Forget the supposedly soothing (but actually immensely irritating) holding music, your GP surgery may as well play the Gladiators or Hunger Games soundtrack, as it would more accurately reflect the 8.30am scramble to land a doctor’s appointment these days. May the odds forever be in your favour... But seriously, healthcare professionals are now being stretched to their limits by the brutal combination of chronic underfunding and overwhelming demand, and it has had a real knock-on effect on how – and when – we can receive the treatment we need.
And while everyone has been hit by this, the lack of access to healthcare can be particularly tough for the LGBTQIA+ community. Even if we can jump the hurdles and access the care we need, we’re still sometimes confronted with ill-informed stereotypes, a lack of education and excessive gatekeeping, especially when it comes to trans healthcare. We might luck out and find a GP that fully understands our needs, but we could also get stuck with someone who misgenders us repeatedly.
This can all result in a distrust of health services within the queer community, which can lead to skipping much-needed appointments. This has (among other factors) led to an LGBTQIA+ health gap. Systemic inequalities can’t be eroded overnight– and it’s not the responsibility of queer people to fix the system – but knowledge is power, and healthcare is essential. That’s why we’ve rounded up everything you need to know about navigating mental illness, sexual wellness and gender-affirming healthcare for those within the LGBTQIA+ community.
The search for a GP
Finding a GP you feel comfortable with is absolutely vital – and shouldn’t be a luxury. You can visit sites like gp-patient.co.uk, which collates patients’ ratings, for a ranking of the most trustworthy NHS practitioners across England. Trans-led organisations such as Action for Trans Health also keep regularly updated, crowd-sourced Google Sheets of trans-friendly GPs. Sites like Reddit and Facebook are full of queer discussion groups, so even googling your local area plus the term ‘trans-friendly GP’ will often lead to honest, no-frills reviews from other queer people in your local area – though these will not have been reviewed for accuracy and will vary in credibility, so exercise caution.
It can also really help to just scope out your prospective GP’s website. As a first port of call, check if they have anLGBTQIA+ information area on their site. Want to go a step further?You can check their credentials: some GPs and healthcare services will have a Pride in Practice gold certificate, which shows that they were part of a quality assurance programme dedicated to helping them meet the needs of their queer patients. ‘Pride in Practice is a programme run by a charity called the LGBT Foundation that looks to up-skill staff across general practice and covers training in healthcare and encourages sexual orientation and trans status monitoring [at registration],’ explains Alison May Berner, specialty doctor in adult gender identity medicine.
While this isn’t available in all of the UK, there are other things to keep an eye out for. ‘Looking at GP practices that have been involved with any kind of LGBT activism can be helpful. It might be that they don’t have Pride in Practice in their area, but they’re clearly involved with the community in other ways,’ Dr Berner continues.
Mental health support
In July last year, NHS Digital compiled its first LGB report, which showed that 16% of LGB people live with a ‘mental, behavioural or neurodevelopmental disorder,’ compared with 6% of straight people. It might feel daunting, but speaking to a GP about your struggles and being honest about their root causes – which may be tied toLGBTQIA+ discrimination, such as your experience of hate crime or prejudice in the workplace – can yield positive results.
What comes next? Well, some will prescribe medication, whereas others will refer you to NHS counselling services known as IAPT (improving access to psychological therapies), although you can also self-refer online* .
At the bare minimum, you should feel listened to and cared for. If you don’t, you’re well within your rights to complain (more on this later) and switch surgeries or GPs. NHS guidelines state a maximum waiting time of 18 weeks to access support, but this can stretch out longer due to high demand.
While it can be difficult for the NHS to provide counselling that is targeted towards LGBTQIA+ individuals, there are other options out there. ‘There are charity provisions for counselling for LGBTQIA+ people, such as Spectra, which has a number of providers [for trans and non-binary individuals],’ reassures Dr Berner. The NHS website is also packed full of recommendations, from specialist hotlines such as Mindline Trans+ to organisations such as Akt and Stonewall, which both offer mental health support among other services.
Some organisations are more specific, such as mental health charity London Friend’s free counselling for LGBTQIA+ victims of domestic abuse, or Antidote, an organisation that offers support to LGBTQIA+ people who find themselves struggling to deal with drug and alcohol dependency. And finally, while not everyone is in a position to afford private therapy, services such as PinkTherapy – which offers a list of queer-friendly therapists, many of whom offer sliding-scale rates – can help to narrow the search fields for those who are able to pay for sessions.
There’s no one way to be trans. Some people don’t ever require gender-affirming healthcare in the form of hormones and surgeries, but for those who do, the first step is to discuss gender with your GP.
Usually, this initial chat will result in a referral to a gender identity clinic (GIC) or a gender identity development service (GIDS) if you’re under 16 years old. If a GP refuses, patients are entitled to request an appointment with another practitioner, as they would in any other scenario. The General Medical Council also released in-depth guidelines outlining ethical standards of competent trans healthcare, which you can refer to if you feel you’ve been failed.
GICs and GIDS are the go-to hubs for gender-affirming healthcare across the UK. According to NHS guidelines, there should be a maximum wait of 18 weeks between referral and first appointment. In reality, the waiting times vary significantly between clinics, with information compiled by Gender Construction Kit in April 2022 suggesting that they can range between three and 68 months long.
