A colleague asked me for advice: he had performed a heart scan on Jo (not a real name), a trans patient, and he was not sure whether he should use the standard reference values for cis men or for cis women (men and women whose gender is the same as the sex assigned to them at birth).
I had not come across this situation before and there were no official guidelines to help.
I turned for advice to Dr James Barrett, a specialist in transgender medicine whose gender identity clinic in London is the largest in the country. He explained that the majority of health problems encountered by trans people are the same as those experienced by those who are cis-gendered. There are some conditions that are unique to trans patients and if there is uncertainty on how to treat them, he advises a nuanced approach and consultation with specialists. As Jo had not transitioned with hormones or surgery, we opted for reference values that matched Jo’s sex assigned at birth for the test.
Around 0.6 per cent of the population in the UK describe themselves as trans, but this is thought to be an underestimate and the number of patients referred to gender identity clinics has notably risen in recent years. Gender dysphoria is a distressing experience due to a discrepancy between an individual’s sense of their gender identity and the biological sex they were assigned at birth.
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My colleague admitted that he had not known how to talk to his patient about being trans as he had never had formal training in trans health care. This is not unusual: a survey of nurses in the UK found that while more than 75 per cent of them had encountered trans people, only 1 per cent had received preregistration training in trans health care and only 13 per cent said they felt prepared to meet their specific needs. In 2016, the women and equalities parliamentary select committee found that the experience of trans people in UK health care was variable to poor and said: “[This is] due to the attitude of some clinicians and other staff [who] lack knowledge and understanding – and in some cases are prejudiced. The NHS is failing to ensure zero tolerance of transphobic behaviour.” Studies have shown a higher rate of suicidal ideas in people with gender dysphoria. However, the rates of suicide decrease once trans people have undergone transition.
There is a growing need to care for people with gender dysphoria – in England there are eight gender identity clinics that any doctor can refer patients to, but currently there are none in Wales. Medical students in the UK are still underexposed to trans issues, with not much beyond general diversity and equality training.
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To counter this, the Royal College of Nursing, General Medical Council and several Royal Colleges have produced guidelines and standards for health care workers. They stress the importance of dignity, respect and compassion. For example, if there is uncertainty on how to address a trans person, they advise health care workers to ask them how they prefer to be addressed and to use those terms in their notes and correspondence.
It is unlawful for doctors to divulge the gender history of trans patients without their consent and their gender history must be relevant to the condition being discussed.
Much of the focus in the media is on sensationalised concerns about trans people using spaces – public toilets and changing rooms, for example – that are considered exclusively for cis-gendered people. In this fevered atmosphere, salient facts about trans people and their vulnerability are neglected.
Dr Barrett sums up the attitude that he thinks health care workers should have towards trans people: “Trans men are men and trans women are women.” I am grateful to Jo for inadvertently prompting me to learn more about trans issues. When it comes to trans health care, we need to go back to basics and acknowledge that trans people deserve the dignity, opportunities and rights we strive to offer everyone.
This article appears in the 20 Feb 2019 issue of the New Statesman, The last days of Islamic State