Guide To Supporting Patients Accessing Specialist Gender Identity Services
Trans patients should be offered cancer prevention screening that is not sex-specific in line with standard recommended practice (e.g. bowel screening). However, GPs can be confused about what sex-specific screening is necessary – does a trans man need cervical screening for example? This rule of thumb can guide decision-making: screen for the organs present, not the gender. For example, if a trans man retains a cervix, conduct cervical screening. A trans woman won’t need cervical screening, even if she undergoes sex reassignment surgery (genital surgery) as no cervix is present. But she will retain a prostate, so offering prostate-specific antigen testing in line with usual practice would be appropriate. Breast screening should be based on what breast tissue is present.
Trans patients will ‘drop out’ out of automated sex-specific screening recall systems if they change their gender designation on NHS computer systems. GPs and patients will need to ensure that screening continues and patients should be informed of this. As GPs will need to make individual arrangements for these patients, the following suggestions may be useful:
- Explain to the patient that they may not be recalled for some types of screening when changing their gender designation.
- Inform the patient what screening would be appropriate for them and which types may be affected. Ask them to work with the practice to ensure that this happens.
- Conduct the screening according to the organs/tissues present – see above.
- Where relevant, confidentially and with the patient’s permission, identify the patient as trans on paperwork/forms accompanying the samples. It is critical that the reason for this is explained and consent given. Advise the testing facility of the need to keep the patient’s trans status strictly confidential.
- Provide a copy of the results to the patient for future reference.
- Where possible, issue a reminder for future screening via the practice-based patient database. However, the patient should also be advised to keep a note of when screening is due and to request this if they do not receive an automated reminder.
Clinic T, the local trans sexual health clinic, conducts cervical screening for trans men and NHS Wales has produced some resources that may provide useful general information (see the table below). For expert advice, readers should contact the following:
- The Health Promotion Cancer Team at Sussex Community NHS Trust
- Public Health England Cancer Screening Programmes.
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
Resources on Health Screening for Trans People
- Brighton and Hove CCG (2017) Cancer Screening for Trans People (Patient Leaflet)
- Brighton and Hove CCG (2017) Cancer Screening for Trans People (Leaflet with additional information for Health Professionals)
- Cancer Prevention Team Sussex Community NHS Trust (2015) Trans Health Cancer Screning Leaflet
- Centre of Excellence for Transgender Health (2014) General Prevention and Screening
- Potter, M. (undated) Tips For Providing Paps To Trans Men
- National LGBT Health Education Centre (undated) If You Have It, Check It: Overcoming Barriers to Cervical Cancer Screening with Patients on the Female-to-Male Transgender Spectrum (slide set)
- NHS Wales (undated) Screening For Life Transgender Information.