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

Abstract

Background 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. 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. Method We 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. Results A 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. Conclusions We 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.

(Dis)advantaged positions in accessing gender-affirming healthcare in Finland: an intersectional qualitative study of foreign-origin transgender people

“…The findings of the study are very much in line with those of previous international research about the experiences of transgender individuals when accessing gender-affirming care [ 7 , 13 , 39 ]. When locating the study in the broader international context, it confirms that there are a number of changes that are to be implemented in order to decrease structural inequalities in the gender-affirming health service system in general, but also on the broader societal level in particular.…”

“…In the Finnish context, the necessity of performing one’s identity is mostly, but not entirely, connected to the currently practiced diagnostic processes. This is well-exemplified with the cases of non-binary individuals, who often feel that they need to perform their gender in a particular way to receive gender-affirming care [ 13 ], who do not necessarily seek gender-affirming medical interventions. When they do, however, they might face the problem of how the normative culture of gender manifests and how it may shape their access to particular treatments in the transitioning process [ 6 , 13 , 40 , 41 ].…”

“…This is well-exemplified with the cases of non-binary individuals, who often feel that they need to perform their gender in a particular way to receive gender-affirming care [ 13 ], who do not necessarily seek gender-affirming medical interventions. When they do, however, they might face the problem of how the normative culture of gender manifests and how it may shape their access to particular treatments in the transitioning process [ 6 , 13 , 40 , 41 ]. This indicates that the culture of gender in which gendered bodies exist as a binary is still prevalent.…”

“…Regardless of the changes in the law, the issue of geographical burdens around the transitioning process must be taken into further consideration. The issue of geographical burdens when needing to access gender-affirming care has previously also been addressed by international research [ 13 , 48 , 49 ].…”

“…In the United Kingdom, for example, high rates of dissatisfaction were reported concerning the access to gender identity clinics due to the long waiting lines, the small number of clinics and non-binary individuals often facing specific issues in accessing care [5,12]. Moreover, healthcare professionals often have a limited understanding of pathways and clinical practices in the holistic treatment attempts of transgender patients [13].…”