Ultimately, good trans-inclusive healthcare is simply good patient-centred care. However, there are some issues around healthcare that are specific to trans people or are more likely to apply to trans people.
TransActual’s Trans Lives Survey (2021) highlighted a number of issues faced by trans people in the UK when accessing non-transition related healthcare:
- 14% reported that they were refused GP care on account of being trans on at least one occasion.
- 70% or respondents reported being impacted by transphobia when accessing non-transition related healthcare.
- 57% of trans people reported avoiding going to the doctor when unwell.
Trans people with other protected characteristics often face multiple barriers to accessing healthcare. For example, the Race Equality Foundation report that trans people of colour experience higher rates of discrimination when trying to access mental health support, access to substance abuse treatment and domestic violence support.
TransActual’s Trans Lives Survey 2021 found that:
- 53% of Black people and people of colour (BPOC) reported experiencing racism while accessing trans-specific healthcare services.
- BPOC respondents also experienced transphobia from trans-specific healthcare providers at more than double the rate of white respondents (13% compared to 6%).
- 60% of disabled respondents reported experiencing ableism when accessing trans-specific healthcare.
Poor experiences with healthcare providers act to deter trans people from accessing medical treatment and support when they need it. This can lead to poor mental and physical health.
It is essential that healthcare providers are trans inclusive and that they signal that inclusivity to their patients. It is best practice to give all staff basic trans inclusion training and to give medical staff more specific training around trans people’s health needs. The most important thing you can do is listen to your trans patients when they tell you about their needs, as well as remembering that the fact that they are trans is not always relevant. For example, if a trans person visits you about a sprained ankle, there is no need to ask them about any aspect of their transition. Remember that a person’s gender, title or pronouns might not be what you expect them to be. Avoid making assumptions and if you’re not sure about a person’s gender, title or pronouns you should ask them.
Trans inclusive services avoid making assumptions about people’s bodies. For example a trans inclusive maternity service would use “name of pregnant parent” rather than “name of mother” on forms and would have the option to indicate whether the pregnant person is a woman, a non-binary person or a trans man. Literature would refer to “women and other pregnant people” rather than assuming all pregnant patients are women. This does not (and should not) prevent healthcare staff continuing to refer to women as pregnant women or mothers, but instead it signals that the service is inclusive of pregnant non-binary people and pregnant trans men too.
Sexual health services should also avoid making assumptions about people’s bodies. Service provision and any electronic systems should avoid assuming that all men accessing services have a penis and that all women have a vagina. They should also avoid making the assumption that everyone is a man or a woman. It is important to take this into consideration when screening or treating both transgender and cisgender service users. For example a cisgender gay man might have a trans boyfriend.
If you offer phone appointments, it is important that staff at your service understand that you cannot determine a person’s gender based on the pitch of their voice. You should refer to the person’s medical record or to the information you were given on the referral form. If in any doubt, you should check who you are speaking to before assuming that they are/aren’t the person you intended to call.
Hospital staff might need to make extra considerations when admitting a trans patient. It is important to understand that trans women are entitled to be treated on a women’s ward and trans men are entitled to be treated on a men’s ward (unless there are exceptional circumstances, which you can read about in our information on the Equality Act).
NHS guidance states that “a trans person does not need to have had, or be planning, any medical gender reassignment treatment to be protected under the Equality Act: it is enough if they are undergoing a personal process of changing gender. In addition, good practice requires that clinical responses be patient-centred, respectful and flexible towards all transgender people whether they live continuously or temporarily in a gender role that does not conform to their natal sex.”
You should ask non-binary patients where they would feel most comfortable. NHS guidance states that “non-binary individuals, who do not identify as being male or female, should also be asked discreetly about their preferences, and allocated to the male or female ward according to their choice. “
Some trans people might find it uncomfortable to be on a ward with others. For example, some trans men and non-binary people might feel incredibly dysphoric if they normally bind their chest and are unable to whilst in hospital. Being seen by others whilst not binding can be especially distressing. If this is the case if may be helpful for them to have a bed in a side room if possible. This should be offered as an option (if available) but should not be a decision that is imposed upon a patient without first asking them.
GMC: Ethical hub – trans healthcare
Healthwatch: Trans and non-binary health experiences
NHS England: Delivering Same Sex Accommodation
Royal College of Nursing: Fair Care for Trans and Non-binary People
Stonewall: LGBT in Britain: Trans Report
The Ambulance Service trans tooklit
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