Messages to healthcare professionals from trans and gender-diverse young people

To a GP specifically be super supportive. Even if you don’t get it. Be super supportive because Ive had the most supportive GP ever. And she has made the biggest difference to everything. I really was feeling awful and dysphoric. I was wearing three binders and stressing out cause I didnt think I was gonna be able to get testosterone and then she’s been here and she’s said, Yes, shared care. Yes, well do what we can. Yes, well help you. And it has been the best experience ever. If you gonna support this person, youve got to support it with all your energy. Be proactive almost like, you know, suggest going down this route or looking at that. You know, if they say, can you email this place, you know, can you email GIDS. Can you do that or can you ask the head doctor of the surgery like if we can set up shared care. Instead of saying, okay, well get back to you in a couple of weeks. If, you know, if it’s such a small thing as writing an email. If you can get that thing done quickly that shows that that trans person, someone cares that you’re getting, you’re making progress. And to that person it’s, it feels like youve just gone up a whole flight of stairs, not just one step. You know, it feels, it feels great. For other healthcare professionals, make sure you really are competent and know what you’re doing and know what you can and cant say to a trans person. And lots will say, oh, everyone’s so sensitive and easily offended. It’s one thing being super sensitive and easily offended. It’s another thing where youve said something that kind of really isnt okay and that person’s upset and that person isnt gonna want to open up and theyre not gonna want to talk to you. Theyre not gonna want to continue down that route. Theyre gonna be looking at other ways. You really need to know what you’re talking about. If someone has made it very, very clear that hormones are the way then even suggesting, do you need hormones? It feels like, you know, a, a punch to the stomach. It’s not pleasant. That person isnt taking you seriously. They obviously havent listened, sort of thing. And make sure, make sure you understand what that person is and isnt okay with. If that person says theyre very much not okay with anything, you know, sexual [aircraft flying over] themselves and they don’t even wanna think about it, because of the dysphoria and you’re like, well have you tried it. Have you done this. You know, if someone’s made it clear then suggesting they go against something that they really made clear is just offensive. So, I think make sure you’re fully competent on, on stuff and that you’re not upsetting that person more than they already are. And if theyve already been waiting two years, living as their true gender they don’t need a six month assessment. They need action.

I think try and do your research and try and find out as much as you can online, I mean even if it’s wrong, you know, a lot of trans people won’t be that shy about correcting you just treat the patient no differently than you would anyone else, just accept that they may have some additional needs. And also just yeah take care of them in the same way that you would another patient. And if you can try and see if you can attend any sort of, because they have like weekend courses in London where they teach you things about how to like properly interact and, you know, what the right questions are to ask and, you know, also realising that because a lot of GP’s have it where they will change people’s records and put them down as male or you know, like FTM but the problem with that they then get screened in for prostate checks and it happens the same way as well for like ovarian cancer and stuff and it’s, you know, like breast screening and like But yeah so it’s sort of I guess I know that I’ve been put down as like Mx because you have to be either one or the other and like they should just create like a third term where you can just put down this person is like FTM, MTF or just, you know, anything else it would make so much more sense, it would make life so much easier for people because it’s not tricky being put either male or female particularly with passports, you know, because you’ve got to be one or the other.

I think the, one of the things that I’m so grateful that my GP knew and I didn’t know going in, was that he could prescribe me testosterone, off the back of the recommendation from the gender clinics. Gender clinics make recommendations, but GP’s can actually make prescriptions. It would be great in general if, and I don’t know how you would even do it, but, if GP’s could particularly, no any GP’s. I was going to say particularly if they know that they’re dealing with a trans person, but there is so little knowledge available there for GP’s, and so much of the time they don’t know what they’re looking for or why they’re looking for it, or why it might be a problem. An example: I got a, I had some blood tests, I got a panicked telephone call from my doctor at the GP, being like we’ve got your blood results back and we need you to come in. And I was like, Oh okay. This doesn’t sound good And I went, Can I ask why And she said, Your testosterone levels are through the roof And I was like, Yeah That’s because I take testosterone daily. And there was a pause on the end of the phone, and she was like, Well why would you do that And I was like, Because I’m trans Those kinds of things I think GP’s need to be aware of before they sort of do the, this is just a normal kind of investigation. It would also be great if GP’s understood that being trans is part of my body, but also my body runs in different ways, like when I say I can’t sleep, or if I have tonsillitis or if I’ve broken my arm, or if I’ve fallen over, there are so many things that I do that are not, they are only trans because it happens to be me that’s doing it. And I think GP’s tend to jump to, Oh you’ve got the trans flu and you’re like, No, just the regular old kind and it sucks So like both information and less reliance on it, all at the same time I think would be great.

