KEY POINTS:
New Zealanders may soon be able to change their sex on their passports and birth certificates without having to have costly sex change surgery.
A two-year inquiry by the Human Rights Commission has found that transgender people, who identify as having a different gender than their physical bodies, are discriminated against at school, at work, in accessing health services and in the community.
"Forms of discrimination and harassment ranged from low-level (avoidance and insults) to very severe (violent physical and sexual assaults)," the commission says.
It recommends amending the Human Rights Act to make gender identity a specific ground of illegal discrimination, alongside sex, race and others.
It also recommends changing the criteria for altering a person's sex on birth certificates and other official documents from physical body structure to taking "decisive steps to live fully and permanently in the gender identity of the nominated sex".
This proposal would be even more liberal than in Britain, where the law was changed in 2004 to allow sex changes on birth certificates if people have lived in their new gender identity for at least two years.
Transsexual former MP Georgina Beyer, who was forced to withdraw her own bill to amend the Human Rights Act in 2006, said she "always said this thing was going to come back to haunt them". But she doubted that the political climate had changed enough to get the change through.
"Under a Labour Government you might have a chance, but I doubt it somehow," she said. "But my god, if we get a right-wing government in, there will be no way."
The report says there has long been a small number of people in many societies whose gender identity differed from their physical bodies.
Wellington Hospital geneticist Dr Joanne Dixon said she saw at least six people a year who were either physically male and genetically female with two X chromosomes, or physically female and genetically male with an X and a Y chromosome.
Other patients had other genetic abnormalities such as XXY, XYY, XXYY, one X alone, or combinations of X, Y and non-sexual chromosomes.
"Those working in the medical field know that sex is an extremely fluid concept," she said.
"There is a long pathway between the chromosomes you get at conception and the sex you present at the end. Between chromosomes and functional signals are a lot of hormonal things.
"If the law was pedantic, it would recognise chromosomal sex, physical sex and psychological sex. It is quite possible to be male genotype, female phenotype and to function as either one or the other."
However, the inquiry has found that sex-change services for transgender people vary widely around the country, despite a 2003 Health Ministry direction to district health boards to provide hormone treatment, psychological services and surgical removal of breasts, testicles and wombs.
Only one New Zealand plastic surgeon, Peter Walker in Christchurch, provides a complete genital sex-change from male to female, taking tissue from the penis and colon to build female sex organs. He has been on leave because of ill health but expects to start services again in three months.
He has done 58 sex changes since 1992, currently around three-quarters of them for New Zealanders.
Most pay a fee of around $40,000, but the Ministry of Health funds operations for up to three patients every two years.
The ministry also funds one female-to-male operation every two years, but this is a more complex, costly and risky operation which is no longer done in Australasia.
The last surgeon to do it here, Simon Ceber in Melbourne, said he stopped four years ago because of results that were "not ideal".
"In Thailand they do a very simple procedure - what I would call just a sausage," he said.
"Belgium is the place they do the best work that I know of at the university hospital of Ghent."
The Human Rights Commission says many transgender people have "serious reservations" about the current ministry policy of contracting out surgery either to Mr Walker for male-to-female changes or overseas for the reverse procedures.
It urges the ministry to develop a "treatment pathway" for people with gender identity issues, running from local GPs and mental health services through to surgery where needed.
The ministry's chief clinical adviser, Dr Sandy Dawson, said the ministry would work with the commission and transgender people to educate health professionals about the issue and improve services.
FACT BOX
Transgender by number
* In Europe one in every 30,000 men (0.003 per cent) and one in 100,000 women (0.001 per cent) have sought sex change operations.
* 400 New Zealanders (0.01 per cent) show their gender as `X' rather than male or female in their passports.
* 400 to 800 people (0.01-0.02 per cent) belong to NZ transgender groups.
* 10 to 20 out of 8100 NZ prisoners (0.12-0.25 per cent) are transgender.
* 159 out of 2307 NZ sex workers (6.9 per cent) were transgender in an Otago University survey last year.
ON THE WEB:b>
www.hrc.co.nz/transgenderinquiry
www.agender.org.nz
www.genderbridge.org
