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 out to the trans community
- Better communication and inclusive language
- More resources to improve service provision
- Decrease in waiting times
- Better mental health provision
- Better access to healthcare
Changing how trans healthcare works
Many of the trans and gender diverse young people we interviewed wanted to see changes to how trans healthcare works as a system.
Young people wanted to see fewer barriers to getting the treatment they needed. They wanted the people involved in their care to work in partnership with the young person in partnership (see GIC). Rosa felt ‘that [the] GIDS and the GIC system …is geared towards gatekeeping over actually providing healthcare and I think that’s just incredibly wrong.’ They felt that the current system of healthcare ‘seems to be all coming at it with this attitude of trying to discourage people from getting any further treatment or getting any treatment at all.’
Jaz would like trans people to not have to jump through hoops in order to acquire the things that we need’ and healthcare built around trans people’s knowledge.
Shash wants to see a primary care model’ of trans healthcare with the eventual goal’ for all GP’s to prescribe.
Many people said there should be an informed consent model*. This would let young trans and gender diverse people get treatment without having to be seen first by mental health services. Jay felt that ‘the informed consent model would be a lot more effective than what we’ve got right now’. June said he ‘felt a lot of pressure to have all the answers going into any health service…this pressure to have a very cut and dry conception of what my gender was, what trajectory I wanted to take and what services I needed’.
June talks about the pressure he feels to have all the answers when accessing gender identity services
Jack wants to abolish gender identity clinics’ and take up and informed consent model of trans healthcare.
Reaching out to the trans community
Jessica wanted to see a healthcare service that is more ‘people-focused’, working directly with the trans community. Patrick felt that trans healthcare can only be improved ‘by talking to the communities that are accessing the health care’. He thinks healthcare providers should be ‘talking to trans people finding out what they need and like what would be helpful and then actually doing it’. Begam wanted trans healthcare services to understand the needs of trans communities.
Anderson thinks a priority in trans healthcare is community outreach’ and putting funding into community projects.
Theo says healthcare professionals should be aware that gender is fluid’ and all GPs should be aware of trans issues.
Better communication and inclusive language
People said that there’s a need for health services and professionals to talk in a way that respects and includes young trans and gender diverse people. One example is not to ask very personal questions. Summer felt that healthcare professionals should ‘stop asking [trans people] about our sex lives’. Rahul agreed and said, ‘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.’
Erion says trans healthcare processes should be changed and be made more inclusive and suggests ways health care professionals can support their trans patient.
Young people told us they want better communication in trans healthcare, including the use of language that includes all identities. Max wanted healthcare professionals to be ‘more transparent’ with patients. Beth wants healthcare services to ‘use neutral language when possible.’ They said ‘I would like to not have to list my birth sex on files and forms and things’. They gave the suggestion of having ‘a form that says, “Do you have x body part?” so that they can then treat me accordingly, rather than it being about what they think a man is, and what they think a woman is.’
Cassie wants to see sexual healthcare services for trans people to use more inclusive language.
Others talked about wishing that clinicians would listen well and ask thoughtful questions. These young people wanted respectful discussions where they and their doctor could agree together what should happen. G said, ‘I want to go to a clinic and sit in a little waiting room with a cup of tea and then I want to talk to a couple of clinicians who ask me a bunch of genuinely insightful questions about what I want. Then talk to me about my questions surrounding health. Then we come up with a health care plan that we stick to.’
Safia says healthcare service need to depathologise’ and move away from putting people into boxes.
More resources to improve service provision
Young people suggested that healthcare for trans and gender diverse young people would improve with more money and better staff training. Jay felt ‘more invest[ment] into trans healthcare’. He worried that ‘the waiting lists are only getting longer …it has to change …something that needs to be addressed or it’s only just gonna get worse.’ Jessica said what was needed was not just ‘more staff’ but, ‘a wider range of staff… trans people who have had experience of this… working [within] [health] services and helping the next generation move forward’. PJ agreed ‘even more gender specialists would be nice’ (see Trans and gender diverse young people’s messages to healthcare professionals).
Theo wants shorter waiting times’ and a gender identity clinic in every major city.
Funds for health services was a key problem for young people. Sophie felt that trans healthcare should be made a priority by ‘making it better funded,’ along with ‘legal changes …so that all gender identities can be recognised [in law]’. Eel said he felt more generally that ‘the NHS [in general] would be [better] supported’ if it were better funded. Patrick agreed and wanted better ‘traditional Government funding so the NHS is actually properly funded’.
Summer shares how she thinks trans healthcare can be improved. One way is to train more clinicians’ and gender specialists.
