Introduction to Transgender Healthcare

Question 1

What are the 3 different support types for trans patients?

Answer 1

Question 2

What is the reversible and irreversible effect of blockers and testosterone?

Answer 2

Question 3

What is the reversible and irreversible effect of oestrogen?

Answer 3

reversible is on the left

Question 4

What are the specific health considerations you must take for trans patients and what they can be more at risk of?

Answer 4

Question 5

Outline the process of referral to a gender identity clinic

Answer 5

GPs may refer pts directly to a GIC and do not need to refer them to mental health service for assessment beforehand.
GPs in England don’t need to seek prior approval from their Clinical Commissioning Group (CCG) or perform any specific examinations.
Treatment should be patient-led; clinician will need to allow choices that were not necessarily foreseen at the outset to be made along the way.
GICs= invaluable resource and will advise and support.

Question 6

Can trans patients/gender dysphoric patients use private care?

Answer 6

• Patients may use private services instead of/alongside NHS health services, this does not disqualify them from accessing NHS care.
• Most private clinicians are also employed at NHS GICs.
• Private services can inc psychological assessment and support, hormone treatment, voice therapy, surgery.
• The main reason for private referral is NHS waiting times.

Question 7

Explain the concept of shared care and harm reduction

Answer 7

• The NHS should continue to provide care that the patient would have been entitled to had they not chosen to have private care.
• Where the same diagnostic, monitoring or other procedure is needed for both the NHS and private elements of care, the NHS should provide this and share the results with the private provider.
• GPs must cooperate w GICs/other gender specialists by prescribing meds, providing follow up and making referrals as recommended by specialists.
• GP may issue prescription if a pt is already self-prescribing via an unregulated source, and where the prescription is intended to mitigate SH risk and is supported by appropriate specialist advice.

Question 8

Which genders services and facilities do we refer trans people?

Answer 8

Trans individuals should always be directed to the facilities which accord with their identified gender.
Offensive and unlawful to insist that a trans pt uses facilities designated for their sex assigned at birth.
This inc patient bays in wards, but check where the trans patient feels most comfortable as their safety may be a concern for them.
“Screen for the parts you have” – ensure patients are empowered and don’t slip through the gaps

Question 9

Describe the legal matters associated w trans individuals

Answer 9

• Coming out and document changes.
• Applications for GRC and gender change.
• Confidentiality is vital for safety and breaching it is unlawful, you must not share information regarding someone’s trans status without their explicit consent.
• Incidents and threats against someone because of their transgender identity are hate crimes and should be reported to the police.