An open letter to Auckland Sexual Health Services

This is an open letter to the transgender health service at the Auckland Sexual Health Services (ASHS) clinic. Feel free to share or forward, and if anyone wishes to contact me I can be found on Twitter, Mastodon @ cloudisland.nz or via email thea@hutchings.gen.nz.

It’s very fortunate that in Auckland transgender people have access to an informed consent model for access to healthcare. This removes a lot of barriers to access, but unfortunately some remain. The biggest barrier is the opinions on hormone treatment is the ASHS transgender health clinic. As most of our GPs are not well versed in transgender HRT they reach out to the clinic for advice, and unfortunately that advice can place siginifcant obsticles in the way.

While the basic HRT advice is sound, I and many others believe that hormone therapy is not a one-size-fits-all process. Trans people have different goals in their transition and customising treatment is important for long term mental health.

ASHS have consistently denied changes that go against their self-written guidelines, even when international experience has demonstrated that there are no serious health risks to doing so.

As a trans woman my interests are oestrogen levels, progesterone availability and alternative anti-androgens. I’m going to focus on progesterone for now as unlike the others there are no alternatives.

The best model we have for hormone levels are that of cis women. Currently ASHS only consider oestrogen and testosterone levels as important, but progesterone has also been identified as a sex hormone and is used in treatment in other countries including Australia1.

As J. C. Prior2 has described there are no studies on the effects of progesterone in trans women, but this is also true for oestrogen and anti-androgens as noted in the WPATH standards of care3. As noted in J. C Prior’s work synthetic progestins have some serious side-effects, but no similar effects have been found for bio-identical progesterone when used for menopausal HRT.

Among trans women there are conflicting reports, with some people reporting progesterone has resolved several issues including lack of libido and sleep problems, and others where it has no effect.

I think this lays out my grievances with ASHS approach to hormone therapy. While there is no evidence for progesterone being effective, this is because nobody has looked for evidence in a clinical setting. I have heard more than a few cases of people self-sourcing hormones because of the reluctance of ASHS and GPs to prescribe, which obviously comes with greater risks than supervised prescriptions. Just the chance of solving problems, particularly the lack of libido, is worth the risk for a lot of trans women. After all, cis women have sex drive, so you can’t say there’s nothing that can be done!

This is also reflected in other areas, such as usage of injected or implanted oestradiol rather than oral or transdermal, or use of alternative anti-androgens such as bicalutamide. All of which can be obtained in New Zealand (though implants must be imported), if you can convince a doctor to prescribe when ASHS say no.

So my plea to ASHS - stop saying no. It’s completely appropriate to say there is no evidence, but under informed consent patient-driven hormone levels are allowed given these warnings”. Let us determine what makes our transitions work, we’re all different. By all means establish dosage levels which would be harmful, but if you believe it’s not harmful, only ineffective, let us try and be the judge of what works for our bodies.


  1. AusPATH standards of care↩︎

  2. Prior, J. C., Progesterone Is Important for Transgender Women’s Therapy—Applying Evidence for the Benefits of Progesterone in Ciswomen↩︎

  3. World Professional Association for Transgender Health Standards of Care↩︎

May 28, 2022 trans health

Introduction!

Well, this is my first post on this blog. Will I stick with it? Maybe.

So a quick intro! I’m Thea, I’m currently an AWS DevOps engineer, but I’ve also been a C#, Java, Objective-C, Python and PHP developer, just not all at the same time. I’m also pretty good with databases.

I’m not sure what I’m going to post here. Probably life and technical musings. It’s mostly somewhere for me to get thoughts out of my head.

May 8, 2022