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Gender in healthcare: a practical approach
  1. Lucy Elizabeth Benson1,
  2. Deborah Emma Allen2,
  3. Natalie Axiotis3,
  4. Neil H Metcalfe4,5
  1. 1Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  2. 2Medicine, Hull York Medical School, York, UK
  3. 3St George's University Hospitals NHS Foundation Trust, London, UK
  4. 4General Practitioner, York, UK
  5. 5QEPEP supervisor, University of Manchester, Manchester, UK
  1. Correspondence to Ms Deborah Emma Allen, Medicine, Hull York Medical School, York YO10 5DD, UK; debbieemma.allen{at}


Transgender law is complex and developing. Increasing general practitioner referrals for gender dysphoria without sufficient resources for specialist units have left gaps in transgender healthcare. Surveys repeatedly find transgender patients have lower satisfaction with healthcare experiences, stating doctors have a poor understanding of their needs. Meanwhile, waiting times for referrals remain high.

This review article outlines UK laws and guidelines relevant to trans healthcare, including practical advice for clinicians. Current issues are explored, including the referral process for gender dysphoria.

Transgender law is continually evolving; currently, individuals require a diagnosis of gender dysphoria to legally change gender. However, the gender on NHS records can be changed without legally changing gender.

Clinicians may find support from the General Medical Council for this area. Specifically, guidance exists for including trans patients in screening programmes relevant to their assigned sex at birth. Similarly, advice exists for ensuring the privacy of patients’ gender history.

  • law
  • primary care
  • sexual and gender disorders

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  • Contributors LEB conducted the original research into this topic as the first author, and is responsible for the overall content as the guarantor. DEA is the second author, who edited and critically appraised the research. NA assisted with resource collection and editing of the research. NHM supervised this research.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.