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"Working in partnership to improve support"
In Suffolk, there is a commitment to provide services that are fair and accessible for everyone. To do this, we need to work together and ensure that we understand the diverse needs and characteristics within our population. This page gives ADULT service user information. Information for children and young people can be found via The Source.
When thinking about providing fair and accessible services, it is necessary to broaden understanding about gender and gender identity to make sense of the range of experiences members of our population may have, and consequently, to understand how we can work more inclusively to ensure everybody receives the same level of high quality care and support.
- Gender Identity Clinics in the UK
- Referral to specialist Gender Identity Clinic
- Understanding gender identity
- Transgender Health: including mental health and wellbeing and sexual health
- Policies and Best Practice Guidance supporting Trans* men and women
- Local Support supporting Trans* men and women
- Gender Dysphoria Care pathway
- Training opportunities and E-Learning on Transgender-related topics
- Resources, support, Reports and Guidance on Transgender Health
Gender identity refers to a person’s innate sense of their own gender. It is the way people experience gender, and can correlate with the sex assigned at birth, or differ from it completely. ‘Sex’ can be thought of as the physical biological sex characteristics which include our genes, chromosomes and genital organs. ‘Gender’ however, refers to the more complex social, psychological and emotional experiences relating to an individual’s felt and expressed sense of self.
For most people, sex and gender seem to align in an uncomplicated way, However for some, sex and gender are not aligned as society usually expects. People have the right to self-identify, and many people reject the whole idea of binary tick-boxes, and describe themselves in non-binary, more open terms which move away from the traditional model of ‘male’ and ‘female’.
The concept of gender as a spectrum, with masculine and feminine as two points at each end, can be more helpful than that of a binary. This accommodates people who permanently change their gender or who experience it as a blend of masculine and feminine, or something ‘fluid’, which shifts. Brighton and Hove Clinical Commissioning Group provides have produced a guide which contains further resources.
All of us providing services and support should take time to develop an appreciation of these differing experiences, to ensure we can demonstrate empathy and understanding when providing support.
The Department for Education has produced a report on transgender awareness and child and family social work education.
The term 'Gender dysphoria' is used to describe 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 identity disorder (GID), gender incongruence or transgenderism.
Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It's not a mental illness.
It is important to note that some trans people find this way of thinking and talking about gender variance stigmatising and offensive, so when liaising with patients, professionals should be mindful of this, and demonstrate a recognition that trans people are simply part of the human gender diversity that exists (Brighton and Hove CCG, 2017).
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 referred to as Trans, Trans* or Transgender.
Visit the NHS Choices Gender Dysphoria Page for more information. You can also access the full guidance on the assessment and treatment of adults with gender dysphoria produced by the Royal College of Psychiatrists.
Currently, 'transgender' or 'trans' is used as an inclusive term to describe people whose experience of gender differs from their biological sex assigned at birth, regardless of whether or not they have received medical intervention.
It can be used to describe those who change their gender role permanently, as well as others who, for example, cross-dress intermittently (also referred to as transvestism), or who prefer to identify as neither male or female.
Note on terminiology...
Trans man - a transgender man is someone who was assigned the sex of female at birth, but identifies as a man
Trans woman - a transgender woman is someone who was assigned the sex of male at birth, but identifies as a woman
Non-binary - any gender identity which does not fit the male and female binary
Why terminology and naming is so important in the LGBTQ community Oxford University Press's
Academic Insights for the Thinking World (2019)
Both local and national policy and law outlines the right to equal access to services for Trans people. However, we know that inequalities in health still exist and that trans people still have negative experiences when trying to access help and support locally.
In 2015, Public Health Suffolk conducted a health needs assessment, and found that trans people:
- Have higher levels of health risk behaviours such as smoking, drug and alcohol use
- Have a high incidence of anxiety and depression, and are more likely to self-harm
- Have higher rates of suicide
National research has also highlighted that people who are transgender are less likely to engage with health interventions and screening programmes.
Continuing to work together to promote and support the health of people who identify as transgender or non-binary is important. If somebody you are working with is questioning their gender identity or feels they may be transgender, or if they have already begun or have gone through the process of transitioning, it is crucial to have an understanding of the support and services available, and any specific considerations that need to be made in relation to their health. Locally, The Health Outreach Service can provide targeted support through their marginalised adults offer for trans individuals who are also one of the priority groups the service works with. A copy of the Health Outreach Service information leaflet and referral form can be accessed through these links.
Below is some information and guidance surrounding key areas of need in relation to transgender health:
Specialist support and services
From April 2019 NHS England has established a Programme Board for Gender Dysphoria Services including specialist clinics that provide services to people who are experiencing concerns or problems relating to their gender and who need access to expert clinical care. The Gender Dysphoria Clinical Programme is commissioned by NHS England, this has the latest on clinical services, consultations and guidance.
