UK Healthcare Workers’ Experiences, Confidence and Comfort Supporting Trans Patients
When seeking healthcare (whether for general healthcare or transition-related care), we know that most trans people in the UK don’t experience the high standards of care they ought to be able to expect from healthcare professionals.
We also know that most healthcare professionals want to help their patients and to provide high quality, patient-centred care. But in too many cases, something is stopping them.
Some issues do of course impact all patients, but research tells us that trans people have worse experiences than most.
We wanted to know more about healthcare professionals’ attitudes towards, confidence with, and competence in caring for trans people. So, we commissioned a survey of healthcare professionals. Thank you to the 646 people who responded to it.
Key findings
When interpreting these findings it is important to note that our sample was heavily skewed toward those who are most likely to be knowledgeable and supportive of trans experiences and medical needs – LGBTQ+ people and people with trans friends and/or family members were over-represented in our data.
Access to training
- Less than a third of respondents thought they’d received sufficient medical training or supervision to support their trans patients.
- Those who’d accessed training had often had to proactively seek it out, with some even paying for it out of their own pocket.
- Many professionals told us that they’d gained most or all of their knowledge and understanding on trans people’s healthcare needs from their trans patients.
Confidence and competence
- Whilst two thirds of healthcare professionals agreed that they felt competent assessing a trans person in a therapeutic setting, only a fifth strongly agreed that they felt very competent.
- Whilst 60% had knowingly care for a trans patient, more than a quarter had not. Given that trans patients are most professionals’ main source of information on trans people’s healthcare needs, this is important.
- Less than half of respondents reported feeling very or extremely comfortable in their abilities to support their trans patients.
Prescribing GAHT
- 80% of prescribing GPs had been asked to prescribe GAHT for a trans person.
- Of those that had been asked to prescribe GAHT, only 58% had prescribed it for a trans person.
- Of those that had prescribed GAHT for a trans person, 80% had offered shared care with an NHS gender clinic.
- Just 30% of those that had prescribed had provided a bridging prescription for their trans patients. The most common reason for not offering a bridging prescription related to prescribers’ lack of confidence and/or competence.
- Nearly a quarter of prescribers described having difficulties getting the specialist support they needed to be able to prescribe GAHT for their trans patients.
Other issues
Respondents told us about a number of other barriers to providing good practice care to their trans patients. These included:
- Inflexible IT systems;
- Local policies;
- Lack of information about local and national services, including how they can be accessed; and
- Funding issues, particularly in relation to prescribing GAHT for trans people.
Relationship to other research
The findings in this report are a notable contrast to the findings of the (soon to be published) Trans Lives 2025: Healthcare Report, which found that:
- Out of 4,008 trans respondents, 52% had experienced transphobia and/or poor care in a medical setting, including 64% of trans People of Colour.
- 33% of trans people experienced transphobia and/or poor care from a GP, 15% from a nurse, and 12% from a pharmacist.
- Where these negative experiences were were reported, 97% of trans people told us this been (at least in part) due to the healthcare professional’s lack of knowledge around trans issues.
Combined, our two reports suggest that moderate to low levels of confidence and comfort are insufficient to provide appropriate medical care and treatment to trans individuals, with further steps needed to raise knowledge and skill sets.
Recommendations
For policymakers:
- All medical practitioners should be required to complete training in best practice in caring for trans people. This should be embedded within the relevant pre-qualification curricula, as well as within required CPD post-qualification.
- There is an urgent need to provide clear policies and guidance relating to the provision of trans-inclusive medical care. There should be consistency in this across the UK to prevent a ‘postcode lottery’.
- GP contracts and NHS Service Specifications should make GPs’ responsibilities for prescribing GAHT clear, and national and local policies should be in place to support GPs to fulfil their responsibilities in relation to them.
- IT systems need to be updated to enable flexibility in patient biology to account for intersex and trans individuals, whilst retaining the ability for intersex and trans individuals to update the sex marker on their medical records.
For medical practitioners:
- Recognise that trans patients have some needs that require specific understanding and training. Be proactive in developing your trans-inclusive practice by attending training, reading about trans people’s lived experiences and learning from examples of good practice.
- Remember that whilst your trans patients are often experts in their own care, they shouldn’t have to be. Avoid placing the burden on them as your sole source of information on their healthcare needs.
For prescribers:
- Do what you can to support trans patients to access GAHT. If you currently feel unable to prescribe, reflect on what could make you feel differently and take steps to make that change – for example by accessing training or seeking advice from a more experienced colleague.
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