"You're going to see a lot more money being spent on healthcare in general" was Prime Minister Christopher Luxon's response to calls for improved access to gender-affirming surgery, following a case in which a Kiwi teen attempted to remove their own breasts at home.
On Friday, details of the case - described by doctors as "an act of desperation" - were published in the New Zealand Medical Journal in an article written by three Wellington surgeons, which called for public services to be more accessible to an "under-served population".
The 18-year-old, referred to as Patient Z, attempted to perform a left mastectomy on his breasts by following a 'how-to' YouTube video.
The teenager, who was awaiting female-to-male gender affirmation surgery at the time, said he decided to take matters into his own hands due to the wait times for a referral in the public system. He also cited an inability to afford private surgery and the "significant psychological stress of having breasts at an upcoming pool party".
After spending several hours trying to remove his left breast, he became worried he would damage a nerve and went to hospital, where surgeons performed a double mastectomy.
The case has prompted the three authors - Wellington Hospital surgeons Dr Mairarangi Haimona, Dr Sue Hui Ong and Dr Scott Diamond - to call for better access to gender reassignment surgery.
"In Aotearoa New Zealand, there is an overwhelming unmet need for masculinising chest reconstruction for transgender men," the authors wrote in the case study.
"A lack of access to gender-affirming surgery led to this act of desperation."
When asked on Friday morning what the Government could do to improve access to these surgeries, Luxon said he wasn't aware of the incident "at this point", but was quick to add that Budget 2024 would see "a lot more money" pumped into "healthcare in general".
"I'm not aware of those comments at this point, but what I'd say to you is in the Budget, you're going to see a lot more money being spent on healthcare in general. You're going to see us spending money on health and education and law and order, that's what New Zealanders expect us to do," Luxon responded during the press conference.
"They want better services, particularly in those three areas - and that's what our Budget will deliver."
Dr Rita Yang, the only surgeon who performs genital gender-affirmation operations in New Zealand, told Newshub it was "extremely distressing" to hear about the case.
"It could have easily ended with this person dying," she said.
"All surgeries come with life-threatening risks, even when performed by surgeons. I implore anyone who needs gender affirming surgery to never even consider this for the sake of their own life.
"[The surgery] involves highly trained operating room staff, anesthetists, nurses, and hospital-level wraparound care. There are few reconstructive surgeons in New Zealand qualified to perform this surgery and even then, there are serious risks that must be mitigated."
A 2019 report from the 'Counting Ourselves' survey found only 13 percent of trans men who had chest reconstruction surgery had accessed it through the public system.
"This is a significant under-service and likely an under-representation of the unmet need due to poor documentation and lack of information of how to access services," the doctors said in their report.
"With increasing demand and associated psychological and possible physical harm it is crucial for public services to be more accessible to an under-served population."
Patient Z has since reported "improvement in self-esteem and self-confidence" and is looking forward to enrolling at university.
