In recent years gender-affirming healthcare has expanded in New Zealand, with wider access to hormone therapies and surgical options for transgender people. A NZ Doctor feature, “EDUCATE REVISITED: Gender-affirming care,” summarises a series of clinical commentaries by sexual‑health specialist Dr Massimo Giola. While presented as professional insights into best practice, Dr Giola’s pieces also expose the uncertainties and risks that surround many current interventions – what he himself describes as “the art of gender‑affirming care.”
In his discussion of switching trans women from oral oestrogen to transdermal gel, he emphasises that oral oestrogens increase the risk of blood clots and that, even when transdermal formulations reduce this specific risk, additional cardiovascular factors remain relevant for many patients.
In reference to vaginoplasty (one form of gender-affirming surgery) Dr Giola highlights the “most common complications are granulation tissue (7–26 per cent), wound infection (up to 27 per cent), stenosis (up to 12 per cent), intravaginal hair growth (29 per cent), discharge (13 per cent), bleeding (up to 13 per cent), chronic pain (up to 20 per cent) and recurrent UTIs (4.4–7 per cent). With complication rates this high, it reiterates why an evidence-based and cautious approach is necessary before normalising genital surgery as routine. Perhaps one thing we can agree with Dr Giola on is that “a neovagina will never be identical to a natal vagina” – that is surgical reconstruction has biological limits, further reaffirming the overlooked biological realities of sex.
While advocates frame these changes as compassionate progress, the wider evidence base for some gender‑affirming interventions – especially for adolescents – remains weak. Major systematic reviews and national reviews have repeatedly rated the certainty of evidence for puberty blockers and cross‑sex hormones in youth as low or very low; long‑term outcomes are still unclear. The NHS England Cass Review (2024), for example, concluded that the evidence for these interventions in young people is of low certainty and does not yet demonstrate that benefits clearly outweigh harms. Similar conclusions were drawn by the Swedish National Board of Health and Welfare (2022) and the Finnish Health Authority (2020), both of which recommended limiting hormonal and surgical interventions for minors to research settings.
Notably, Dr Giola’s NZ Doctor pieces do not engage substantially with these national reviews or with models that call for more cautious, research‑centred pathways. Instead, much of the discussion leans on observational, community‑based surveys (for example, Counting Ourselves and Trans Pathways), which capture lived experience and important patient perspectives but cannot establish causality or long‑term clinical outcomes. Such studies are valuable, but are no substitute for high‑quality trials and longitudinal research.
International practice is shifting toward more multidisciplinary, cautious assessment models for young people. In contrast, New Zealand has moved to fund several hormone therapies and expand access without imposing equivalent safeguards or robust long‑term outcome monitoring. Off‑label use of medications for gender care remains largely unregulated, and gender‑affirming genital surgery has been normalised in parts of the medical literature and clinical practice despite unresolved questions about harms and long‑term benefit.
Dr Giola does acknowledge clinical prudence in individual cases: in one example he counselled a patient that there was no need to rush into surgery and invited the patient to re‑approach the team if circumstances changed. That cautious, patient‑centred approach is welcome, but it is the exception rather than the rule for many patients who proceed to irreversible surgical interventions.
These surgeries are invasive and irreversible procedures that
have permanent anatomical changes.
For young people whose identity and decision‑making capacities are still developing, such surgeries carry profound and irreversible consequences. Framed as empowerment, they can in practice have long-term permanent consequences on fertility and sexual function. That is not empowerment – it’s mutilation. This is not compassion. It’s compliance with an ideology that denies biological realities, medicalizes childhood confusion and in some cases undermines parental rights.
New Zealand must not follow the mistakes of other nations captured by the transgender ideologues. Clinical pathways for individuals dealing with gender-related distress need to be anchored in a cautious and transparent, high-quality evidence-based approach.
We must lead with courage, truth, and a commitment to protecting our children from harm – even when that harm is dressed up as progress.
This article was originally published by Family First New Zealand.
