A new protocol issued this week by the Scottish Government is set to revolutionise the way trans people are served by the health system.
Under the new rules, treatment will be faster and more flexible, with guaranteed minimum standards of care. It will also be easier for trans people to take charge of the direction of their treatment.
Based on guidelines set by the World Professional Association for Transgender Health (WPATH) , the protocol is much more patient-focused than the previous system. Scottish trans people will now be able to approach gender clinics directly instead of having to go through their GPs, avoiding a recognised problem with some GPs being poorly trained and uncooperative in relation to trans issues.
Trans people accessing Scottish gender identity clinics should now find it much easier to be prescribed hormones. Except where significant physical or mental health risks are identified, anyone over the age of 16 who has experienced persistent gender dysphoria will be eligible for hormone treatment.
Crucially, this can start before the 12 months of ‘real life experience’ required before surgery, so many trans people will find themselves more confident about their ability to blend in during what can be a very difficult period. Hormones will also be available to those who are transgender but not transsexual, or who do not intend to undergo genital surgery for personal or medical reasons.
Young people under 16 will be eligible for assessment in gender clinics and, if deemed mature enough, may be able to consent to their own treatment. Unfortunately, Scotland still lacks the expert staff needed to care for young trans people so they would probably be referred to clinics in London. It is understood that efforts are being made to remedy this situations as families often struggle with the expense and the added emotional strain of regular travel.
The new protocol is significant in the emphasis it places on what are often considered secondary procedures. Early top surgery is recommended for trans men to reduce the risk of health problems associated with wearing binders. For trans women, early facial hair removal is now considered essential and is recognised as making real life experience safer. Everyone going through the process of transition is recognised as having a right to counselling and psychotherapy, for their families as well as for themselves, though this is intended to be patient-centred and not – apart from key assessments – obligatory.
Several different organisations contributed their expertise to designing the protocol, with the Equality and Human Rights Commission Scotland working alongside NHS bodies. Trans people themselves were also active in shaping it, participating in the process via focus groups.
The protocol has been welcomed by the Scottish Transgender Alliance, which describes it as an important step forward. Some concerns remain regarding how it will work in practice, especially in relation to the timely provision of service in a sector that is already under-resourced.