Liaison with secondary care
When referring a patient to hospital either for scheduled or unscheduled care, it is important to ensure that the referral contains only that information relevant to the presenting condition. For example, it would be wholly inappropriate to mention a person’s trans status when referring them to a dermatologist to have a sebaceous cyst excised.
However, there will be referrals to hospital for sex-specific organ-based complaints, for example hysterectomy for a trans masculine individual. There might also be the requirement for urgent investigation that requires the use of sex-specific reference ranges, for example troponin in suspected acute coronary syndrome, or eGFR in renal compromise. In this scenario, where feasible, patient permission should be obtained to mention their trans status and an explanation provided as to why this would be important for the hospital team to know.
Sometimes it might be necessary to make staff aware in order that due attention can be given to ward placement. It is vital that hospitals assign patients a bed in an area that corresponds to their lived gender presentation, and not the sex on the computer system (sex not gender is recorded in secondary care). In cases of early or non-transition, a dialogue may be required to establish where they would be most comfortable (which may be a private room if possible).
Working in a sensitive way, you can help to ensure that your trans-masculine patient requiring gynaecological care is admitted onto a General Surgical ward, and that the ultrasound scan is trans-abdominal only unless they are comfortable with the use of a trans-vaginal probe.
Gender Reassignment is one of the nine protected characteristics of the Equality Act 2010, and it extends to those proposing to undergo as well as undergoing or having undergone a process of reassignment. Discriminatory behaviour from healthcare staff can lead to disciplinary procedures which may culminate in dismissal.
The Gender Recognition Act 2004 allows eligible trans people to apply for a Gender Recognition Certificate (GRC). This grants full legal rights and responsibilities in accordance with their acquired gender and provides them with an updated birth certificate. A patient does not require a GRC to be placed in single sex ward concordant with their gender identity.