Trans Healthcare Report
This is one of three Community Engagement reports from the TRANSforming Futures partnership. Drawing on a survey, workshops and contributions from health and community experts, the research details trans participant’s experiences of problems in healthcare and highlights participants’ proposed solutions to some of these problems. This is qualitative research led by, and focused on, a diverse range of trans people in England.
The proposals and solutions included here are not policy recommendations, and they do not represent the view of any one organisation or individual. We have foregrounded a range of suggestions from trans people themselves, to spark further discussion and future action. Suggestions may also go on to become funded projects with TRANSforming Futures partners.
This report is the starting point of a conversation. As well as exploring trans people’s experiences of healthcare, this project provided crucial time and space for trans communities to discuss the problems they face. Even more importantly, participants were asked to imagine their own solutions – large and small – to these problems. This in itself is an act of healing and reclaiming power.
Issues in Healthcare for trans people
Issues with the gender clinic system
Many participants identified experiences with gender clinics as one of the hardest parts of their transition, mainly because of long wait times and difficult experiences with clinic staff. Problems included a lack of communication while waiting, administrative errors leading to people waiting longer, and many struggling with mental health breakdowns during the long wait.
Navigating NHS diagnoses and referrals processes was difficult, and many turned to private care or self-medication instead.
Many participants experienced medical gatekeeping, including invasive inspections of their personal histories, mannerisms and dress. Participants said information was withheld or obstructed, making it harder to navigate the system.
Barriers to accessing healthcare
Participants reported that getting access to healthcare can be dependent on your identity and level of privilege.
Trans people of colour reported avoiding healthcare far more often than the white trans people they know.
Autistic respondents reported being refused referrals to gender clinics - with their autism having been viewed as invalidating their gender identity. Neurodiverse people reported experiencing additional delays in their transitions because they were not able to access information.
Trans migrants and people who had experienced homelessness said a lack of permanent address made referral and registration difficult.
Some trans sex workers also found it difficult to access appointment-based healthcare due to precarious and/or unpredictable schedules.
Trans people in rural areas said they lacked trans-specific services and many reported being the only trans patient that their GP had met.
Issues with healthcare practitioners
Participants and experts reported a lack of understanding from healthcare practitioners, in many cases having to educate their doctors about trans healthcare themselves.
Many GPs were unclear on how NHS transition pathways worked. A lack of GP knowledge led to some participants refused gender clinic referrals and others referred to specialists for simple primary care needs. Participants struggled with GPs who were uncertain about prescribing hormones.
Participants reported often facing invasive and inappropriate questions, physical exams being conducted outside of standard procedure, and being repeatedly misgendered.
Accessing information about transition-related healthcare
Participants highlighted how difficult they found it to access information about trans healthcare, getting most of their information online from trans forums or informally from friends. Trans people often rely on people with no medical training for important medical information. Reliance on networks and online information means some people are cut off from knowledge completely.
Trans fertility, pregnancy and parenthood were highlighted as areas where health services have and provide particularly poor information and understanding, leading to confusion about fertility and a lack of access to appropriate support.
Participants and experts also pointed to policy gaps that leave trans parents without legal recognition of their gender.
Issues in the NHS
Transition-related care on the NHS was roundly seen as underfunded. This underfunding was seen to lead directly to lengthy wait times in gender identity clinics. The NHS was specifically criticised for underfunding or not funding aspects of feminising transition
Participants expressed difficulties with changing a gender marker in NHS patient records during or following transition, and there is no option to record your gender as non-binary in NHS systems. The way that NHS records are set up results in some trans people’s medical histories being deleted, and leaves others without access to important preventative care.
Hospital wards and sexual health services the NHS are highly gendered, which forces trans people to identify as either ‘male’ or ‘female’ to access healthcare. Participants of all genders reported being questioned about their right to be in a certain hospital ward, but transfeminine non-binary people and including trans women in particular reporting higher levels of hostility within ward settings.
Availability of mental health support
Healthcare anxiety reportedly led trans people to avoid accessing healthcare in case they have negative experiences.
Participants had great difficulty accessing trans-inclusive general mental health services and negative experiences with therapists who did not understand trans backgrounds.
Workshop participants who had gone through a gender clinic often stated that they were negatively impacted by the lack of mental health support throughout the clinical process.
Ideas for improving healthcare for trans people
After identifying problems that trans people experience in healthcare, workshop participants generated ideas they thought would help alleviate these problems. Their ideas were as wide-ranging as the perspectives and experiences of the group. Those ideas included:
Improving outcomes in the current healthcare system
Training specialist advocates and advisors so trans people can receive professional, reliable assistance when accessing general and trans-specific healthcare.
Creating resources to help GPs provide thorough care by helping them understand transition pathways and transition-related care.
Creating resources to help trans people navigate healthcare and transition pathways, with a focus on patients’ rights, how to self-advocate, and simple information on key challenges within trans healthcare.
Making changes to the healthcare system
Mandatory trans training integrated into healthcare training and professional development programmes, provided by a trans speaker collective.
Creating a trans healthcare think tank to advocate for trans people’s healthcare more broadly.
Reducing waiting times for Gender Clinics and improving mental health support.
Moving to an informed consent model for gender-affirming treatment to enable people to choose the right healthcare without an assessment by a mental health professional.
Specific support to overcome barriers that some identities are more likely to face, e.g. a support hotline for black trans people and trans people of colour.
Introducing trans district nurses to help improve broader healthcare needs while trans people are waiting for support from gender clinics.
Improving how gender markers are recorded in NHS records by introducing a unified system to update names and pronouns across all services and doctors’ offices