The trans young people we spoke to also brought up staff training. Declan felt that all staff should have to take training on how to work in a way that welcomes and includes trans and gender diverse people. Rahul felt that ‘general knowledge of trans issues’ needed to be improved so that health professionals ‘know the policies and procedures in place for trans people but also like, be comfortable and confident administering them and also be confident talking to trans people’ (see Trans and gender diverse young people’s messages to healthcare professionals).
CJ wants to see an investment’ in trans healthcare to meet increasing demand. The UK have an opportunity to be top of the field.
Decrease in waiting times
Young people felt that more resources could bring down long waiting times so people could be seen quicker (see also GIDS and GIC). PJ said, ‘In a perfect world there would be more clinics, which would then mean less wait time’. Theo wanted ‘shorter waiting times and shorter times in between appointments’. Jay also said he ‘would definitely like to see the waiting times reduced.’
The young people felt that waiting long periods of time posed a risk to trans patients’ mental health. Tyra said, ‘The healthcare system needs to stop putting people on waiting lists and leaving them in a hole, because this is when people are accessing their own hormone treatments, accessing private doctors and [only] some people can do that’. She said ‘it shouldn’t be something you have to do’.
Ari says so many things’ need to be improved. More gender specialists to reduce waiting times and trans healthcare recognised as an individual branch of medicine.
Jacob says the waiting times are ridiculous and disgusting.
M says there is a need to, ‘prioritise trans healthcare but not prioritise it above anything else because it’s a service that should be accessed as much as any other service…and it just means that NHS needs a whole lot more funding.’ Other participants felt that there should be an optional fast track service for those who have mental health problems or need hormones.
Better mental health provision
Reuben said he’d ‘love for there to just be a huge injection of money into trans healthcare’ that focusses specifically on mental health. Jay agreed and said, ‘I definitely think there should be access to counsellors who are specialised in dealing with [trans and gender non-conforming] people because it takes a toll on people mentally’. Alistair thought ‘everyone on a waiting list should have access to regular counselling’ (see Trans and gender diverse young people’s experiences of counselling and Child and Adolescent Mental Health Services (CAMHS)).
Bay says Improve the mental health support for young people waiting for their first GIC appointment.
Finn feels that mental health services for young people in general need more funding.
PJ suggested ‘more psychological support for trans young people because [the] only trans related mental health support you get is with the doctors at the [gender identity] clinic, and you’re [not there] very much’. Ezio said, ‘It would be nicer if there were more gender [identity] counsellors’. He felt that the counsellors he’s seen so far have ‘no experience in what [they’re] talking about’. Tyra said, ‘The healthcare system needs to focus on mental health…. Like even if it’s just whilst you’re on the waiting list for three years, here’s a service you can access with other like-minded trans people, with other trans people.
H wants some sort of support while you wait because the wait is very extensive.
Charke wants a major overhaul of CAMHS’ and supporting the mental health of trans people.
Henry wants to see an affirmative trans healthcare service that prioritises trans people’s mental health.
Better access to healthcare
People said they wanted to be able to access healthcare more easily. In particular young people felt that they should not have to rely on private healthcare to get the treatment they need. Patrick wanted trans healthcare to be ‘much more inclusive and accessible’ and to break down the ‘unnecessary barriers’. Similarly, PJ wanted ‘better accessibility to treatment and more affordable treatment for people who can’t get private hormones because it’s too expensive.’
When talking about better access to healthcare, young people also wanted better services for non-binary trans patients. A wanted to see NHS gender identity clinics be ‘a lot more non-binary friendly’ and ‘a lot more welcoming.’ They said ‘there’s this kind of feeling among trans patients that you can’t say the wrong thing because otherwise they’ll take that as a sign that you’re not really trans’.
Sally says trans healthcare needs to actually function, and it doesn’t.
M said trans healthcare should be free, fair and equal’ and the ways that we think about trans people needs to transform.
H talks about the lack of provision of surgeons capable of performing top surgery and the impact this is having.
*The informed consent model for trans healthcare “allows for clients who are transgender to access hormone treatments and surgical interventions without undergoing mental health evaluation or referral from a mental health specialist” (Shulz, 2018, p. 72).
“This approach to transgender health care
a) promotes a departure from the use of the diagnosis of gender dysphoria as a prerequisite for accessing transition services and
(b) attempts to impact the way that trans-gender individuals experience and access health care by removing the psycho-therapy/gatekeeping requirement.
Instead of a mental health practitioner assessing eligibility for and granting access to services, transgender patients themselves are able to decide on whether they are ready to access transition-related health services.
In this model, the role of the health practitioner is to provide transgender patients with information about risks, side effects, bene-fits, and possible consequences of undergoing gender confirming care, and to obtain informed consent from the patient” (Shulz, 2018, p. 83).
Schulz, S.L., 2018. The informed consent model of transgender care: an alternative to the diagnosis of gender dysphoria. Journal of humanistic psychology, 58(1), pp.72-92.