Gender medicine expertise is built the same way every clinical subspecialty develops: through postgraduate practice, research, peer learning, and years of working with people. Medical school curricula have historically taught little about gender identity, and saying so plainly is not an admission of incompetence. It is an accurate description of a well-documented gap.
Why does medical school teach so little about gender identity?
There is a version of this argument that gets used against gender specialists, and it runs like this: "You admitted that medical school doesn't teach gender identity. That means you don't know what you're doing." I've heard it more than once, and I want to deal with it directly, because it misrepresents how medicine actually works and why it matters that we describe it accurately.
Medical schools teach a curriculum that reflects what the profession has decided, at any given moment, is core knowledge. That curriculum changes slowly. It has historically underserved sexual health, addiction medicine, palliative care, and yes, gender identity. None of that means doctors working in those areas are practising outside their competence. It means that, as in every specialist field, expertise was built after the degree.
When I say that medical school didn't teach me about gender dysphoria, I am not confessing ignorance. I am telling the truth about a gap that is well documented, widely acknowledged, and entirely fixable through postgraduate learning, which is exactly what happened.
How clinical expertise actually develops
Think about how any specialist becomes expert in their field. A gastroenterologist didn't leave medical school knowing how to manage inflammatory bowel disease in all its complexity. An oncologist didn't graduate already fluent in the decision-making involved in adjuvant chemotherapy. They learned those things through supervised practice, through research, through cases that taught them what textbooks couldn't, through peer discussion with colleagues who had seen more, and through the sustained experience of working with real people over years.
Gender medicine is no different. The postgraduate learning that builds genuine expertise here includes time spent with trans people listening to what their lives are actually like, engagement with the published evidence base, familiarity with international clinical guidelines such as WPATH Standards of Care 8 and the Endocrine Society guidelines, and the kind of clinical experience that only comes from doing the work over time.
What I know now about gender identity, gender dysphoria, the physiology of hormone therapy, and the real-world experience of transition, I did not learn in a lecture theatre in Cardiff. I learned it through two decades of listening, reading, asking, and being willing to be taught by the people who knew most about it, the trans people who were generous enough to share their lives with me.
The specific misrepresentation to name
There is a rhetorical move that runs two separate claims together in a way that is designed to mislead. It goes like this: "She admitted that medical school doesn't cover gender identity. Therefore, gender doctors don't have the training to practise in this area."
Those are not the same claim, and treating them as equivalent requires you to believe that the only legitimate medical knowledge is knowledge acquired between the ages of eighteen and twenty-four in an undergraduate setting. Nobody believes that in any other context. Nobody argues that a hepatologist lacks expertise because liver transplant medicine wasn't on the first-year syllabus. Nobody says a gerontologist is underqualified because geriatric frailty syndromes got one afternoon in the third year.
The argument is applied selectively, and it is applied selectively to gender medicine because the goal is not to interrogate the evidence base. The goal is to create doubt about whether this field should exist at all.
Acknowledging an educational gap is part of intellectual honesty. It is what distinguishes a clinician who has thought carefully about the limits of their training from one who has not. The honest answer to "did medical school prepare you for this?" is no, and it should be, because that is true of almost every subspecialty that has developed in the last thirty years.
What good postgraduate training in gender medicine looks like
People often ask me what it actually means to be trained in this field, given that there is no single accredited postgraduate pathway in many countries. It is a fair question, and the honest answer is that the field is still developing its formal structures, as many specialties have at equivalent points in their history.
What marks out a clinician who has done the work? Familiarity with the evidence base across endocrinology, psychiatry, psychology, and surgery as it applies to trans people. Genuine engagement with the international clinical guidelines rather than invented local restrictions. A practice shaped by what the research shows about outcomes, not by assumptions about what transition should look like. And crucially, an understanding of the lived experience of the people seeking care, which comes not from textbooks but from actually listening.
Peer learning matters greatly here. The clinicians doing this work well are in conversation with each other, attending the same conferences, reading the same journals, and often collaborating across borders precisely because the expertise is not yet evenly distributed. That is not a weakness of the field; it is what an emerging subspecialty looks like from the inside.
The wider point about how knowledge works
There is a version of epistemic humility that gets weaponised. Saying "I don't know everything" is not the same as saying "I know nothing." Saying "the curriculum didn't cover this" is not the same as "I have no basis for practising." Every specialist who is honest about the limits of undergraduate education, who can point to the specific postgraduate learning that built their competence, and who keeps updating their knowledge as the field develops, is doing exactly what good medicine looks like.
The alternative, a doctor who insists that their undergraduate degree covers everything they need to know, who cannot point to postgraduate learning, who dismisses new evidence because it wasn't in their original training, is the more concerning picture. In gender medicine, as everywhere, the question is not "where did you first learn this?" but "do you understand it now, and do you keep learning?"
I do. And so do the many clinicians who have built real expertise in this area by doing exactly what the profession has always asked: studying, practising, listening, and updating.
What this means for trans people seeking care
If you are trans and trying to work out whether the person in front of you knows what they are doing, the honest signals are not where they trained or which university gave them their degree. They are whether the doctor is familiar with current guidelines, whether they treat your experience as the primary data source, whether they can explain the evidence base for what they are recommending, and whether they are honest about what they know and what they are still learning.
A doctor who says "medical school didn't prepare me for this, but here is what I have learned since" is more trustworthy in this context than one who implies their training was complete at graduation. The field has advanced considerably in recent decades. Any clinician who hasn't kept up with that is behind, regardless of where they studied or how long ago.
The gap in undergraduate education is real, it is historical, and it is slowly being addressed as gender identity takes its proper place in medical curricula. But the work done to build expertise in its absence, through research, clinical practice, peer learning, and sustained engagement with the trans community, is entirely legitimate. Naming the gap is not a confession. It is the beginning of an honest conversation about how medical knowledge actually works.
If there is a topic that you would like me to cover, just let Sammy know.
Dr Helen Webberley is a Gender Specialist, Medical Educator, writer, and advocate, and the founder of GenderGP. She writes about gender diversity, trans healthcare, and the lives around them.
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