There are seven gender dysphoria clinics for adults in England and one for children and young people. They are consultant-led and generally staffed by psychiatrists, psychologists, endocrinologists, speech and language therapists and support staff. These services vary, but will usually focus on some key activities such as:
- Psychological, clinical and diagnostic assessment
- Endocrinology assessment and hormone treatment (or referral for this)
- Referral for surgical procedures
- Some direct service provision (or referrals) such as speech and language therapy, electrolysis and limited mental health support
Treatment at a SGIS may include aspects of the following. However, not all patients will require all elements described below.
- Assessment by qualified clinicians to determine whether a diagnosis of gender dysphoria is appropriate
- Allocation to a lead clinician (usually a psychiatrist or a psychologist) for care planning and management
- Assessment by an endocrinologist and recommendation for cross-sex hormone therapy – to be co-managed with the GP
- Assessment for surgical procedures and referral to specialist surgeons
- Referral to speech and language and electrolysis specialists where indicated
This information is retrieved from Brighton and Hove CCG Supporting Patients Accessing Specialists Gender Identity Services Guide
The nearest GIC for Suffolk is the London Clinic. For Information on referrals, please visit Gender Identity Clinic Referral Page.
Sexual health is an important part of enabling healthy relationships. Supporting good sexual health can ensure that people stay free of disease, avoid unplanned pregnancies, and can engage in healthy and happy relationships free of prejudice and discrimination.
The sexual health needs of people identifying as transgender can vary significantly from person to person, as people's goals concerning hormone use and surgery, sexuality and relationships will be different.
In Suffolk, there are a range of services which can help people to maintain good sexual health. Information on these can be found on our sexual health page.
Below is also some useful information which can help to provide a better understanding of some of the specific sexual health needs of people who identify as transgender:
- Terrence Higgins Trust have useful links to information on HIV and STIs, contraception, sex and relationships. The trans* pages are being revised as the THT website has recently been updated.
- National Centre for transgender Equality which provides some key facts on the sexual and reproductive health of transgender people, as well as well as recommendations to improve transgender sexual and reproductive health
- A statement from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists which provides guidance on contraception choices for transgender and non-binary people, as well as general sexual health advice
In order to facilitate better partnership working for sexual health, a network has also been established to bring commissioners of services, practitioners and people providing services together for the sharing of good practice and learning about sexual health in Suffolk.
Mental health and wellbeing
"I think my mental health would have not suffered in the way that it did during transition if I was more prepared for the process and had better emotional support during it" - Quote from the Trans Mental Health Study (Scottish Transgender Alliance, 2012)
People who identify as transgender are more likely to experience a mental health problem than the wider population.
This can be due to a range of stressful experiences which relate to the social impact of transitioning and the social stigma of being transgender, contributing to an increased risk of depression, anxiety, self-harm and suicide. Some common experiences include:
- Feeling ‘different’ from other people
- Transphobic bullying or discrimination
- Worries that gender identity will not be accepted by friends and family members
- Feeling unsupported or misunderstood
- Feeling pressure to deny feelings or conform with biological sex
Being aware of these challenges are important for providing effective and appropriate support. If you feel somebody is experiencing poor metal health or wellbeing, The Suffolk Wellbeing Service (for those living in East and West Suffolk) and the Norfolk and Waveney Wellbeing Service (for those living in Waveney) offer a range of free support services.
The services offered include:
- Stress control and wellbeing workshops
- Telephone support
- Short term therapy
- One to one counselling
There is also more tailored support available from organisations such as Mind mental health charity who now host a Trans+ support line. For support for those 16 years and under contact Outreach Youth.
It is also recognised that supporting mental health should be everyone's business, and that collectively we should be creating supportive environments through our services and in the workplace.
Suffolk has joined the national 'Time to Change initiative', which aims to change how we all think and act about mental health problems. Employers can now receive support in creating mentally healthy work environments. If you are an employer, you can find more information out on the 'Time to Change' employer pledge
NHS population screening
The NHS population screening information for transgender and non-binary people website provides an overview of the national screening programmes and indicates which are available, where an automatic invite will be issued and where requests can be made.
The four screening programmes are, breast screening, cervical screening, abdominal aortic aneurysm screening (AAA) and bowel cancer screening.
National screening guidance was last updated May 2019.
Recognising the health inequalities that exist for Trans people, it is important that professionals are aware of relevant guidance and best practice in supporting people from transgender communities. Below is some guidance which has been separated according to the role you may play in supporting people who are transgender:
Health and Social Care professionals
The guidance that governs gender dysphoria treatment in England is the ‘Interim Gender Dysphoria Protocol and Service Guideline 2013/14’, published by NHS England. It includes detailed information about treatment criteria and care pathways, and it is advisable for any GP supporting a patient accessing SGIS to read it in full. This document is also useful for understanding what surgical treatments are available via the NHS.
