Guide To Supporting Patients Accessing Specialist Gender Identity Services
It is necessary to broaden understanding about sex and gender because the ‘old’ models for thinking about this are simply inadequate for making sense of trans people’s experience. Thinking in new ways can facilitate discussion about being trans and enable GPs to demonstrate understanding and empathy. This is important when working with patients seeking Specialist Gender Identity Services (SGIS).
Some of these ideas may be unfamiliar or challenging, and extended detail about these complex subjects is not possible here but these key concepts may be helpful to understand.
Seperating Sex and Gender
Put crudely, ‘sex’ can be thought of as the physical biological sex characteristics: genes, chromosomes, genital organs, etc. ‘Gender’ is the more complex social, psychological and emotional phenomenon relating to one’s felt and expressed sense of self. For most people, sex and gender seem to align in an uncomplicated way, e.g. a person’s sex is ‘female’ and they identify themselves and are perceived by others as such. The term used for this is to be ‘cis-gender’; in other words not transgender.
However, for some people sex and gender are not aligned as society usually expects, e.g. a person’s sex is female, and others regard them as such, but their deep sense of self is masculine and male. This would be one example of being trans.
Separating the concepts of ‘sex’ and ‘gender’ is a helpful way to make sense of the fact that a person’s biological sex characteristics do not always determine their felt sense of self as a gendered person.
A Spectrum Not A Binary
We are perhaps used to thinking of sex as a binary: male/female. However, this is misleading. We now understand that for some people, the simple sex designation of male or female does not fit. Historically, such people were called ‘hermaphrodites’ but this is offensive, out-of-date language now. The term ‘Intersex’ would be used instead. In clinical terms, Disorders of Sex Development may be used but some patients do not like this.
Similarly, for some people the concept of gender as a spectrum, with masculine and feminine as two points at each end is more helpful than that of a binary. This accommodates people who permanently change their gender or who experience it as a blend of masculine and feminine, or something ‘fluid’, which shifts. It also allows those who simply feel themselves as traditionally masculine or feminine to express their sense of self too.
Diversity Not Disorder
Much discussion about gender variance, particularly in medical contexts, still uses the language of pathology, e.g. ‘gender dysphoria’, ‘gender identity disorder’ (see Section 4.2). Some trans people find this way of thinking and talking about gender variance stigmatising and offensive. It is important to recognise that trans people are simply part of the human gender diversity that exists. The scientific and medical advances enabling physical transition are fairly recent (from around the 1930s onwards) but examples of gender variance can be found throughout human history and societies. The World Professional Association for Transgender Health has called for the ‘de-psychopathologisation’ of gender non-conformity.
To sum up, separating ‘sex’ and ‘gender’, seeing gender as a spectrum instead of a binary and recognising gender diversity can give us a more sophisticated way to understand gender variance and discuss trans people’s experiences. If you would like more information about new ways of understanding gender, see the table below.
Introduction Guide Home Page
Section 1.0 About This Guide
Section 1.1 Why This Guide Is Needed
Section 1.2 Current Context
Section 2.0 Developing Understanding About Trans People
Section 2.1 New Thinking About Gender
Section 2.2 About Trans Identities
Section 2.3 About Gender Pronouns
Section 3.0 High Quality Services for Trans People
Section 3.1 Getting It Right
Section 3.2 A Special Note on Children and Young People
Section 3.3 A Special Note on Screening: Screen for the Organs Present
Section 4.0 Understanding the Patient Groups
Section 4.1 Understanding Specialist Gender Identity Services
Section 4.2 The Approach to Treatment
Section 4.3 Treatment Protocols
Section 4.4 Available Treatments - Adults
Section 4.5 Available Treatments - Children and Young People
Section 4.6 The Role of the GP
Section 5.0 Changing NHS Records
Section 5.1 Information Sharing - The Gender Recognition Act 2004
Section 5.2 Medical Reports
Section 6.0 Supporting Patients
Section 6.1 Sources of Information and Support
Section 7.0 Glossary
Thinking About Sex and Gender - Sources of Information
- Bornstein, K. (2013) My New Gender Workbook: A Step-by-Step Guide to Achieving World Peace Through Gender Anarchy and Sex Positivity. New York: Routledge
- Burn, S. (2014) Understanding the Changing Landscape of Gender Identity. PsychologyToday.com
- Teich, NM (2012) Transgender 101: A Simple Guide to a Complex Issue. Columbia University Press: New York
- Yarlett, S. (2013) Non-binary: An Introduction to Another Way of Thinking About Identity. NewStateman.com.