Transsexual change: a problematic path?

Dr. Susan V. Carr

Senior Clinical Medical Officer, Centre for Family Planning and Sexual Health, Glasgow. Gender Trust Associate.
Gendys Conference, 1996

Transsexual change

is a problematic pathway, not only for the transsexual themselves, but for everyone connected with them.

The 'Circle of Care' surrounding the transsexual consists of close friends, family, professionals, service providers, support networks and the general public all of whom are affected by the needs of the gender dysphoric individual in their midst.

Transsexuals

themselves have many difficulties in their gender change pathway such as self-recognition, family acceptance, access to services and acceptance by the general public. It is only by addressing wider issues that transsexual care can be streamlined. There needs to be wider knowledge and earlier recognition by primary care clinicians. Better education of the public is required, in order to dispel the fear that comes of ignorance. Easier and open access to both professional services and self- help groups is needed.

Family and friends

can face a lack of knowledge and understanding. They themselves have to adapt to both the practicalities and the emotional aspects of the situation. Strong feelings are experienced, such as bereavement reactions and feelings of personal inadequacy. Much benefit could be achieved by ensuring adequate access to information about transsexualism and its different treatment pathways. Counselling support for families and friends would ensure that they as individuals were having their feelings realised, and this in turn would help them to help the transsexual. Self-help groups provide the general support of shared experience, and often provide a new social network

Professionals

who are dealing with a transsexual patient can be lacking in knowledge about the condition and can therefore be lacking in confidence in initiating or continuing therapy. There is frequently a lack of knowledge of services both locally and nationally, such as specialist locations for surgery, referral policies and waiting lists. Unfortunately not all professionals have an acceptable attitude to gender dysphoria and this can be detrimental and time wasting to the transsexual. These problems can be minimised by better education of doctors, nurses and psychologists at a one year and two year level. Increased research into gender dysphoria is required. Co-ordinated and readily accessible information about networks of service provision should be available.

Purchasers of health services

are often ignorant of the condition. In order to ensure adequate provision of service the incidence and prevalence of gender dysphoria must be known. Due to restricted budgets, health-care rationing comes into play, and transsexualism can be subject to financial restrictions due to policies influenced by public prejudice. Lack of professional interest can also diminish the demand for service provision. This can be helped by establishing the numbers of individuals for whom services will be required, education of service providers and the encouragement of professionals to put forward stated cases for provision of care.

The positive pathway.

• Education to public and professionals.
• Needs assessment to establish prevalence and incidence of gender dysphoria.
• National guidelines for treatment and referral.
• Audit of treatment outcomes and client satisfaction.