The only surgeon in New Zealand who can do sex-change surgeries is not employed to do them - frustrating the trans community who are currently waiting up to 40 years for a procedure.
Dr Rita Yang started work with Counties Manukau DHB in January this year as a plastic surgeon. At the time her appointment gave the transgender community hope that access to gender confirmation surgeries would be sped up.
But an Official Information Act response showed that is not the case. The DHB wrote that Yang "will not be carrying out surgeries associated with a gender assignment service" and there was "no plan regarding a multidisciplinary surgical team for gender reassignment".
New Zealand has been without a gender reassignment surgeon since Dr Peter Walker retired in 2014 who performed male-to-female surgeries. Female-to-male surgeries have always been performed overseas.
Auckland trans woman Amanda Ashley said disappointment had spread throughout the trans-community.
"A lot of people have been hanging on to that hope. We've been waiting for a long time.
"To some, gender dysphoria can be life threatening and cause depression, anxiety and can really affect your daily life."
Ashley, who started to transition last year, would like to get gender confirmation surgery, however feels like it is unattainable at present.
"It feels like something I'll never actually achieve. It means I've got to try come up with the money to go overseas myself.
"With this promise of we've got a surgeon who can do these surgeries in New Zealand it felt like there was a possibility in my lifetime. But it's been pulled away again."
Associate Minister of Health Julie-Anne Genter has asked the Ministry to investigate options for performing gender reassignment surgeries in New Zealand, but this work is in a very preliminary stage
Surgeries might not be cheaper if done by a local doctor. Dr David St George, chief advisor at the Ministry of Health, wrote last year that the cost of a private sector male-to-female surgery with the retired Peter Walker was around $35,000. Costs in Thailand are around $16,000 and costs in a DHB could be around $20,000.
St George also wrote that Yang would set up a gender clinic six months into the job for the Northern Region. The Ministry would then have to negotiate with CMDHB about establishing a national gender reassignment surgery programme. This could increase the rate of surgeries.
Yang is a fully trained plastic surgeon with additional postgraduate training in the full range of microvascular and transgender procedures.
The New Zealand Institute of Plastic and Cosmetic Surgery website described Yang as having a passion for gender-related surgery which she pursued by travelling to work with the most experienced surgeons worldwide. She also worked in Amsterdam and at the Chang Gung Hospital in Taiwan as a microsurgery fellow performing breast and head and neck reconstruction.
"Dr Yang offers a wealth of experience in the field of body and breast surgery as well as gender affirming surgery," the Institute reported.
CMDHB spokeswoman Lauren Young said it was not possible to determine when transgender services would be available.
"The Auckland Regional Plastic Surgery Department continues to strive to meet the needs of the community within the limits of a capacity and funding constrained public hospital environment. It is hoped that these (transgender) services will be provided when capacity and funding allows."
Dr Jackie Blue, Commissioner for gender and sexuality issues, encouraged the Ministry of Health to look at diverting money used to fund overseas gender reassignment surgeries so Dr Yang could begin performing these crucial surgeries in New Zealand.
"We know that will be hugely disappointing for New Zealand's trans community, for whom this is a long-standing issue. We are working towards better healthcare for them, through our advocacy on all New Zealanders' right to the highest attainable standard of health."
There is public funding available for three male to female surgeries and one female to male surgery every two years, with the operations taking place overseas.
Yang declined to comment.