Under the Equality Act (2010) trans people are entitled to freedom from discrimination when accessing healthcare. From the moment they come out as trans, trans people all ages are protected under the ‘gender reassignment’ characteristic. This also includes non-binary people.
Learn more about your legal and professional responsibilities to trans patients on our Your Responsibilities page.
It’s important not to make assumptions about your patients. Like anyone else, trans people may be disabled, neurodiverse, from a faith background, from a variety of ethnic and racial backgrounds, and have a range of sexual orientations.
Pronouns are the words used to refer to people’s gender in conversation – for example, ‘he’, ‘she’, or ‘they’. Be aware that a person’s pronouns may not align with the sex marker on their medical record. If you’re not sure about a patient’s pronouns, just ask them.
Trans patients are eligible for screening tests based on their anatomy, so for example:
- any patient with breast tissue is eligible for breast screening
- any patient with a cervix is eligible for cervical screening
However, many trans patients will not automatically be sent an invitation to the screening they are eligible for:
- in England, many trans patients will not receive an automatic invitation – more information on GOV.UK
- in Northern Ireland, many patients will not receive an automatic invitation – more information on the HSC Public Health Agency website
- in Scotland, trans patients who changed their CHI number after 14th June 2015 should be automatically be invited to the correct screening tests. Patients whose CHI number was changes before this date will not be automatically invited. More information can be found on NHS Inform.
- in Wales, many trans patients will not receive an automatic invitation – more information on the Public Health Wales website
You can read full details of considerations for trans patients related to population screening tests, and how to ensure patients receive the appropriate tests, on our Administration page.
There is no reason not to make a referral to a Gender Clinic if a patient requests it.
In England, ask the patient for their choice of the services listed on the list of NHS gender clinics. The services have significantly varying wait times (these are listed on the service web sites), and often offer video appointments, so patients may prefer not to be referred to the geographically closest service.
In Northern Ireland: refer to the Brackenburn Adult Gender Identity Service.
In Scotland: check the NGICNS website for a list of gender clinics and their catchment areas.
In Wales: refer to the Welsh Gender Service at St David’s Hospital, Cardiff.
In some specific ICBs and health boards, there are locally commissioned services which patients can access.
Referral should be made for patients regardless of:
- changeable or uncertain sense of gender
- mental health diagnoses
- autism spectrum conditions or ADHD
- high BMI / obesity
- immigration status
- chronic health conditions
- disability
- learning disorders or disabilities
- tobacco or narcotic use
You can read full details of how to make a referral on our Making A Referral page.
The clinic will ask you to enter into a shared care agreement and take responsibility for blood tests and prescribing.
Many patients seek private healthcare whilst waiting to be seen by an NHS clinic. It can be helpful to enter into a shared care agreement with the private provider. You can read more about these agreements on our Private Services and Shared Care page.
Under GMC guidelines, GPs are allowed to provide a bridging prescription. This is a prescription for hormone treatment to bridge the gap between the referral to a gender clinic and the trans person being seen by the gender clinic. Bridging prescriptions act as a ‘holding and harm reduction strategy’, to mitigate the effects of waiting to receive care from a GDC and the resultant risks of suicide, self-harm and self-medication.
You can read more about bridging prescriptions and harm reduction on our Self-medication and harm reduction page.
Guidance for non-specialists on monitoring hormone treatment for trans patients is available on our Prescribing page.
The GMC have also published guidance specifically around bridging prescriptions for trans patients: https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#mental-health-and-bridging-prescriptions
Some trans people registering as new patients at your practice may already have been accessing NHS prescribed HRT. As with any other patient, they ought to be able to expect continuation of their care.
You can find detailed information about how to handle continuing treatment for trans people, including people who have moved from another UK national health system or from a country outside the UK, on our Prescribing page.
Supply issues with HRT are not uncommon. The information on prescribing sent to your by your patient’s specialist endocrinologist normally has information about alternative medications that can be used. You can also speak to your patient’s gender clinic if they are registered with one.
Some gender clinics have created specific guidance on this subject:
Tavistock and Portman GIC: Alternatives when there are hormone shortages
Chalmers GIC: Hormone Treatment Alternatives
Leeds GIS: testosterone, estradiol
Testosterone treatment does not act as a contraceptive, so it is important to talk to trans patients with a uterus about contraception. Some trans men and non-binary people choose to give birth, it’s important to use inclusive language when talking about their pregnancies.
Before starting hormone therapy, some trans people may wish to access gamete storage. NHS funding should be available through the ICB.
Whilst being trans is not a mental health condition, trans people are disproportionately impacted by mental health difficulties. Remember that not all trans people’s mental health difficulties are related to them being trans. Some patients will benefit from services designed specifically for trans people.
Details of trans inclusive mental health services: https://www.transactual.org.uk/transorgs
Want to learn more?
You can find other resources on our website about:
- administration considerations for trans patients in our detailed guidance for GP surgery administration staff
- professional guidance resources on our Policies and Guidance page
- trans inclusive primary care on our Primary Care page
- our training offer for healthcare professionals on our Training and Consultancy page.
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