When Ellen Mellor’s doctor said that her severe headaches were caused by the stress of being transgender, it did not sit right. “My life was at the calmest point it had been in a long time,” she said. A year and a half previously she had undergone surgery that reduced her gender dysphoria to “negligible” levels, and her work was going well.
Mellor, who is now being tested for coeliac disease, put down the phone feeling “very angry and quite upset”. “He didn’t take my issue seriously and just fobbed me off with, ‘it’s because you’re transgender’,” she said. She was “too bloody minded” to be put off going back to her GP altogether, but said the experience made her more wary.
She is not alone – 57% of transgender people said they put off or chose not to see their GP if they were ill, according to a survey by TransActual, an organisation that shares information about trans people’s experience and trans rights.
The research, part of the 2021 Trans Lives Survey report, also found that 14% said they had been refused GP care because they were trans, and 70% had experienced transphobia from their primary care provider. Some 45% said they felt their GP did not have a good understanding of their needs. The problem was worse for trans people of colour and trans people with disabilities, the online survey of nearly 700 trans people found.
Chay Brown, director of TransActual, said he knew of numerous cases where people had seen their doctor for a problem unrelated to being trans and found their doctor treated it as a trans medical issue, or even used it as a reason to make changes to their hormone treatment.
In the transgender community this is common enough to have a name, “trans broken arm syndrome” – being seen as requiring specialist treatment for something as simple as a broken arm. “This is especially the case with mental health,” he said.
“I was talking to someone the other day who was saying it had been that much of a struggle to get them to agree to prescribe hormones as recommended and do blood tests that ‘I daren’t talk to them about my mental health, because they’ll just start refusing to prescribe hormones again’.
“That’s something that’s really common. There’s a feeling of needing to downplay it or not seek support because of a fear of having access to surgery taken away.”
Trans people also face barriers on the admin side of primary care. Many report being told they cannot change their name or gender on their GP records, despite General Medical Council guidance making it clear that trans people are entitled to have the appropriate gender recorded.
Meanwhile, trans men over the age of 25 still need cervical screening and trans women over the age of 60 need prostate screening, but – unlike cisgender (non-trans) people – they usually do not get invited, and need to seek those appointments out themselves. As a result, they are at risk of missing the early signs of cancer.
Sometimes a barrier is as simple as a lack of knowledge or understanding from doctors about how to interact with their transgender patients, Brown explained.
He said: “I recently had an appointment and my GP told me I was ‘very convincing’. It’s like, what are you needing to be convinced of? But he meant it in the nicest possible way.” More training is the key to helping bridge this gap, he said.
The Royal College of General Practitioners (RCGP) has a training module for GPs about transgender healthcare, though it is not compulsory. A spokesperson told the Observer that GPs “should treat our transgender and gender-questioning patients on the basis of need and without bias, as we would any patient”.
The spokesperson said: “This includes being mindful of the terminology and language we use when talking to our trans patients, based on each patient’s individual preference.
“GPs have an important role in delivering care to trans patients – including in holistically assessing patients, promptly referring them to gender identity clinics where appropriate, and working with specialist colleagues to continue treatment after diagnosis under a shared care agreement, if they are confident that doing so is within their competence.”
The RCGP said it supports this being included in the GP curriculum, for more training programmes to be developed and for updated systems to allow trans people’s gender to be properly recorded.