Accessing and utilising gender-affirming healthcare in England and Wales: trans and non-binary people\u2019s accounts of navigating gender identity clinics

Talen Wright,Mitzy Gafos,Aedan Wolton,T Charles Witzel,Fiona M Burns,Leanne Mccabe,Roger Pebody,Alison J Rodger,Emily Jay Nicholls,Peter Weatherburn

doi:10.1186/s12913-021-06661-4

Abstract

BackgroundTransgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility. The pathway through primary care to specialist services is a particularly precarious time for trans people, and misinformation and poorly applied protocols can have a detrimental impact on wellbeing.MethodWe recruited trans participants from an HIV Self-Testing Public Health Intervention (SELPHI) trial to interviews which explored contemporary gender-affirming service experiences, with an aim to examine the path from primary care services through to specialist gender services, in the UK.ResultsA narrative synthesis of vignettes and thematic analysis of in-depth qualitative interviews were conducted with twenty trans individuals. We summarise positive and negative accounts of care under three broad categories: Experiences with primary care physicians, referrals to gender identity clinics (GICs), and experiences at GICs.ConclusionsWe discuss implications of this research in terms of how to improve best practice for trans people attempting to access gender-affirming healthcare in the UK. Here we highlight the importance of GP’s access to knowledge around pathways and protocols and clinical practice which treats trans patients holistically.

Highlights

Transgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility
In the UK, there are various paths trans people might take in accessing gender-affirming healthcare, either through the National Health Service (NHS) or through private General Practitioners
Twenty trans people were recruited from Self-Testing Public Health Intervention (SELPHI), which included seven trans women with a mean age of 40 years, and 12 trans men with a mean age of 34 years, and one non-binary trans masculine person

Summary

Introduction

Transgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility. In terms of accessing primary care, one will typically sign up to one GP practice, often within a defined geographical area (with some GP practices having catchment areas), and will remain under their care for the foreseeable future (e.g. until there is a reason to leave, such as relocating to a new area). Under this system, individuals are discouraged from seeing multiple providers and GPs are generally the first point of call for most health issues or concerns. There is some clinic data for trans people who have successfully accessed a Gender Identity Clinic (GIC), referral sources are not highlighted [11]

Objectives

Methods

Results

Discussion

Conclusion