The British Medical Association has published guidance on the inclusive care of trans and non-binary patients, and there is real good in it. Using correct names and pronouns, understanding the basics of gender identity, treating trans people with the same dignity and competence you would bring to any other patient: these things matter, and it matters that a body as influential as the BMA is saying them. But I cannot read this guidance without thinking about what the same organisation did when the Cass Review landed. And that tension is worth naming plainly.

What good guidance on trans care actually requires

Inclusive care is not a communications strategy. It is not about remembering to use the right pronoun in a consultation, though that is the very minimum. Real inclusive care means understanding that trans and non-binary people face specific health barriers that are not just about gender dysphoria: higher rates of depression and anxiety, often rooted in discrimination and rejection rather than trans identity itself; avoidance of healthcare because of previous bad experiences; and a medical system that has been designed, tested, and calibrated around binary assumptions. Good guidance names those structural problems and asks clinicians to take active responsibility for them.

It also means being honest about what trans patients need from their GP when the specialist pathway has a waiting list measured in years. In that world, the GP is not a gatekeeper to care they do not provide; they are often the only clinical relationship a trans person has, and the guidance should say clearly that this matters and that GPs can help. Issuing a bridging prescription, monitoring hormone levels, updating records to reflect a person's gender, treating a trans man's reproductive health without making the appointment about his gender identity: these are things GPs can and should do, and guidance that gestures at inclusion without addressing them is incomplete.

The Cass problem sitting underneath this

I said there is a tension, and here it is. The BMA welcomed the Cass Review in terms that gave political cover to a document whose evidence base has been severely criticised by international systematic reviewers and whose methodology has been challenged by clinicians across Europe and North America. For an organisation now publishing guidance on inclusive care, that matters. You cannot call for inclusive practice while simultaneously lending authority to a report that has been used to restrict, delay, and deny care to trans young people across the UK. Those two positions do not sit comfortably together, and the BMA has not, as far as I can see, reckoned with that publicly.

I am not saying the guidance is worthless because of that. I am saying that inclusive care guidance published without an honest account of how we got to this moment, and what the political climate has done to trans people's access to care, is incomplete in a way that matters. Doctors reading it deserve the full picture.

What trans and non-binary patients actually need from their doctors

They need to be believed. Not assessed, not questioned about whether they are sure, not referred for psychological evaluation before their hypertension gets treated. Believed, in the same straightforward way any other patient is believed when they describe their life and their body.

They need their records to reflect who they are. A trans woman whose notes describe her as male will not always feel safe correcting every clinician she sees, and that silence has clinical consequences.

They need clinicians who understand that delay is not neutral. Telling a trans person to wait longer, see another specialist, or come back after more assessment is a clinical decision with real costs: worsening dysphoria, avoidable distress, and in the case of young people, irreversible changes from a puberty they did not want.

And they need the medical profession's representative bodies to hold a consistent line: that trans people are patients with rights, that the evidence base for gender-affirming care is established and robust, and that clinical practice is not adjusted every time a politically motivated report makes the headlines.

The BMA guidance is a starting point. I would like to see it become a floor rather than a ceiling, and I would like the BMA to say, out loud, that it will not allow political pressure to dictate the standard of care trans patients receive. That would be inclusive care worth the name.

If this is useful to you, please share it. Every share helps more people find accurate information about gender diversity.