Health issues

Health issues

Information exists on the differences in health experiences and outcomes by gender and age, but much less is available in Scotland for health experiences and outcomes by ethnicity, disability, sexual orientation, religion or belief and transgender.

Equally Well, the Scottish Government’s report of the Ministerial task force on health inequalities (external link), notes in its Introduction that transgender people experience lower self-esteem and higher rates of mental health problems and these have an impact on health behaviours, including higher reported rates of smoking, alcohol and drug use.

These behaviours have their associated health risks such as cardiovascular disease and various cancers.

From a survey of 872 people, 34.4 per cent of respondents had attempted suicide as a result of being a crossdresser, transgender / transsexual person or because of other people’s reactions to them being trans (Source: Legal Survey and Focus on the Transgender Experience of Health Care, Press for Change, Whittle et al, 2008). (PDF: 1.43MB) (external link)

The Department of Health’s 2007 briefing on trans people’s health (PDF: 123KB) (external link), notes that:

  • female to male trans men are rarely included in breast screening programmes
  • male to female trans women are rarely offered prostate screening
  • trans people have experienced the refusal of care such as smear tests, breaches of confidentiality and the practice of placing trans women on male wards, and trans men on female wards.

The National Osteoporosis Society advises that a transsexual person is at risk of osteoporosis if they discontinue hormone therapy (external link) whereby no oestrogen or testosterone is produced to maintain bone density.

Practice guidance

NHS Inform’s website provides information on treating gender dysphoria (external link).

Services and uptake of gender reassignment services differs across Scotland’s health boards, with gender identity services provided in four Scottish health boards on behalf of NHSScotland. Referrals can be made to these clinics to explore with the patient the options available to them. These are available at:

  • NHS Grampian: Royal Cornhill Hospital, Aberdeen
  • NHS Greater Glasgow and Clyde: Sandyford Gender Identity Services, Glasgow
  • NHS Highland: Sexual Health Clinic, Raigmore Hospital, Inverness
  • NHS Lothian: Sexual Problems Clinic, Royal Infirmary, Edinburgh.

Most gender reassignment interventions are available in Scotland with the exception of specialist services for genital surgery. As a result patients are referred to clinics in England for this part of their treatment.

The Tayside Violence Against Women Training Consortium has produced guidance for mainstream women’s services on the inclusion of transgender women (PDF: 381KB) (external link).

NHS Greater Glasgow and Clyde’s transgender policy (PDF: 287KB) (external link) sets out the health board role and responsibilities to transgender people as both a service provider and employer.

Guidance from the rest of the UK

The UK Government has released Advancing Transgender Equality: a plan for action (2011) (external link) which lays out their vision and the focus for the Government’s commitment to deliver greater equality for transgender people.

The Department of Health has produced:

Gender Identity Research and Education Society has prepared five publications for the Department of Health which can be downloaded (external link). They include:

  • Transgender experiences: Information and support (2009)
  • Guidance for GPs, other clinicians and health professionals on the care of gender variant people (2008)
  • A guide to hormone therapy for trans people (2007)
  • Medical care for gender variant children and young people: answering families’ questions (2008).

International guidance

The World Professional Association for Transgender Health (WPATH) has released The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version. (external link)

The WPATH guidelines aim to “provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfilment”.

Legal challenges relating to gender reassignment services

A.D & G v Lancashire Health Authority (Court of Appeal, July 1999).

“A, D and G were three separate transsexual women (M to F) and each had been refused NHS funding of gender reassignment surgery which was recommended by the gender identity clinic specialists dealing with their cases. The law permits NHS bodies (known as Primary Care Trusts) to make local decisions about how to prioritise the way they allocate limited public funds to provide treatment for the full range of medical conditions in their area.

"The Lancashire Health Authority decided on this basis not to allow funding for gender reassignment surgery. In the High Court it was held firstly that Gender Dysphoria is a medical condition and that, as such, it should be treated on the NHS.

"Justice Hidden held (on the basis of expert testimony) that gender reassignment surgery was the appropriate treatment for gender dysphoria and that the funding policy which amounted in practice, to a blanket ban was unlawful and irrational."

(Source: EqualJus online database of legal documents and references related to sexual orientation and gender identity). (external link)

The UK Court of Appeal ruled that:

  • Gender dysphoria is a medical condition and as such should be treated on the NHS.
  • Gender reassignment is the appropriate course of treatment.
  • It is unlawful for NHS commissioners to operate any policy that amounts, in practice, to a blanket ban on such treatment.

(Source: Transgender case decisions, Equality and Human Rights Commission website). (external link)