Messages to healthcare professionals from trans and gender-diverse young people

Content warning: mention of suicide risk

The trans and gender diverse young people we interviewed had many messages for healthcare professionals. They suggested some key ways in which GPs and healthcare professionals could support their patients, including:

  • Improve knowledge of trans healthcare processes
  • Understand the diversity of trans bodies and pathways
  • Be proactive in getting training on trans issues
  • Listen to your trans patient and believe them
  • Respect that trans healthcare is urgent and have compassion
  • Engage with the local trans community
  • Be respectful with language and questions

Improve knowledge of trans healthcare processes

Many trans and gender diverse young people told us they wish that GPs and healthcare professionals had better knowledge about trans healthcare. Steps they could take included educating themselves on up-to-date procedures, processes and pathways for trans patients.

  • Tyra suggested healthcare professionals “should be aware of the services that are available” for trans healthcare.
  • Henry said, “It would be good for [doctors] to have a knowledge of the gender clinics that exist and how each of them works.”
  • Declan said, “I wish they knew all about all the procedures that we’re supposed to take”. He gave the example of the process for referrals and said “they can refer people and they should know how to do that”.
  • G would like “a GP who knows something about endocrinology (hormones) and trans people, to talk to me about it, [and] to just not assume that I’m an expert on my own body.”

Noelle suggests ways GPs can support their trans patients.

Age at interview 23

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Two key areas of knowledge that need improving are Shared Care agreements and bridging prescriptions.

  • Jessica explained that she wanted her healthcare professionals to have better “understanding of the issues with the current system and the issues in the NHS pathway”, to be “more accepting of alternative routes and… Shared Care agreements.”
  • Henry felt that “the more that [doctors] know about what they’re prescribing and the more they know about how that’s monitored, the better equipped they’ll then be to support that person.”

Jacob says talk to a trans person in a sensitive way that shows you have listened, understood what is important them and are taking their request seriously.

Age at interview 17

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Bridging prescriptions are when doctors prescribe hormones for patients waiting to access specialist services such as a Gender Identity Clinic. People had the following things to say about them:

  • PJ wished that healthcare professionals knew “more about bridging prescriptions” and wished “they were more available.”
  • Declan said it related to whether a trans person was “at ‘risk” and GPs especially should have more knowledge and are “open to prescribing”.
  • Cassie also added that healthcare professionals need to “accept the reality of self-medication… and normalise the disclosure of that fact and how to go about that in a safer sense.”
  • PJ said he wished his healthcare professionals also “knew more about being able to monitor your bloods’. He explained how he has ‘heard so many stories of trans guys not having their bloods regularly monitored and then that screws up their levels”.

‘G’ talks about their wish for healthcare professionals to be experts in trans healthcare rather than relying on the patient.

Age at interview 23

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Understand the diversity of trans bodies and pathways

Young people wanted their healthcare professionals to be aware of the diversity of trans bodies and specific healthcare needs.

  • Cas said, “try and educate yourself on the more diverse society. Because the world has never actually been in black and white, it’s always been in colour.”
  • Max said, that services will be requested by “different identities” and should be treated “as normal”.
  • Jessica highlighted the importance of “more understanding of non-binary issues”.

Ezio shares the importance for health professionals to treat trans patients no differently than you would anyone else.

Age at interview 23

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The young people we interviewed were keen for health professionals to be aware of the different healthcare pathways that trans people take.

  • June wanted to make clear that “not all trans people want a medical transition and that just because someone does or doesn’t want a medical transition doesn’t mean that they are any more or less trans or, like, need support any more, or less”.
  • Bay said that often “different things are needed in a medical setting for different bodies”

Declan said professionals need to “have the knowledge that trans bodies are different”. He gives the example of being questioned by a nurse when he asked for something to cover his top half during an examination. He had to the explain that he was trans. He said “if they just had a bit of that knowledge [beforehand] it would be quite [a lot] easier to deal with.”

CJ shares an awkward conversation about the effects of hormone therapy on their body due to a lack of knowledge.

Age at interview 34

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Be proactive in getting training on trans issues

Training and awareness on trans issues was thought to be very important. Young people suggested healthcare professionals should seek out knowledge and do research before seeing a trans patient.

  • Henry advised, “educate yourself before the trans person walks into the room.”
  • Tyra, Rahul and Bay stressed the importance of “basic awareness training.”

Bay gave the examples of “asking what pronouns someone might want to use, or not using gender terms when it’s not necessary to.” They also mention being sensitive about “procedures that are needed based on your [genitals], so things like smear tests”

Jessica talks about the importance of learning about trans healthcare in advance. If you don’t have a trans patient yet, you probably will someday.

Age at interview 17

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Training and awareness is also important in being able to identify inaccurate information. Ari described the importance of GPs “getting a working knowledge of trans healthcare before they next see you.” They added that “otherwise you get misinformation going both ways and then nothing goes anywhere.” Shash added that it was important that professionals educate themselves and “be critical…of what you see in the media.” They warned that “especially when it comes to trans issues, [the media] could be very sensationalised, not necessarily true or misleading.”

N describes the importance of learning trans sensitivity’ and improving an awareness of trans bodies.

Age at interview 34

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Listen to your trans patient and believe them

Many trans and gender diverse young people commented on the importance of being ‘believed’ by their healthcare professionals.

