Trans healthcare: the questions every patient should ask
The questions every trans patient should ask their GP surgery or healthcare provider, and the answers to look for
If you’re trans and you need healthcare, your provider’s approach will shape your experience from the moment you walk through the door. Will you be treated with respect? Will your records reflect who you are? Will you receive appropriate screening and referrals, or will you have to fight for basic care?
Most GP surgeries and healthcare providers don’t have a specific policy on trans patients. Those that do vary enormously in quality. Some are genuinely supportive. Others pay lip service to inclusion while creating unnecessary barriers. Many fall somewhere in between, leaving individual staff to make it up as they go along.
This checklist is designed to help you understand what your healthcare provider’s approach actually means for you. These are the questions that matter, and the answers you should look for.
Names and pronouns
Will staff use my affirmed name?
Look for clear statements that your preferred name will be used in all interactions: at reception, during appointments, on appointment letters, and when calling you from the waiting room. Ask whether this happens automatically or whether you need to make a special request each time.
Will my correct pronouns be used?
Look for explicit commitments that staff will use your correct pronouns. Ask whether there’s guidance for staff on how to ask patients about pronouns, and what happens if a member of staff repeatedly misgenders you.
What if I haven’t legally changed my name?
You have the right to be known by your chosen name regardless of whether you’ve changed it by deed poll or statutory declaration. Ask whether your affirmed name can be used in day-to-day interactions even if your legal name remains on official records.
Medical records
Can I change the name on my medical records?
You have a legal right to change your name on healthcare records. Ask what documentation is required. Some providers accept a simple written request; others ask for a statutory declaration. A provider should not require a Gender Recognition Certificate or proof of medical treatment.
Can I change the gender marker on my records?
This should be possible without a GRC or any medical treatment. Ask what the process is and how long it takes. Be aware that changing your gender marker triggers a new NHS number, which has implications for continuity of care.
What happens to my old records?
When you change gender marker, your medical history needs to be transferred to a new record. Ask how this is handled, whether any information will be lost, and whether your previous identity will be visible to staff who don’t need to know.
Who can see my trans status on my records?
Ask what flags or alerts are placed on your record and who can see them. Your trans status should only be visible to clinicians where it’s directly relevant to your care.
Confidentiality
Is my trans status kept confidential?
The GMC is clear: disclosing a patient’s gender history without consent is unlawful. Ask how the provider ensures confidentiality, and what happens if a breach occurs.
Who is told if I’m trans?
Ask under what circumstances your trans status would be shared with other healthcare professionals, and whether you would be consulted first. It should only be disclosed where directly relevant to your care.
What about referral letters and external communications?
Ask whether your trans status is routinely included in referral letters or communications with other services. It often isn’t relevant and shouldn’t be disclosed automatically.
Referrals and treatment
Can my GP refer me to a Gender Identity Clinic?
GPs in England can refer directly to a GIC without prior mental health assessment and without CCG approval. Ask whether your GP understands this pathway and is willing to make the referral. A good provider will make this straightforward.
What support is available while I wait for a GIC appointment?
Waiting times for GICs are measured in years. Ask what support your GP can provide in the meantime, whether that’s mental health support, bridging prescriptions, or simply regular check-ins.
Will my GP work with private providers or shared care arrangements?
Many trans patients access private care due to NHS waiting times. Ask whether your GP is willing to engage in shared care arrangements, including prescribing and monitoring. Some are; some refuse. It’s important to know where your provider stands.
What about non-binary patients?
Ask whether the provider recognises non-binary identities and what practical support is available. Non-binary patients often fall through gaps in systems designed around a binary model.
Screening and ongoing care
Will I receive appropriate screening?
Screening should be based on the organs and tissues you have, not the gender marker on your records. Ask how the provider ensures you receive appropriate invitations for cervical screening, breast screening, prostate checks, or any other relevant tests.
What if I fall out of automated screening systems?
Changing your NHS number can cause you to drop out of automated recall systems. Ask how the provider will ensure you continue to receive screening invitations. A good provider will have a process for this, including reminders on your record and clear communication with you about what screening you need.
Will I be outed by screening processes?
If you’re a trans man having cervical screening, or a trans woman needing prostate checks, the paperwork may not match your presentation. Ask how this is handled sensitively, whether your trans status will be disclosed to labs, and how results will be communicated to you.
Staff training and culture
Have staff received training on trans inclusion?
Ask whether clinical and administrative staff have received specific training on supporting trans patients. Training should cover language, pronouns, record systems, and clinical needs.
Is there a named person responsible for trans patient support?
Some providers designate a staff member to support trans patients and ensure policies are followed. Ask whether this exists and who it is.
What happens if something goes wrong?
Ask what the complaints process is if you experience discrimination, misgendering, or breaches of confidentiality. Is this taken seriously? What would happen?
Policy and legal understanding
Does the provider have a written policy on trans patients?
Ask for a copy. If they don’t have one, ask how decisions are made and what guidance staff follow.
Does the provider understand the legal framework?
Trans patients are protected under the Equality Act 2010 (gender reassignment is a protected characteristic). If you have a GRC, additional protections apply under the Gender Recognition Act 2004. Ask whether staff understand these obligations.
When was any policy last reviewed?
Healthcare guidance evolves. A policy written years ago may be out of date. Ask when it was last reviewed and whether it reflects current best practice.
What excellent looks like
Trans patients welcomed and affirmed without barriers
Affirmed name and pronouns used immediately and consistently by all staff
Clear, simple process for updating records without excessive documentation
Strong confidentiality protections with staff trained to uphold them
Direct referral to GIC without gatekeeping or unnecessary steps
Willingness to engage in shared care with private providers
Robust process for ensuring appropriate screening continues after record changes
Staff trained and confident in supporting trans patients
Non-binary identities recognised with practical support available
Named person responsible for trans patient experience
Policy developed with trans patients and regularly reviewed
What good looks like
Trans patients included in equality policy
Process for updating name and pronouns
Willingness to refer to GIC
Confidentiality taken seriously
Some awareness of screening issues
Staff open to learning
Complaints process in place
Red flags
No mention of trans patients in any policy
Excessive documentation required to change name or gender marker
Refusal to refer to GIC or insistence on mental health assessment first
Refusal to engage with private providers or shared care
Trans status routinely disclosed without clear clinical need
No process for ensuring screening continues after record changes
Staff unfamiliar with the law or dismissive of legal obligations
“Case by case” approach with no clarity on what that means
Reception staff untrained and using wrong names or pronouns
History of trans patients leaving or being made to feel unwelcome
Complaints about discrimination not taken seriously
Use this list
Print it out. Take it to your GP surgery. Ask for written answers. You have the right to know how you’ll be treated.
If a provider can’t or won’t answer these questions clearly, that tells you something.
Healthcare policy reviews
I’m reviewing individual healthcare provider policies against this checklist and publishing the results. If you’d like me to review your GP surgery or healthcare provider’s policy, send it to me.