According to GenderGP, you can now self-refer to some GICs and their website has a template letter on how to do so. Please check if the GIC nearest you will accept a self-referral and note that this is intended to speed up the process. However, you’re still required to be registered with a GP and may still require their involvement in helping with the medical assessment.
While you wait for your appointment, there are steps you can take. Clinicians will often ask for proof that you’ve socially transitioned (that you’ve come out to people and taken steps to live in your ‘true’ gender), so work references or a name change document can be useful evidence to gather in advance and bring along when the time comes. At your appointment, you’ll meet with medical professionals to decide whether or not a diagnosis of gender dysphoria, described by the NHS as a ‘sense of unease that a person may have a mismatch between their biological sex and their gender identity’, is applicable. Not all trans people experience this, but you’ll need a diagnosis in order to access hormones or, later down the line, gender-affirming surgeries.
As for hormones, the changes depend on what you want and what dosage you need. If you’re a trans guy, it’s likely you’ll start taking testosterone, which redistributes body fat, causes body-hair growth, and deepens your voice, among other changes. Trans women are generally prescribed a testosterone blocker and oestrogen. After you start taking them, you may notice redistribution of body fat, softening of your body hair and breast growth. It’s likely your sex drive will decrease, and your penis will soften, too.
Non-binary people might want to use hormones, but this looks different for everyone. If this does apply to you, think about what physical changes would alleviate your dysphoria, or bring your gender presentation closer to your gender identity. You can, for example, ask to microdose hormones, which will provide more gradual changes.
Accessing these services might sound like a daunting process, but it can be helpful for trans individuals in broader ways, especially as an official gender dysphoria diagnosis is one of the steps in the standard route towards obtaining a Gender Recognition Certificate, which will help your gender be legally recognised and can help you get documents and ID (such as a passport) that reflect who you are. And remember, the trans community – and all of the trans charities and advocacy groups that serve it – have your back and are tirelessly pushing to improve the system.
All it takes is a quick online search of ‘NHS find a sexual health clinic’ to find your local sexual health clinic, and it’s worth having a scan through the services offered at your prospective clinic to figure out how queer-friendly they are. Does the website use inclusive language? Is there awareness of HIV prevention or any mention of the HIV prevention drug PrEP?
If an in-person appointment sounds intimidating, you can order an at-home STI test. Tests provided for free for over-16s by Sh.UK are simple and effective – but if you’d prefer to speak to someone face-to-face or Sh.UK isn’t in your area (you can check at sh.uk/where), sexual health clinics are your best bet.
HIV education has come on leaps and bounds thanks to the tireless work of activists worldwide and now, in the UK, PrEP is available on the NHS to anyone who wants it. All you need to do is book a sexual health check-up and mention you’re interested in it and, theoretically, it should be given to you without any intrusive questions asked.
The myth that you’re not at risk of contracting sexually transmitted HPV (human papillomavirus) if you don’t have sex with cis men is just that – a myth. HPV is a virus that can lead to genital warts and cell changes that can cause cancer, and is linked to cervical cancer in particular. While it’s on the decline thanks to vaccinations in schools, LGB women should consider getting cervical screening tests and, according to the LGBT Foundation, you can request a smaller speculum if you’ve never had penetrative sex before. According to the Vaginismus Network, pain relief medication such as diazepam and longer appointment times are available to those with a vaginismus diagnosis, so call ahead to let GPs know exactly what you need.
Trans men registered as male with their GP won’t be automatically called for cervical screening tests, but they’re still entitled to them ** if they haven’t undergone a hysterectomy, as are non-binary people with a cervix. Call your GP to get booked in – and if you’re worried about what to say, there are plenty of experience-led groups, such as the Facebook group Trans MasculineSupport and Advice UK, and trans subreddits that can help. Jo’s Cervical Cancer Trust also has an in-depth, experience-led guide for transmasculine people navigating the world of cervical screening, created in partnership with the LGBT Foundation.
The LGBTQIA+ health gap can feel overwhelming, but once you have the facts and know where to look for help, it begins to feel a bit more manageable – especially when there are charities and advocacy groups looking to change the system for the better.
How to complain
Remember: the 2010 Equality Act makes it illegal to discriminate against someone for any protected characteristic, gender and sexuality included.
If you wish to lodge a complaint against a GP, you can find details of the GP practice manager and complain to them directly.
Use the NHS website to find a PALS – a Patient and LiaisonService – who will talk you through the process and help you complain.
The General Medical Council’s(GMC) LGBT+ healthcare standards are a brilliant resource, and you can also complain directly to the GMC using the‘Concerns’ page of its website.
For wider, institutional issues, such as access inequality and inadequate training, your best bet is to find out which clinical commissioning group (CCG) oversees your area by searching the CCG Directory online.
Groups like Action for TransHealth and TransActual can offer invaluable advice on how to phrase your complaint.
* Visit nhs.uk/service-search/mental-health/find-a-psychological-therapies-service/find-your-gp.
** From 25 to 49, you should be offered a cervical screening every three years.
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