The transgender community wants health officials to cut the wait time for gender reassignment operations, saying it could take decades before people get one.
Information released under the Official Information Act shows there are 88 people on the wait list.
Seventy-one people are waiting for trans feminine (sometimes referred to as 'male-to-female') gender reassignment surgery, and 17 are waiting for trans masculine ('female-to-male') surgery.
However, public funding remains set at just four operations every two years - three trans feminine surgeries and one trans masculine surgery.
The current policy was set in 2003, but the Health Ministry warned a select committee last year there was a big increase in demand.
Advocates said the problem was not new and the policy was archaic, leaving those wanting operations demoralised and hopeless.
Trans advocate Jennifer Shields said the waiting list time for trans feminine people was 47 years, and it was 34 years for trans masculine.
She said she was saving to see psychologists and psychiatrists as part of the process to get on the wait list.
The process was very expensive, and she doubted she would ever actually have surgery.
"It's absolutely ridiculous. If I was on the wait list today, I would be about 71 at the rate that it is now before I got the surgery at which point it would probably be a health risk to do it," she said.
"For so many of us it just feels really, really pointless to even bother with the list."
Some transgender people felt incomplete and suffered from dysphoria, where a person felt like they were in the wrong body, Ms Shields said.
"It's like an ever-present sense of something not being right in a really, really intense way.
"In our community it leads to massive rates of mental illness, substance abuse, self-harm and suicide, it's really devastating."
People wanting trans masculine surgery had always had to travel overseas for surgery.
However, trans feminine surgery was performed in New Zealand until 2014 when the only surgeon who did it retired.
Now, the ministry pays for people wanting trans feminine surgery to travel overseas for surgery too.
The ministry puts the current cost of trans feminine surgeries at about $35,000-$40,000.
For trans masculine it can be up to $180,000.
Nick McMillan, a trans guy, is on the wait list to have an operation.
About six months ago, he received a demoralising letter from the Health Ministry.
"[It] said I'm number 16 in the queue and at current levels my waiting time is 32 years."
He had paid $600 to meet the requirements to get on the waiting list and spent thousands of dollars more on surgeries that were not publicly funded, he said.
The number of people coming out as transgender was on the increase, he said.
"Because society has become a little bit more knowing, a little bit more open, people are realising that, 'Hey, this broken feeling inside me, it has a name, this is possible.' This is where we are getting a lot more people on the waiting list."
He added that the waiting list only told part of the story. There were hundreds of people who also wanted surgery but were not on the list, he estimated.
University of Waikato psychology lecturer Jaimie Veale, who is transgender herself, said transgender people faced stigma, discrimination and had high rates of suicide.
People could feel a sense of hopelessness when hearing they had to wait decades before surgery, she said.
"Transgender people who are able to access appropriate care which is affirming of our gender identity and giving us the medical treatment that we need, then we do do a lot better."
Health Ministry acting chief medical officer Andrew Simpson said trans feminine surgeries would be provided overseas until a surgical team was able to carry out the procedure in New Zealand.
"There is currently no one in New Zealand with the specific expertise and training to carry out the male-to-female gender reassignment surgery."
Mr Simpson said an additional trans feminine surgery had been approved for the 2016/17 financial year.
"There will be 'catch up' surgeries once the new system has successfully bedded down, to fulfil the commitment to funding four surgeries every two years," he said.