  • Bee stated that it’s “really important to trust and believe your patients’ because ‘patients are the expert on their experience”.
  • Safia recommended professionals “take the time’ ‘to really listen to what your patient is telling you and what they’re asking for.” Most importantly “believe them.”
  • Finn said that professionals should be wary of “saying that [trans young people] might just be confused”.
  • Bailey talked about experiences of being told by health professionals “you are not trans, you’re just autistic”.

Evelyn said, ‘Listen to trans people, and listen to what they want’. Jack said, “listen to your patient, believe them”. Tori felt the benefit of her GP taking this approach: “my GP was incredible, he listened to me and knew that this is what I was gonna want to do anyway”.

Sophie says it’s really tough going to your GP. It was one of the hardest things I’ve had to do.

Age at interview 21

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Shash talks about trans healthcare as “lifesaving” treatment.

Age at interview 23

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Eel explains how the doctor’s office can feel like a safe place’ when experiencing gender dysphoria.

Age at interview 17

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Respect trans healthcare is urgent and have compassion

Young people were keen for health professionals to understand the urgency of trans healthcare.

  • June said that it was “quite unsettling” that his healthcare professional “didn’t understand the immediate urgency in my needing to be on HRT as a trans person with dysphoria”. He said “I don’t think she understood that it was harmful to my mental health to be expected to wait three years to medically transition”.

Theo says healthcare professionals should be aware that gender is fluid’ and all GPs should be aware of trans issues.

Age at interview 23

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Michelle wanted health professionals to acknowledge the gravity of “mental health issues’ in the community”. She said, “Flip a coin whenever you meet up with a trans person, that person will have a 50% chance roughly of having some kind of suicidal crisis in their time.” PJ said that “if a trans person goes to the GP” it’s a “last resort” because “they’re at the end of their tether”.

  • Cassie said “above all, please realise how hard this is and that nobody is choosing it.”
  • Jaz wanted healthcare professionals to “think about what you can do to empower people.” She said “what [healthcare professionals] do can have really serious, really important positive and negative consequences in terms of like what happens to them or doesn’t happen to [trans] people.”

CJ advises healthcare professionals to never forget how much power you have over somebody.

Age at interview 34

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Evelyn says GPs should understand the urgency’ of trans healthcare for young people going through puberty.

Age at interview 14

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Engage with the local trans community

Some trans and gender diverse people told us that talking to the trans community would help healthcare professionals learn about the reality of trans healthcare.

  • Begam stressed the need for professionals to “try and understand the community”.

Tyra talked about “community outreach with people” and being involved in different projects whereby health professionals got training provided by trans people like them. Beth talked about “working with LGBT organisations within my community” and said “when those organisations come to you and say, “Would you like us to do some training to make your workplace more inclusive, more supportive to a larger amount of people?” take them up on it”.

  • Michelle stressed the importance of hearing and “reading some trans voices”.

Anderson wants their health professionals to be clued up’ on LGBT services in their local community and to engage with people and speak to the community.

Age at interview 26

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The trans and gender diverse people we spoke to also felt it was important for health professionals to be a visible advocate for trans healthcare.

  • N said GPs and health professionals should be clear that they are friendly to trans people. They said, “if I can look up GP’s and see that like this GP says they’re trans aware or trans inclusive or something, I’m gonna feel way more confident going there than what the current situation [where] I just have no idea what I’m walking into.” A adds that, “if there was like some way to indicate that you were a trans friendly medical professional that would be cool.”
  • Cassie said she wants healthcare professionals to speak out on behalf of trans people “advocate for trans healthcare as much as you can and normalise general nonconformity and transness within your patient population.”

Be respectful with language and questions

One message to healthcare professionals working with trans and gender diverse people was to work on using the correct names and pronouns and steer away from personal questions.

  • Finn stressed the importance of not saying the wrong gender (misgendering) for patients and Sophie talked about how important it is to “respect people’s name and pronouns.”
  • Bee said that it was important professionals “get up to date with training and language around gender or pronouns”.
  • Eel commented that “it would be nice to be asked, “what’s your pronouns?”. Noelle added that ‘something as simple as like asking pronouns can show that you are on board and you are supportive”. (see also GP surgeries).
  • Another message was understanding that not every illness that people see their GP about is related to being trans or gender diverse.

Michelle reflects on the positive impact of hearing a nurse use the correct pronouns at a crucial time in hospital.

Age at interview 34

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Rahul talks about social etiquette in healthcare interactions, “every time you have a GP appointment with a trans person, you really don’t have to ask them about their genitals every single time like it’s possible to go through an appointment without talking about people’s genitals.”

Michelle commented that a trans person could break their arm “go to A&E and somebody says, “Yeah but, you know, how do you feel about your genitals?” So that’d be one thing for people to be aware of. Don’t do that”. Loges commented that professionals should “make sure you don’t ask any too invasive questions and ask them the right way”.

More widely, the use of names and pronouns and gender markers was especially important for administrative systems.

  • Safia said “if you have an “other” box under the gender form, then you could let people fill out their own thing”. N added “I do think that there could be a “How to refer to you” option.”

See also:

Trans and gender diverse young people’s views on improving healthcare

Trans and gender diverse young people’s experiences of GP knowledge, process and referrals

Trans and gender diverse young people’s experience of GP surgeries

Trans and gender diverse young people’s experiences of shared care, prescribing and self-medication

Trans and gender diverse young people: diverse journeys and pathways

Views on improving healthcare

Young people suggested changes they would like to see from healthcare services based on their different experiences. These included: Changing how trans healthcare works Reaching...