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CPD: How to care for transgender patients

CPD: How to care for transgender patients

Dr Mohammad S Razai advises on how to provide the optimum care for your trans patients

This module will help you gain an understanding of:

  • What transgender means and the challenges trans people face with healthcare
  • How you and your practice team can communicate sensitively with trans people
  • Legal protections and trans rights in relation to access to healthcare
  • How to ensure trans people have equal access to healthcare including screening
  • When GPs should refer people for specialised support for gender identity concerns
  • How GPs can support patients with transitioning, including prescribing hormones

Dr Mohammad S Razai is a GP in south London and National Institute for Health and Care Research in-practice fellow in primary care at St George’s, University of London

With thanks to the Gender Identity Research & Education Society (GIRES) for its advice

‘Transgender’ and ‘trans’ are umbrella terms for individuals whose gender identity, expression or behaviour differs from their biological sex assigned at birth.

Trans people experience poorer health outcomes than the general population and increased mortality,1,2 as well as lower quality of life. In part, this is due to poor healthcare.3 Some will also experience gender dysphoria – a profound sense of unease and distress because of a mismatch between their gender identity and the sex they were assigned at birth.4 This can lead to depression, anxiety and harmful impacts on daily life.4 Treatment is largely safe and can improve health and wellbeing.5

To address the health and care needs of trans patients, GPs and practices should be up to date with relevant laws, professional guidance and contractual requirements.

Demonstrate your sensitivity

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To build trust and gain the confidence of trans patients, it is crucial to work on sensitive and competent communication skills. Trans patients are a marginalised group who face routine discrimination and hate crime. The statistics are shocking – two in five trans people experienced a hate crime or incident in the last year due to their trans status. A similar proportion said healthcare staff lacked understanding of their health needs.6

Misgendering a patient by using the wrong pronoun can make them feel excluded, invalidated and disrespected,7 so get this right from the initial contact. Do not guess a person’s gender from their appearance, voice or expressions. Ask questions like: ‘How do you prefer to be addressed?’ or ‘What are your preferred pronouns?’ If a patient is mistakenly misgendered, offer an apology and try to reassure them sensitively.

Patients may be transitioning to non-binary, and not necessarily from male to female or vice versa. Gender-neutral terms are increasingly being used – such as ‘they’, ‘ze’, ‘ne’ and ‘per’.8  

Patients can request to change their name and gender at any time, and need not have undergone any reassignment treatment. Practices do not need to wait for any document, updated birth certificate or gender recognition certificate to make the change. The patient will be given a new NHS number and registered as a new patient. Your practice must inform Primary Care Support England (PCSE) with their name, NHS number and confirmation the patient is aware a new NHS number will be created. PCSE will then send you a new patient record. The GP practice creates a new record using the new details, and transfers all medical information from the original record. Information relating to the patient’s previous identity should not be included. You should check their new registration is done within five working days to avoid any interruption to care.6

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Please note, only GPs are permitted to add comments to articles

David Banner 17 August, 2022 1:31 am

Twice this article mentioned “sex assigned at birth”. Assuming it’s not an error this represents a change from the more usual “gender assigned at birth”. If you exclude the small number with (eg) intersex or chromosomal anomalies (in which case the sex assigned at birth could well be incorrect), then the vast majority of trans people do not have their sex “assigned at birth”, it is obviously male or female.

This is not mere pedantry.
The crux of the polarised dispute between trans rights activists (TRAs) and certain feminists is on this point. TRAs state that “trans women are women”, and as such should be free to access all areas of female life. Certain feminists will state that whilst the gender identity of trans women may be legally female, their biological sex remains male, and so sex-based rights to safe spaces, changing rooms and sports should only be for biological females.
Previously TRAs have separated sex from gender to help us understand this complex situation better, but to now suggest trans people were assigned the wrong SEX at birth is a radical change. TRAs can now state that a trans woman is biologically female after all, which destroys sex base rights objections.
Given that neither side in this debate is prepared to compromise, and the vitriol on both sides is extraordinarily vicious, this change could turn the heat up even more.

Patrufini Duffy 17 August, 2022 2:31 pm

The LGBT travel market is valued at US$211 billion a year. FYI.

Truth Finder 22 August, 2022 1:12 pm

Only people with clear minds can do science based on facts not opinions. There is no need to follow those who do not have a clear train of thought. Too many variables to practically manage it and it sounds pretty mad.

Darren Tymens 23 August, 2022 12:38 pm

I would suggest
1. be empathic and respectful
2. refer into appropriate services, and where they don’t exist act as an advocate for your patient
3. do not do anything outside of your competency

Hot Felon 25 August, 2022 12:42 pm

Like, transgender is, like, so not a thing

Patrick Mcnally 26 August, 2022 11:59 pm

The PCSE “new NHS number” route is idiotic, and stems from misunderstanding of the GRA 2004. Don’t do it, unless your patient wants you to!

Sujoy Biswas 15 October, 2022 4:35 pm

The best thing to do is empathise and refer on.
The harsh reality is that suicide rates and mental illness rates are far higher post transition. As Tavistock survivors show its not all plain sailing.
You wouldn’t do a hip replacement in primary care so why this?

Dylan Summers 25 October, 2022 1:26 pm


For those who have doubts around the degree to which transgender is “a thing”, you may be interested in the “sex matters” website which campaigns for policies based on biological sex, not gender identitiy.

Decorum Est 5 November, 2022 12:50 pm

At the core of the ideology is the radical claim that feelings determine reality. From this idea come extreme demands for society to play along with subjective reality claims. Trans ideologues ignore contrary evidence and competing interests, they disparage alternative practices, and they aim to muffle skeptical voices and shut down any disagreement.

The movement has to keep patching and shoring up its beliefs, policing the faithful, coercing the heretics, and punishing apostates, because as soon as its furious efforts flag for a moment or someone successfully stands up to it, the whole charade is exposed. That’s what happens when your dogmas are so contrary to obvious, basic, everyday truths.

A transgender future is not the “right side of history,” yet activists have convinced the most powerful sectors of our society to acquiesce to their demands. While the claims they make are manifestly false, it will take real work to prevent the spread of these harmful ideas.

The best thing to do is empathise and refer on.

Dylan Summers 12 November, 2022 1:01 pm

@Decorum Est

Interesting comment. To my knowledge, current medical / GP education offers only the “clinical” perspective on gender identity issues. And the clinical perspective purports to be non-ideological… but of course it is not.

I have attended workplace training on gender identity where I was rather troubled by the lack of any acknowledgment that it might be possible both to be a caring effective clinician and to hold gender-critical views.

Dave Haddock 4 February, 2023 7:49 pm

People are dying because the NHS apparently cannot offer appropriate timely care; why is this stuff even funded by the NHS?