Trans and non-binary health experiences

Healthwatch Lewisham wanted to understand the trans and non-binary community's experience of health and social care services.  They spoke to 20 people about their experiences.

Identity was important to a lot of gender diverse people in Lewisham, including the importance of transitioning to match how they feel.

Almost all the participants could recount negative experiences of poor staff attitudes.  They felt that some medical and admin staff weren't willing to learn about gender diverse identities and care.  Sometimes medical staff asked invasive questions with an inappropriate level of curiosity or their attitudes were cisnormative.

Some people shared stories of how this poor quality of care made them feel discriminated against because of their gender identity, or because they were looking to undergo transition.  Others shared examples of better attitudes.

People felt that services didn't provide an environment that was welcoming to them, for example, displaying information that it would be a welcoming space for LGBT+ or gender diverse individuals.

People felt it was difficult to transition because health care professionals don't have access to the information on how to do it, or the information was out of date.  This lack of information or education on gender diverse healthcare made people feel angry, upset or helpless.

The specialist Gender Dysphoria Clinic (for adults) and Gender Identity Development Service (for under 18s) were generally seen in a more positive light, aside from the administrative staff.  However waiting times for these services were long.  The waiting time was often exacerbated by the fact that not all GPs were willing to prescribe hormones, so people had to move GP practices.

People felt that some NHS IT systems weren't fit for purpose, including changing gender markers on medical records.  They also experienced particular problems with a lack of integration of services.

People felt they had to do their own research and educate medical professionals.  In contrast, one person had managed to register with a GP surgery that was accredited to Pride in Practice and had a very positive experience.

In general, the current system seems to leave gender diverse service users with a lot of unmet needs. This often means that people seek out other alternative forms of care. Sometimes this means making the traditional medical process simpler by self-educating or advocating, through a service like Spectra, or by self-advocating. Sometimes this means enmeshing themselves in gender diverse spaces and communities, for emotional support. Some people access private care in order to avoid a system that causes them difficulty and finally, some access DIY care for the same reason.

The report contains recommendations on ensuring that GPs meet the needs of trans and non-binary people; expanding primary care services for trans and non-binary people, improving signposting and more research.