Trans is a term that includes people who identify as transgender, or transsexual. Transgender people have a gender identity or gender expression that differs from the one given at birth.
Transgender is sometimes called transsexual if the person wants medical help to transition from one sex to another. These are separate issues but for the purpose of this section we'll use the word trans to cover both terms. There are also many other terms used in the transgender community.
Trans and non-binary people's general health needs are the same as anyone else's. But trans people may have specific health needs in relation to gender dysphoria or gender reassignment, or confirmation.
Your particular needs may be best addressed by transgender health services offered by NHS gender identity clinics (GICs).
Your GP can refer you directly to one of the GICs. You do not need an assessment by a mental health service beforehand. Neither does your GP need prior approval from their Clinical Commissioning Group (CCG).
Although awareness of trans and non-binary health issues has increased, some GPs may not have much experience with trans health issues or gender dysphoria.
"Being transsexual, transgender, or gender non-conforming is a matter of diversity, not pathology". This statement is from The World Professional Association for Transgender Health (WPATH).
They provide clinical guidance for health professionals and challenge medical classification that has long considered gender identity disorder, a term that has largely been replaced by gender dysphoria.
Many trans people have chronic anxiety and depression, suicidal ideation, self-harm, agoraphobia, substance abuse, and feelings of low self-worth, detachment, and body dysmorphia.
Dr Stuart Lorimer is a consultant psychiatrist working in the National Health Service (NHS) Gender Identity Clinic in Charing Cross (London, UK) and GenderCare (London, UK), a private practice of clinicians specialising in gender medicine. He believes that, mostly, psychological symptoms are relieved when the core gender concerns are addressed.
Gender dysphoria is a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity. It's sometimes known as gender incongruence. Biological sex is assigned at birth, depending on the appearance of the genitals. Gender identity is the gender that a person "identifies" with or feels themselves to be.
While biological sex and gender identity are the same for most people, this isn't the case for everyone. For example, some people may have the anatomy of a man, but identify themselves as a woman, while others may not feel they're definitively either male or female. This mismatch between sex and gender identity can lead to distressing and uncomfortable feelings that are called gender dysphoria.
Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It's not a mental illness.
Some people with gender dysphoria have a strong and persistent desire to live according to their gender identity, rather than their biological sex. These people are sometimes called transsexual or trans people. Some trans people have treatment to make their physical appearance more consistent with their gender identity.
assessment
A diagnosis of gender dysphoria can usually be made after an in-depth assessment carried out by two or more specialists. This may require several sessions, carried out a few months apart, and may involve discussions with people you are close to, such as members of your family or your partner.
The assessment will determine whether you have gender dysphoria and what your needs are, which could include:
- whether there's a clear mismatch between your biological sex and gender identity
- whether you have a strong desire to change your physical characteristics as a result of any mismatch
- how you're coping with any difficulties of a possible mismatch
- how your feelings and behaviours have developed over time
Children with gender dysphoria may display some, or all, of these behaviours shown in the image to the left. However, in many cases, behaviours such as these are just a part of childhood and don't necessarily mean your child has gender dysphoria.
For example, many girls behave in a way that can be described as "tomboyish", which is often seen as part of normal female development. It's also not uncommon for boys to roleplay as girls and to dress up in their mother's or sister's clothes. This is usually just a phase.
Most children who behave in these ways don't have gender dysphoria and don't become transsexuals. Only in rare cases does the behaviour persist into the teenage years and adulthood.
It's not known exactly how many people experience gender dysphoria, because many people with the condition never seek help. A survey of 10,000 people undertaken by the Equality and Human Rights Commission found that 1% of the population surveyed was gender variant, to some extent. While gender dysphoria appears to be rare, the number of people being diagnosed with the condition is increasing, due to growing public awareness. However, many people with gender dysphoria still face prejudice and misunderstanding.
If the feelings of gender dysphoria are still present by the time your child is a teenager or adult, it's likely that they're not just going through a phase.
If you're a teenager or an adult whose feelings of gender dysphoria begun in childhood, you may now have a much clearer sense of your gender identity and how you want to deal with it. Many people with strong feelings of gender dysphoria are fully transsexual during their teenage years.
Without appropriate help and support, some people may try to suppress their feelings and attempt to live the life of their biological sex. Ultimately, however, most people are unable to keep this up. Having or suppressing these feelings is often very difficult to deal with and, as a result, many transsexuals and people with gender dysphoria experience depression, self-harm or suicidal thoughts.
As well as hormone treatment and surgery, adapting to a gender role that has not been part of your social conditioning, with changes in cognitive and emotional functioning, brings its own set of challenges. Every trans person experiences these to a lesser or greater degree.