Accessing services

The most significant healthcare need for trans people is treatment for gender reassignment. However, like other groups, trans people have wider health care needs, although there is considerably less research in this field compared to research on access to treatment for gender reassignment.

This briefing highlights a range of evidence sources about trans health inequalities. The briefing could be used to inform impact assessment and also the implementation of the Gender Reassignment Protocol

Qualitative research highlights barriers experienced by trans people when accessing health services. For example:

  • Research by Engender in 2010 found that trans people reported experiences of GPs having little or no knowledge of gender reassignment.
  • A survey of 71 trans people by the Scottish Transgender Alliance reported that trans people are less likely to seek out-of-hours medical care because of uncertainty of how NHS professionals may react to their transgender background or identity.
  • A survey of 873 trans people by Press for Change reported that 21 per cent of respondents’ GPs did not want to help with providing gender reassignment treatment.
  • The research also found that 29 per cent of respondents felt that their trans identity affected their experiences of healthcare in other areas beyond gender reassignment services. It was also reported that some healthcare professionals see trans people as transsexual first, regardless of the non-trans healthcare needs that they may present with.

Evidence of effective approaches

There is currently no highly processed evidence retrievable from the health improvement evidence portal related to transgender people. A search of the Knowledge Network also finds very few review level papers that are relevant to service development in Scotland.

There is a lack of robust evidence of effectiveness of surgical interventions for gender reassignment, due to methodological limitations of studies such as lack of control groups, low follow up and use of unvalidated outcome measures. This conclusion is based upon a review undertaken by Bazian for East Midlands Specialist Commissioning Group.

This absence of robust evidence highlights the need for a more qualitative approach to demonstrating the importance of investment in gender reassignment surgery, commitment to carrying out robust evaluation of the impact of treatment on individual outcomes and the need to address separate approval processes.

Updated April 2015

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