Be open to Shared Care Agreements. They are not scary. they’re a good thing and they’ll help a lot of people and I think that I am someone who is like very proud of the NHS. Like the best thing to happen to this country is the NHS. My favourite prime minister is Clement Atlee, all the rest. Like yes, the NHS are great. And so like I think that Shared Care Agreements and supporting trans healthcare and stuff are an extension of the fundamental ideals of the NHS and the fundamental message of the NHS. And if taking a Shared Care Agreement is part of that and part of extending those services and helping the most people in the most cost effective way possible and helping them get the healthcare they need and helping everyone get the healthcare that’s accessible to them. If taking Shared Care Agreements is a part of that and it’s making it cheaper for a person who isn’t you that healthcare tax to access services then that should be, that should be the standard because that should be the goal of the NHS. I’d say, be open to that and get clued up on trans issues. Even if you don’t have a trans patient yet, you probably will someday. it’s best to read up on it in advance rather than say, I’ve got a trans patient, now I need to read up on it because you may already have one and you might not even know. So, I’d say, definitely read up on, read up on stuff and be open to Shared Care Agreements and stuff. Keep a close relationship with those private healthcare services cos a lot of people rely on them at the minute. And, hopefully, they won’t have to in the future, but, right now, that is the case.

I think there’s like how to support trans people even getting into the room, and then there’s how to, how to prevent that being so traumatic they never come back again. And so on the first one I think it would be good if, I haven’t thought this through I’m kind of out, answering it out loud, but I feel like it, if I can look up GP’s and see that like this GP says they’re trans aware or trans inclusive or something, I’m gonna feel way more confident going there than what the current situation is which is that I just have no idea what I’m walking into. I think then ifso I, this is a, I think there’s a structural issue that I’m not sure how they overcome which is that they categorise you, like part of their search terms for people is male or female, and so like I had this thing last year where I went to A&E, I thought I’d, I thought I might have fractured my ankle, and the woman at reception was trying to find me in the system and couldn’t find me. And then it turned out she was searching me as male, and then that’s why she couldn’t find me basically, and which was, and then she was really embarrassed and awkward, and apologetic, and it just made the whole experience like semi-humiliating, even though it didn’t need, like it didn’t need to be, it wasn’t inherently humiliating, something about that, so I think that there’s a thing about like not, I don’t know how a GP gets around that because that, it’s not the GP, well to my knowledge it’s not the GP’s surgery that can control that specifically, that they have to designate you one or the other, but I do think that there, there could be a kind of like How to refer to you option, and a non-gendered way of, I mean I think, because it’s medicalised often it does end up being non-gendered, because they’ll talk about, they won’t talk about well not always but, they’ll talk about what’s there, rather than like who you are. But I think having some like trans sensitivity, I mean I don’t want to say training cos I don’t think training changes things necessarily, but trans sensitivity practice of using like trans affirming language, and giving agency and choice around things.

I wish they understood what the like I wish they understood that trans healthcare is not a, an elective kind of treatment, or something like that, you know. It is a lifesaving and an emphasis on the lifesaving, like trans people are, like suffering from not getting the healthcare they need. And like it does cause them genuine distress, it causes, like I, like people have been traumatised from their like experiences of healthcare, and like it’s not, for so, one thing I’d say is like GP’s is to be educated and educate yourselves attend any like training that’s offered that’s around gender, gender things as general, because I know, I know it does happen, I know it’s, it can, it’s mostly optional that’s the unfortunate thing, really. it’s not really, it’s not mandated in any way, even in med school and stuff like, so do educate yourselves. Make, like, and if in doubt I guess, always make, contact like the GIC or one of the local GIC’s or like whatever, because more than, more, more often than not they are willing to help, try and help you navigate a trans patient’s care. Even though if they are like inundated by requests, at least just sending an email can’t hurt, you know.

Like and it’s not, and like, and a lot of the time trust what like, to an extent what trans people say to you because they would’ve probably learnt a lot about this in, than you have, in like your few months of med school, like wherever it’s been. You know like this is a lived experience for them. This isn’t like, this isn’t something they can just read a module on and skip, you know, or like just attend a, this is a something they’ve been going through day in day out. So when trans people tell you about like what they’re experiencing or what they need, they are not like just saying it for the kicks, you know like, that, it’s something they genuinely feel like they need. And it’s, could change their lives for the better.

