E10. Gender Identity Services (Adults)

Scope

This Clinical Reference Group (CRG) provides advice to NHS England on how specialised services for people with gender dysphoria should be provided. This includes both specialised assessment, and treatment planning and co-ordination in Gender Identity Clinics and the provision of specialised surgeries for sex characteristic modification (primarily genital and chest reconstructive surgeries; GRS providers).

The CRG leads on the development of clinical commissioning policies, service specifications and quality dashboards. It may also provide advice on innovation, conduct horizon scanning, advise on service reviews, identify areas of unexplained clinical variation and guide work to reduce unwarranted variation and deliver value.

This is an area where multidisciplinary and interdisciplinary care is not only good practice but is necessary to ensure that appropriate choices in treatment pathways are available, tailored to the needs of the individual patient. The interventions offered, according to clinical need, include psychological therapies, endocrine therapies, hair reduction therapies, voice and communication therapies and sex characteristic-modifying surgical procedures.

Out of scope

This CRG does not provide advice on gender identity development services for children and young people under 18 years. This is within the remit of the CRG for Paediatric Medicine.

Membership

Chair: Dr John Dean, Clinical Director, Devon Partnership NHS Trust.

Helen Greener, North
Grainne Coakley, North
Christina Richards, Midlands & East
Mel Wiseman, Midlands & East
Matthew Mills, London
James Bellringer, London
Maria Morris, South
Philip Drew, South
Michele Sie, Lead Pharmacist
Tanner Gibbins-Klein, Patient & Public Voice
Paul Martin, LGBT Foundation
Vacancy, Patient & Public Voice (if you are interested in applying for this vacancy please email england.voice-crg@nhs.net for more information)
Steve Hamer, Lead Commissioner, steve.hamer1@nhs.net

Background

Gender identity is an individual’s personal sense, and subjective experience, of their own gender. The development of gender identity is not well-understood with limited evidence to support the many proposed factors that might influence it. A 2009 report published by the UK Equality and Human Rights Commission found that as much as 1% of the population may experience such a degree of gender variance that it would constitute a ‘protected characteristic’ under the Equality Act 2010.

The term currently used to describe a discrepancy between the sex assigned to a person at birth (usually on the basis of observation of their genital anatomy) and gender identity is gender incongruence. This term is preferred to the formerly used terms ‘gender identity disorder’ and ‘transsexualism’. From 2004 onwards, the UK government has been clear that ‘transsexualism’ is not a mental illness. It is a condition considered in itself to be free of other pathology.

Gender incongruence is frequently, but not universally, accompanied by the symptom of gender dysphoria. Gender dysphoria refers to the distress that may accompany incongruence between a person’s experienced or expressed gender and their assigned sex. Dysphoria may be experienced with respect to how a person lives/is expected to live their life, as well as their physical sex characteristics. Left untreated, gender dysphoria may lead to profound psychological and social disturbance, and severely affect the individual’s quality of life. There are probably between 300,000 and 600,000 people in the UK are affected to at least some degree by gender incongruence; not all experience their difference as problematic, requiring healthcare interventions for gender dysphoria.

Most gender incongruent people have a ‘binary’ gender identity (exclusively a man or exclusively a woman). Around 10% of gender incongruent individuals attending specialist clinics present with non-binary identities, with facets of both binary genders (‘gender variant’, ‘trans masculine’, ‘transfeminine’, ‘non-binary’, ‘neutrois’, ‘GenderQueer’, and other terms are used in self-description) or do not perceive gender as a characteristic that they possess (‘non-gender’, ‘agender’).

Consultations

We are currently consulting on specialised gender identity services for adults (17 and above).

Publications

Important publications that relate to this CRG include:

  • An NHS England blog written by Will Huxter, chair of the NHS England Gender Identity Services Task & Finish Group, provides regular posts on the latest developments in NHS gender identity services.
  • Interim Gender Dysphoria Protocol and Service Guideline: The protocol aims to achieve national consistency in the commissioning of these services. It is the culmination of extensive work to adapt the NHS Scotland protocol, ensuring that it meets the needs of patients, provides for the safe delivery of services and reflects NHS England structures. The document, which has been the subject of extensive engagement with patients and carers, has been introduced primarily to allow time to develop, and publicly consult on, a new NHS England policy and service specification which will be developed through the Gender Identity Services Clinical Reference Group (CRG). It should be used and read in conjunction with the UK Intercollegiate Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria and is cross-referenced to its relevant sections. The NHS England Interim Protocol is not intended to be exhaustive in content. Issues not covered in this document should be managed in accordance with the UK Intercollegiate Good Practice Guidelines.
  • This report sets out the findings of research carried out on behalf of NHS England’s Gender Identity Services Task & Finish Group, looking at the clinical models operated by England’s gender identity clinics, and impact on waiting times of a continuing growth in demand (Operational research report following visits and analysis of Gender Identity Clinics in England).
  • Summary of findings captured during a listening exercise in 2013/14 with transgender patients and NHS staff using, and working in, NHS services (Experiences of people from, and working with, transgender communities within the NHS- summary of findings, 2013/14).