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
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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