Question 2 - Remi
Remi is a 27-yr old University student who was assigned female at birth. They identify as non-binary and have changed their name via deed poll, but their social transition has been difficult. Although toilets on campus are gender neutral, navigating elsewhere in a binary world has been tough.
They will soon undergo bilateral mastectomy to create a flat chest as binding is proving very restrictive and uncomfortable. They found breast development distressing through puberty, and this has not abated. They have no interest in cross-sex hormone therapy. They are having trouble persuading the surgery reception staff to change their primary care record to display their new name, title and a neutral gender marker, so they book an appointment to see you about it.
Regarding patients with a non-binary gender identity:
there is often an underlying intersex condition
he/him or she/her pronouns are used interchangeably
chest or “top” surgery cannot precede testosterone therapy
“unspecified” or “unknown” can be used as a gender marker on the medical record
‘X’ is a valid gender category in the UK
they are able to acquire a UK Gender Recognition Certificate (GRC) denoting their non-binary gender