Dr Massimo Giola obtained his medical degree in 1991 at the University of Pavia (Italy) and specialised in Infectious Diseases in 1996 (Italy). He studied antiretroviral drugs’ pharmacokinetics during a PhD programme in Clinical and Experimental Pharmacology from 2005 to 2008 at the University of Varese (Italy). He moved to NZ in 2009 and worked as a general/ID physician in Invercargill until November 2010, then in Tauranga. He was accepted for the FRACP in December 2012, and completed further specialty training in Sexual Health Medicine in Auckland in 2013-2015. He has been back in Tauranga since July 2015, working for the BOPDHB as acute general, infectious diseases, and sexual health physician. He is a Board Trustee of the NZ AIDS Foundation since 2012.
Transgender Medicine As A Life-Saving Intervention
Background: It is unique to Transgender medicine that the diagnosis relies entirely on a Mental Health assessment, but the ensuing management is entirely Medical, unless concomitant mental health issues are identified during the baseline assessment or appear later on. Gender identity variants are not a medical or a mental health condition per se (i.e. they are not a disease); however, the assessment must ascertain that no mental health conditions co-exist, which might mimic or complicate them. The stigma and psychological violence that society inflicts on gender-diverse minorities explains the very high rates of self-harm and suicidality in these populations (5 times higher than the general population). It is encouraging that those rates decline to the baseline after successful medically supported transition to the desired gender.
Our experience in BOPDHB: No adult transgender medicine services were available in the BOPDHB catchment area prior to July 2015. Since July 2015, the Author started a fortnightly Specialist Sexual Health Clinic accepting, among others, referrals to support the medical transition (i.e. gender-affirming hormones) of trans* people. The cooperation with the Adult Community Mental Health Service has been instrumental. To date, 33 patients are under follow-up; 16 are transitioning from female to male, and 17 from male to female. Their mean age is 25.9 ± 8.4 years (range: 17 to 52). 25/33 (75.7%) have currently been started on gender-affirming hormones.
Next steps: Based on our experience, we envisage our model (medical follow-up based at the sexual health clinics, with mental health support) as mostly suited for regional New Zealand. We are advocating at present for multi-DHB cooperation in the Midlands Region to establish a shared pathway and multidisciplinary approach involving also Endocrinology and Surgical Services.