Given that it is a Waitangi Day commemorations period, it’s really important that the Treaty of Waitangi is the focus, and therefore the Treaty partners should front up and have a conversation.”

He would be disappointed, but not surprised, if parties in government were not represented there on the day.

“It has happened before where governments or political parties have chosen not to front up at Waitangi.”


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Te Pāti Māori protests – Day of action focuses on new government’s Māori policies



Police says protesters are causing widespread delays at key transport networks around the North Island, but there have been no arrests so far.

A police spokesperson says commuters should allow travel time this morning, with Te Pāti Māori’s planned protests disrupting travel routes.

There are large gatherings in Tāmaki Makaurau and central Wellington, along with a number of other cities and towns.

The spokesperson says Auckland motorists are advised there are heavy delays on parts of the motorway network this morning.

The demonstrations are in response to Te Pāti Māori’s call for action against the new government’s policies on co-governance and the Treaty.


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