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Transgender people and healthcare

In order to understand how medical intervention may assist someone who is trans, it is important to understand the terminology.

  • A person’s ‘sex’ is defined by the appearance or anatomy of their genitals, or their chromosomal make-up at birth: male, female, intersex.
  • A person’s ‘gender’ relates to how they identify. It can be male or female, agender (no gender at all), non-binary (somewhere between the binary male and female genders), or something else entirely.
  • A ‘transgender’ person is someone whose gender identification is different to the sex they were assigned at birth.
  • A ‘cisgender’ person’s gender identification is the same as the one they were assigned at birth.
  • Transgender, or ‘trans’ is an umbrella term that covers the spectrum of gender identity.
  • Someone who was ‘assigned male at birth’ (AMAB) or assigned female at birth (AFAB), may identify as male, female, non-binary, agender, or anywhere else on the gender spectrum.
  • Gender identity is a spectrum, a natural variation of human identity. It is innate and cannot be forcibly changed, although someone’s journey and expression of their gender identity may change naturally over the course of their lifetime.

Unlike other human variations, such as sexuality or personality, transgender people can experience unhappiness if their body does not align with their gender. If they have the primary (genital) and secondary (pubertal development) sex characteristics that match their assigned sex at birth, rather than their gender identity, then this can cause social ostracisation and personal distress.

Gender dysphoria describes the unhappiness, discomfort, stress and anxiety that is caused by this mismatch and the subsequent ways in which it affects day to day life. If unresolved, this can lead to clinical anxiety, depression, self-harm and suicidality.

Some people express their gender in ways that match their gender identity, rather than their phenotypical sex. This might be through their clothes, hair, make-up etc., they may change their name and pronouns. People may also seek medical intervention to prevent the development of, or to change their physical and psychological sexual characteristics, so they match their gender rather than stay aligned with the sex they were assigned at birth.

Transgender people have become more visible over the last ten years, with more education and information available to help them to understand their feelings and how gender can be different to sex. This has led to a large increase in people coming forward for medical and surgical interventions.

Classifying gender identity as a medical condition has been problematic. Those whose gender is simply different to the one they were assigned at birth, understandably do not wish to be classified as having a disease, or a disorder, or an illness. Previous Classification of Diseases (ICD) have classified gender-identity related health as Gender Identity Disorder in a category of mental health. However, ICD-11 now classifies it as ‘gender incongruence of adolescence and adulthood’ and ‘gender incongruence of childhood’ in a category of matters related to sexual health.

Pre-pubertal children do not require any medical intervention other than support for them and their family. However, adolescents may request interventions to suppress their natural puberty and replace their hormones so that their bodies undergo pubertal changes in line with their gender identity, rather than their birth assigned gender. Adults who have already undergone puberty, may seek medication to change their hormone profile, and surgery to reassign their genitals, chest, face or other gender-defining characteristics.

In line with the increase in people requesting medical intervention, healthcare professionals have become more aware, developed medical protocols and undertaken research to better help their patients. Unfortunately, there is still a significant amount of discrimination and prejudice faced by transgender people. Some people feel very strongly that gender identity cannot differ from sex, and medical opinion can be divided.

Case studies, clinical experience and research studies are all very positive, showing that medical intervention can increase life satisfaction scores, reduce mental health issues and reduce self-harm and suicidality.

The World Professional Association for Transgender Health (WPATH) is an international, interdisciplinary, professional association devoted to the understanding and treatment of individuals with Gender Dysphoria (GD). In a position statement on medical necessity published in 2016, they recognise that ‘gender affirming/confirming treatments and surgical procedures, properly indicated and performed as provided by the Standards of Care, have proven to be beneficial and effective in the treatment of individuals with transsexualism or gender dysphoria.’