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Male to female transsexual clients are a group of clients for whom there are few dedicated services in New Zealand. To examine service utilization in Wellington, New Zealand, 70 male to female transsexual clients were identified and their medical records audited for selected aspects of sexual health service delivery. Audit revealed that sexual health history is recorded incompletely and behavioural risk factors are not fully explored, sexual health examination and testing is incomplete. We conclude opportunities to expose relevant behavioural factors and to educate for sexual safety and health promotion are lost with this infrequently attending minority client group.