“What do you want me to call you?”
“Oh, I really prefer to go by Zoe, but most of my family call me David.”
The woman who asked the question was Julia, a 36-year-old building industry worker.
She has now been Zoe’s guardian for five years, after Zoe’s mum struggled to accept her daughter’s gender identity, she tells the Herald.
For some transgender young people, like Zoe, who is now 19, entering puberty can be distressing.
“She hated the feeling of testosterone in her body,” says Julia, who is also transgender.
“The way it makes you smell. The skin texture. The body hair grows. Everything. She didn’t really like even the start of those effects in her body.”
According to the 2023 Census, there are more than 26,000 transgender people in Aotearoa. That’s around 0.5% of the total population. It also found 15,039 people were born with a variation of sex characteristics.
But it’s difficult to obtain precise data. The Census counts only those who choose to respond to the survey, live residentially and are aged 15 and over.
Stigma and shame may mean others feel they can’t be open about their gender identity.
The Ministry of Health says the number of young people with gender dysphoria on puberty blockers was 113 in 2023, down from 140 in 2021.
At 13, doctors prescribed Zoe gonadotropin-releasing hormone analogues, commonly known as “puberty blockers”.
They are drugs that temporarily suppress pubertal sex hormones (chemical messengers), like oestrogen and testosterone, which develop both physical and behavioural pubertal characteristics.
New Zealand’s puberty blocker ban
New prescriptions for puberty blockers were to be banned on December 19, 2025. Introduced last November, the policy under the Medicines Act prevented clinicians from prescribing puberty blockers to new patients who are transgender children, or adolescents experiencing gender dysphoria or gender incongruence.
The latter is the psychological distress arising from the feeling of being born in the wrong body, or assigned the wrong sex at birth.
However, on December 17, an urgent injunction filed by Professional Association for Trans Health Aotearoa (PATHA) was granted by the High Court, halting the regulations from coming into force until a judicial review on May 6-7.
PATHA is an interdisciplinary professional organisation that works to promote the health, wellbeing and rights of transgender people.
Health Minister Simeon Brown was prompted to introduce the new policy after the findings of the 2024 Cass Review, an independent report commissioned by NHS England and authored by Dr Hilary Cass, which said gender medicine was built on “shaky foundations”.
Health New Zealand Te Whatu Ora echoed this in its 2024 evidence brief, stating: “Given the dearth and poor quality of evidence, and New Zealand-specific evidence, there is an urgent need for high-quality, longitudinal data and research to help us understand the specific needs of gender-dysphoric adolescents in New Zealand”.
The ban was to remain until the completion of a major clinical trial in the United Kingdom assessing its use in this context, Brown said on November 19.
Since then, the trial has been paused after safety concerns raised by the nation’s medicines watchdog, which cited “unquantified risk of long-term biological harms” to participants.
The Herald has contacted the Ministry of Health for comment.
Hitting pause
Puberty blockers have been used clinically in New Zealand for more than 30 years to treat children experiencing precocious or early-onset puberty.
It’s common to use them to also treat breast and prostate cancers, endometriosis and polycystic ovary syndrome for children and adults.
Sometimes, the medication is prescribed off-label, meaning it’s used for a purpose other than what it was originally manufactured for.
Off-label prescriptions are not uncommon. For about 15 years in New Zealand, it’s been used off-label to treat gender dysphoria or gender incongruence.
For Zoe, it meant the facial hair stopped. It meant some of the “downstairs development” stopped.
“She essentially passed as a girl and it never really got questioned,” says Julia.
Hitting the pause button on puberty allows transgender young people to have time to “psychologically mature and become old enough to make decisions that will have permanent implications for their later body appearance”, explains Professor Paul Hofman, a paediatric endocrinologist from the University of Auckland.
“Many, if not the majority, of these youth, react negatively to developing secondary sexual characteristics [physical traits caused by puberty such as the development of breasts or facial hair] that are of the gender they don’t feel they are.”
He adds that “some self-harm” and “others become suicidal”.
A 2022 Counting Ourselves survey report published in February researched the health and wellbeing of New Zealand trans and non-binary people.
It identified that half of the 2631 participants had deliberately injured themselves, and over half had seriously considered suicide at least once.
About 10% had attempted suicide.
“I can’t imagine her life being who she is internally and looking vastly different externally. I think she would have been miserable,” says Julia.
“Having known she has attempted [suicide in the past] … I’m worried that she would have been successful had she not had access to this health care.”
‘She’s truly blossomed’
Puberty blockers are reversible.
“Once stopped, puberty will recur after a three to 12-month period,” Hofman tells the Herald.
This meant that Zoe, who wants to have biological children one day, could safely preserve her fertility.
“Zoe is a case of someone who did want to still have biological kids at some point. That discussion was had prior to her getting on the pathway to starting cross-sex hormones,” says Julia.
“We talked through what that means. And what that meant was coming off her blockers.
“When that ran out … we just let it trail off, and it was about five months after that she was able to produce viable sperm and deposit for her fertility [before going back on the blockers].”
Now, Zoe is taking cross-sex hormones, a steroid hormone opposite to one’s biological sex (for a trans man, this would be testosterone and for a trans woman, this would be oestrogen) that one can be prescribed from the age of 16.
“She’s truly blossomed ever since [starting them],” says Julia.
“She’s just gone up and up, and she’s doing really well. She graduated from high school last year – the first in her family to do so.
“She’s going to do a nursing course … she’s excited about her career prospects.”
While changes from cross-sex hormones are permanent and may lead to infertility, unlike puberty blockers, which are reversible and have no effect on fertility, there was no mention of them when the Government introduced the ban.
Justice Wilkinson-Smith noted in her judgment that the Ministry of Health’s Regulatory Impact Statement (RIS), provided to the Health Minister, Simeon Brown, advised that decisions about prescribing puberty blockers should continue to sit with clinicians.
According to the judgment, Brown accepted the reviews of the Cabinet, which do not reflect the medical advice outlined in the RIS.
“Whether that suffices as an exercise of the Minister’s statutory power will need to be decided, but the factual picture is now quite clear, and it supports PATHA’s position that this was a political decision and contrary to advice from the Ministry,” wrote Wilkinson-Smith.
Wilkinson-Smith added there is an argument that regulations are discriminatory.
“That is because there is no doubt that puberty blockers are regarded as sufficiently safe to treat precocious puberty, and children begin puberty blockers earlier and remain on them for longer when used for that purpose,” she wrote.
“The concerns about bone density do not apparently justify a ban on puberty blockers generally but only when used for gender dysphoria or gender incongruence.”
Julia fears a ban may lead people to turn to riskier measures.
“I’m absolutely worried that people are going to turn to DIY and do black-market ways of accessing their health care,” she says.
“Stopping trans health care doesn’t stop people from being trans. It just makes them harder to receive their health care and makes them miserable.”
Varsha Anjali is a journalist in the lifestyle team at the Herald. She is based in Auckland.
