Gender diversity in general practice

Transgender, non-binary, and gender diverse are just some of the terms used to describe people whose gender doesn’t align with the sex they were assigned at birth. A recent survey estimates that about 1.6 percent of young people in Aotearoa report as trans or non-binary, and more than that are questioning their gender. In a practice of 1400 patients, this could equate to at least 20 people who identify as trans or non-binary.  

This marginalised group has historically struggled to have their healthcare needs met. There is a lack of trained, competent healthcare providers, and inequitable and inconsistent access to services and funding across the country. Patients have had to face disheartening wait times, jump through hoops, or be forced to pay for private care, to access the services that they need.  

At the recent GP21: Conference for General Practice, Dr Cathy Stephenson (she/her) and Alex Ker (he/him) offered valuable insight and guidance to GPs wanting to better understand the unique healthcare needs of the rainbow community and create a safer and more inclusive practice.

Understanding gender dysphoria 

Gender dysphoria can be a foreign concept for those who are cisgender (when your gender identity matches the sex you were assigned at birth). Gender dysphoria describes the distress caused by the mismatch between a person’s gender, and their birth-assigned sex. It can be debilitating and those who suffer with gender dysphoria often have mental health struggles.  

A 2019 survey called Counting Ourselves found that in the New Zealand trans/non-binary (TNB) community:  

• 36 percent avoided seeing a doctor because they were worried about being mistreated or disrespected  
• 48 percent felt uncomfortable talking with their GP about being trans or non-binary 
• 71 percent reported high or very high mental stress, which is 10 times higher than that of the general population.  

The findings of this survey highlight the unmet needs of the TNB community and how important healthcare professionals are to creating safer, trustworthy spaces.  

Understanding gender-affirming healthcare 

Gender-affirming healthcare is a term used to describe healthcare that supports people to medically transition, enabling them to affirm their gender and live comfortably as themselves, helping to alleviate their gender dysphoria.  

Gender affirming healthcare can include treatments such as puberty blockers, hormone replacement therapy, voice therapy, or gender reassignment surgery.  

How to create a safer, more inclusive practice  

• Use correct pronouns, preferred names, and gender. Misgendering can be very distressing so if you get it wrong, apologise. Language around gender diversity is evolving all the time and its okay not to know it all. Use your patients as a guide for the language they use to describe their gender.  
• Consider using your pronouns when you introduce yourself.  
• Make your space inclusive with the use of rainbow flags, posters, door signs, name badges. This includes your physical practice space, but also your online space. Show the community that you are a safe space. 
• Be aware of online bullying and ensure you moderate your social media pages. Work out how you can document gender, preferred name and pronouns on your PMS system/understand the limitations of your PMS system. Ensure correct naming in lab tests, prescriptions, recall texts, etc. You might need to hand write the correct information.  
• Use affirming language (e.g. around body parts), and be guided by your patients re what wording they use. 
• Be open about privacy and confidentiality, especially when you are working with a young person. 
• Ask open questions and try not to anticipate what the patient wants.  
• Have a knowledge of what local and national support systems are available and connect patients with those groups  
• Familiarise yourself with the health pathways and gender affirming services that are available in your area 

Resources for health professionals 

• The Professional Association for Transgender Health Aotearoa (PATHA) - The PATHA website has all the information you need about ongoing care and monitoring of trans patients on hormone therapy, and a wealth of other resources including the national guidelines.
• Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand - A valuable guide that provides detailed recommendations and advice on how to support trans and gender diverse people and their families and whānau, including age of consent for different processes and consent forms for different gender-affirming healthcare.
• Health care for transgender New Zealanders - A summary by the Ministry of Health of the healthcare pathways available to trans and gender diverse New Zealanders, including this resource for health professionals.   
• Gender-affirming healthcare – written by Cathy Stephenson, Alex Kerr and Rachel Johnson. This article covers the diverse aspects of providing gender-affirming healthcare for Aotearoa’s transgender and non-binary people, including the use of puberty blockers and hormone therapy, as well as the general principles behind this rapidly evolving area of medicine.
• Gender Inclusive Language: Clinical settings with new clients – Some terms you can use when providing care for gender diverse people. Once you know the words a person uses to describe their body, use their words in a respectful & professional manner.