The Royal College of Psychiatrists have also published ‘Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria’, which underpins the NHS England Guideline. Appendices 2-4 of this document provide an overview of hormone treatment and the monitoring regime. Taken together, these documents form the policy and practice framework for gender dysphoria treatment in England.
Additionally, readers are directed to the ‘World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People’. These are based on the best available science and expert professional consensus and inform the NHSE and RCP guidance.
The General Medical Council has also produced guidance for doctors treating trans patients, which is relevant to doctors across the UK, and covers treatment pathways, prescribing, respect, confidentiality and the law.
The Transgender Children and Social Work - Theory, discourse and debates discussion paper (February 2019) explores how social workers and professionals can approach an understanding of the complexity of working with transgender children. Drawing on current literature, it attempts to locate a debate and discussion, within the key realms of social work; support, safeguarding and advocacy, making suggestions as to how this can be attained by placing the needs of the young person paramount, whilst paying attention to public and political debates that can amplify transgender issues in both positive and detrimental ways. “Social work constructs its practice in the way that every case (service user, or family), adds a small but cumulative piece to the corpus of practice knowledge. The importance of constructing narrative with transgender youth is clearly stated by Mallon (2009 p104):
“First person accounts offer a unique perspective. Each story of a transgender person's life is different, unfolding around the particulars of that person’s life.”
In November 2015, The Government Equalities Office in partnership with Gendered Intelligence produced ‘A guide for Providing Services for Transgender Customers’. This document sets out guidance and good practice examples to help service providers ensure transgender people are welcomed, included and valued as customers, clients, users or members, and to ensure they are treated fairly and appropriately. It also aims to help service providers comply with the law. This is for anyone who provides services and includes statutory services, voluntary sector services or business / commercial services.
The Trans Inclusion Schools Toolkit has been produced from a toolkit originally developed by Brighton & Hove City Council and AllSorts Youth Project, to support trans, non-binary and gender questioning children and young people in educational settings.
The recruitment and retention of transgender staff - guidance for employers is designed to provide employers with practical advice, suggestions and ideas on the recruitment and retention of transgender employees and potential employees. It is also a useful guide for the managers of trans staff and for trans staff themselves and aims to help employers comply with the law.
Additionally, the Gender Identity Research and Education Society (GIRES) have produced a transgender policy guide for employers (2019) which provides a comprehensive overview of how you can work to support trans employees in the workplace.
Equalities Office - dress code and sex discrimination guidance (May 2018).
As professionals, it is important to take the time to continuously progress our learning to ensure we understand the needs of the people we are working with. Below you will find a number of sources of learning and development opportunities, as well any current opportunities available in Suffolk.
Offers train the trainer courses for Schools on tackling homophobic, biphobic and transphobic bullying, and creating trans inclusive school environments.
E-learning and fact sheets
Guidance for GPs, other clinicians and health professionals on the care of gender variant people on NHS NELFT Foundation Trust Resources page
National LGBT Partnership: Trans Health Factsheets - several Public health England Support fact sheets on a range of clinical issues.
Royal College of Nursing: Fair care for trans patients - guidance for nursing and other healthcare staff working with trans service users across range of health settings.
Transgender Awareness (GIRES) E-Learning - Modules targeting business and other service providers covering general awareness of trans issues.
Beaumont Society Training Resources. The Beaumont Society regularly supports local training sessions with Samaritans, Police, NHS as well as various businesses.
Evolve Trans - Service for adults who are at any point of their transitioning journey, from summer 2019 being provided by Suffolk Mind
Trans* Families - a peer support group for parents/carers who have children (under 18 years) who identify as Trans*, gender variant or non-binary, or who are questioning their gender identity.
Suffolk Hate crime reporting - provides a confidential service for reporting incidents of hate crime, which are criminal acts towards individuals which are motivated by hostility or prejudice based on their gender identity.
The Health Outreach Service - can provide some targeted support as part of their marginalised adults offer.
Support and services
Beaumont Partners is a volunteer resource run by the wives and partners of trans people who provide confidential support and extend the hand of friendship to other women who have discovered that their partners are transgender.
Reports and research
National Children's Bureau: Gender-sensitive approaches to addressing children and young people’s emotional and mental health and wellbeing, aspects can be translated to adult interactions (2017)
Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands [Abstract]
de Blok CJM. BMJ 2019;365:l1652.
Policies and guidance
The Gender Recognition Act (2004)
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Page reviewed: July 2020. Next Review date: December 2020.