Guide To Supporting Patients Accessing Specialist Gender Identity Services
It is impossible to say how many trans people there are in the UK because this information is not often officially recorded and there is no agreed definition of transgender. Many trans people never access Specialist Gender Identity Services (SGIS) or ever declare their trans status in an official context. However, a best estimate based on 2007 data (likely to be a significant underestimate) suggested that:
- 12,500 people had presented for treatment at SGIS and this number was doubling every 6.5 years 8. Sussex showed the highest ratio: 45 per 100,000 aged over 16, compared to a national average of 20 per 100,000 9.
Brighton and Hove has a reputation for welcoming diversity and an active and vibrant trans community, with its own social resources, cultural events and political engagement. For example, the city hosts the UK's Trans Pride festival each year. There is every reason to think that the number of people coming forward locally for SGIS will grow and clinicians working in Brighton and Hove can expect to see an increasing number of trans people, including children, young people and their families.
This guide focuses on people who seek or undergo treatment from SGIS in England because GPs have an important role to play in supporting these patients. However, before looking at SGIS, it is important to note two other groups of trans patients:
- Trans people who do not need to access SGIS – Some trans people do not want to use bio-medical treatments to express their gender and do not want access to SGIS. In some cases, the transition experience is an entirely social one, e.g. change of name, style of dress, self-presentation etc., which does not require any medical services. Also, trans people have a host of health needs that are not connected to their gender, which can and should be managed in primary care.
- Former, discharged SGIS patients – Patients continue to see their GP throughout their care at a SGIS for on-going hormone treatment and monitoring in a shared care arrangement. This continues after discharge from the SGIS (see Section 4.6). In some instances, a re-referral to a SGIS will be necessary because patients require surgical procedures they had originally discounted, or specialist surgery for post-operative complications, which can arise some years after the original procedure. However, if the GP can safely and competently coordinate care with specialist advice and input from a SGIS, a re-referral is not always necessary.
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
8 GIRES (2011) The Number of Gender Variant People in the UK - Update 2011.
9 Reed B, Rhodes S, Schofield P, Wylie K. (2009) Gender Variance in the UK: Prevalence, Incidence, Growth and Geographic Distribution.