And it’s and another thing is like not to conflate like gender dysphoria something with something mental health related, because that’s something that popularly happens, and it’s definitely, it’s not a mental health condition. And it’s what like, and treat it as, it’s something that needs to be treated but it isn’t something that needs to be like. Trans isn’t the illness, gender dysphoria is the illness here and gender dysphoria is what you’re treating. they’re still going to be trans at the end of the day and so making sure that they’re like one of the easiest things you can do, like even just to start with is changing their pronouns, preferred name on the system, and making sure especially for non-binary patients because I know it’s tricky whatever system they use, tends to only have a binary gender system, make sure you put the pronouns, or in the notes at least, to, and this is especially important because the amount of times, it’s not the GP’s that’ll be the transphobic people, it’s the receptionists and it’s, you don’t want to have to be going into an appointment and in a room full of patients to hear your dead name or something like that. You don’t want that. So like, you want your patients to be comfortable and one of the things you can do easily is changing the name and pronouns.

It would be nice to be asked, what’s your pronouns? like for a GP I guess I would really like it if like if I was having like a mental kind of like, if I was feeling like the world was against me and I am so alone and I have no one to turn to and I know I am one gender, yet the world sees me as another and I want to be able to like talk to my GP and kind of maybe be quite vague, cos you don’t wanna be like, well, I have a penis, but I feel like I should have boobs and a vagina and I am mentally torn and I want to die because of the situation. Like you don’t wanna spill your heart to a GP as a stranger. I feel like, you know, again, like maybe some training could be done to be like one of the person comes and they say these things or they give off a vibe. You could say, well, hey, maybe you’re experiencing gender dysphoria and kind of be very like helpful and be able to guide the young person or whoever to and just make the GP and the doctor’s office like a safe space, I guess.

Never forget how much power you have over somebody, it may not feel like it, if may feel like you are just a cog in a thing against another cog, you are the most terrifying thing to most trans people, because we’re just terrified that you’re going to say no. And please don’t forget the amount of time that it takes for us to have the run up to say something to you. The amount of conversations that a trans person has had in their own head, playing out conversations with other people, I don’t believe anybody wakes up on a whim and then just decides, That’s it, I’m going to start medical transition And I think GP’s and specialists in particular need to be aware of the fact that in so many ways they are, they are gatekeeping and people just want to be let in.

I think with trans youth, the GP’s should understand like the urgency of it, as opposed, because she was like, Oh I’ll write the referral letter but the referral letter was quite a while for it to be written out to the Tavistock, and sent to the Tavistock, and obviously when you’re not on blockers and you’re twelve, thirteen years old, going through puberty, it’s a really rushed thing, like whilst we were waiting on, if it was pulled back a bit you know, if she’s done it sooner or things had been done quicker, we could have maybe prevented some areas of puberty that I went through more than they are now.

Try to get the pronouns right, as much as you can, cos one of the best, well actually another positive experience, right, cos I had, I went into an A&E after my first suicide attempt, and this one , she went out the room to talk to someone, like on the phone and I could hear her, and she was saying like, Well she’s got insight, so she knows that there’s something wrong, so I don’t think like, and I don’t think a wards going to help her And she was talking to a third party, where she didn’t think I could hear her, and she was still respecting my pronouns and stuff. And like that made me feel so much better. So just the little things like that, you know, say, do the pronoun game. If you get it wrong apologise quickly and just try again next time. don’t make a big thing of it. Like making the room that you’re in with the trans patient feel like a refuge from the world where their identity will not be questioned. I mean mistakes are cool obviously, mistakes, everyone makes them so don’t worry over too much. But if you make that room a place where they don’t have to worry, you may find that trans people may just start unloading some stuff from you in their life, I mean that’s something I’ve done, getting my injection, and then suddenly just because I felt safe enough I’ve been able to go like, Things have been really tough lately, you know and be prepared for that conversation to come up, cos it might happen.

Education. Information. Even it if means giving NHS staff, you know, like ideas of like pronouns and updating of systems and that kind of thing. I think there needs to be also a slight deviation from the NHS and like the government and legislation. I think the paperwork of one becomes so much the remit of another, so the idea that my medical transition will be held off because of a name change that I do or don’t make, when that has nothing to do with my health, is a bizarre two-step. I think doctors need support and training, particularly GP’s. I think we need more doctors, certainly more specialists, so that the waiting lists can cut down. And investment, there just needs to be an investment in, in understand that this is going to continue to be something that, that if numbers are anything to go by, it’s increasing year on year. Which means you can’t just go with how things are, and it would be great I think to see the UK take gender and things seriously. I think the thing that’s exciting I guess from a medical perspective is that they have the opportunity to be at the top of the field, for showing what it is that standardised state care could do, and how to embrace the challenges of it. It would be great to see more of that rather than the dread of, Oh no, we’ve got to learn another thing about something that we don’t really care about Cos that’s a boring idea.