24 | Nursing in Practice | Summer 2022
Key issues that underpin your practice nursingin practice . co . uk
PROFESSIONALQ &
A
Transgender healthcare :
Your questions answered
Dr Kamilla Kamaruddin , a GP in transgender healthcare at Tavistock Gender Identity Clinic and the East of England Gender Service , on what nurses need to know about transgender healthcare
Like all healthcare professionals , nurses will care for people from diverse backgrounds and have a responsibility to create a safe and welcoming environment for all patients .
Transgender people often face barriers and discrimination when trying to access healthcare . For example , in a report by LGBTQ + charity Stonewall1 , published in 2018 , 41 % of trans people accessing general healthcare services said staff lacked understanding of specific trans health needs , while 7 % said they had been refused healthcare because they are LGBTQ +. Meanwhile , another report from Stonewall in 2018 found 46 % of trans people had thought about taking their own life in the previous year .²
To help nurses better understand and care for transgender patients , and answer any questions they might have , Dr Kamilla Kamaruddin delivered a well-received keynote session on barriers to healthcare for trans people at the Nursing in Practice live event in London on 28 April . To make sure Dr Kamaruddin ’ s advice is shared with all our readers , below are her answers from the lively Q & A at the end of her talk , alongside a few bonus questions .
What advice do you have for healthcare professionals
Q who have questions about how to address a trans or non-binary patient , but feel awkward asking them ? Just ask , rather than assume . Don ’ t assume by
A physical appearance . Trans people often gets lots of questions and we don ’ t mind telling you what our pronouns are or what our gender identity is . We know that sometimes genuine mistakes happen . If it happens to you , apologise and be willing to learn from it . Mistakes are different from misgendering a trans person with malice . We understand and can tell the difference .
What kinds of questions or comments are
Q inappropriate to say to trans people , and which healthcare professionals should stay away from ? It is inappropriate to comment on a trans person ’ s
A appearance . Do not be shocked or question if a trans man with a masculine appearance and voice comes into the practice and requests a cervical screening . Alternatively , a trans man may have a high-pitched voice , or a trans woman a deep one .
Do trans men and non-binary people with a cervix still
Q require cervical screening ? Yes . When they come to see you for testosterone
A
injections , hormone therapy and other treatments , please invite them to cervical screening . The required forms can be generated via Open Exeter – the NHS digital portal ³ – and ‘ people with a cervix ’ should be used as a reason for cervical screening . This is because they now might be registered as male , and we do not wish to reveal their gender to a third party . They also require breast screening if they have adequate breast tissue ( such as for trans women who have undergone hormone treatment ) and are over the age of 50 . However , if a patient is registered as male with a GP , they may not be invited automatically to breast and cervical screening .
The take-home message is : if a person has adequate breast tissue , irrespective of gender , they need breast screening ; and if they have a cervix , irrespective of gender , they need cervical screening .
How can GP surgeries and other healthcare providers
Q create a welcoming environment for trans people ? Ensure all staff receive trans-awareness training ,
A
which can help increase knowledge and skills about working with trans people and challenge perceptions and assumptions . Humility from a healthcare professional to learn about improving healthcare for trans people can be an enormous support .
Some topics it would be useful to educate staff about include :
• Trans and non-binary inclusive language and the use of pronouns – as sometimes fear of using the wrong language is a barrier to healthcare for trans people .
• Language and actions that can be seen as acts of discrimination against trans and non-binary people ( such as misgendering ).
• The procedure to change someone ’ s registered name with the NHS and what to do when a trans patient has a new NHS number .
• Etiquette during telephone and remote consultations .
Gender-neutral toilets can also help trans people feel comfortable . Practices could also consider putting a small rainbow flag or a poster about trans health in the waiting room .
What should you do if you are concerned about the
Q way a colleague is treating a trans patient ? Initially , I would probably have a quiet conversation
A
with the person , point out that what they have said or done is not acceptable and discuss what they can do better . You should also consider if the issue needs to be escalated further to your line manager , or whether the person needs trans-awareness training .
What are the biggest barriers to accessing healthcare
Q for trans people ? Some of the biggest barriers include :
A • Long waiting lists to be seen at a gender identity clinic .
• Lack of knowledge , understanding and competency among healthcare professionals to meet specific trans health needs , and a lack of trans awareness .