Gender Reassignment

What is Gender Reassignment?

In most cases we grow up feeling a sense of comfort or acceptance with our gender but this is not true for all people. Around 1 in 11,500 people will find that as they grow up, they feel less comfortable with the gender prescribed to them at birth, and will instead, find greater comfort and connection to another gender. They may then express the need to live in this different and more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender’ or ‘trans’ people. ‘Trans’ is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, their birth.

In the Equality Act it is known as gender reassignment*. All transsexual people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one.You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

*’Gender reassignment’ is a term of much contention and is one that Stonewall’s Trans Advisory Group feels should be reviewed.

Stonewall’s glossary of terms

Gender Reassignment and Discrimination

The Equality Act 2010 says that you must not be discriminated against because you have the protected characteristic of gender reassignment, where your gender identity is different from the gender assigned to you when you were born. For example, a person who was born female decides to spend the rest of his life as a man

In the Equality Act this is known as gender reassignment. All transsexual people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one. You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

The Equality Act says that you must not be discriminated against because:

of your gender reassignment as a transsexual. You may prefer the description transgender person or trans male or female. A wide range of people are included in the terms ‘trans’ or ‘transgender’ but you are not protected as transgender unless you propose to change your gender or have done so. For example, a group of men on a stag do who put on fancy dress as women are turned away from a restaurant. They are not transsexual so not protected from discrimination
someone thinks you are transsexual, for example because you occasionally cross-dress or are gender variant (this is known as discrimination by perception)
you are connected to a transsexual person, or someone wrongly thought to be transsexual (this is known as discrimination by association)

Intersex people (the term used to describe a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male) are not explicitly protected from discrimination by the Equality Act, but you must not be discriminated against because of your gender or perceived gender. For example, if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination or disability discrimination

Following is a short film by the Equality & Human Rights Commission titled ‘What is gender reassignment discrimination?’.

Gender Reassignment and Other Protected Characteristics

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many Trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for Trans people include:

Mental health problems including suicide, self harm, anxiety and depression
Lack of primary care facilities as many GPs have no or little knowledge of Trans people’s needs
Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for Trans women
Lack of awareness and understanding of care providers so that Trans people are in appropriately treated in single gender out patient and in patient services.
Inconsistent funding and access to transitioning services throughout Scotland
Lack of social work service to support children, young people, adults and families with gender identity issues.
Social exclusion, violence and abuse and the resulting negative impact on health and well-being

Why Gender Reassignment matters to Health

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many Trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for Trans people include:

Mental health problems including suicide, self harm, anxiety and depression
Lack of primary care facilities as many GPs have no or little knowledge of Trans people’s needs
Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for Trans women
Lack of awareness and understanding of care providers so that Trans people are in appropriately treated in single gender out patient and in patient services.
Inconsistent funding and access to transitioning services throughout Scotland
Lack of social work service to support children, young people, adults and families with gender identity issues.
Social exclusion, violence and abuse and the resulting negative impact on health and well-being

How we are addressing Gender Reassignment issues

NHS Greater Glasgow and Clyde were the first NHS Board in Scotland to publish a Gender Reassignment Policy which sets out our commitment to ensure equality of access to services that are both appropriate and sensitive.

We have the busiest trans services in Scotland at the Sandyford Initiative and provide a number of specialist services that are recognised as being amongst the best in the UK. However, there are still barriers experienced by Trans people using mainstream NHS services.

It is essential that frontline NHS staff do all they can to remove the stigma of transitioning and play their part in delivering services of the highest standard to Trans people. To this end, guidance has been issued to support staff in responding to queries from Trans service users.

People’s Experiences

Fran’s Story

Fran transitioned from male to female 10 years ago. She has spent her life experiencing bullying and harassment because of her gender identity and has been the victim of several hate crime incidents.

Fran was experiencing pain in her right thigh and attended an outpatient appointment. When Fran entered the waiting area she gave her name and confirmed her appointment time. The receptionist explained there wasn’t an appointment for a Fran Walker but there was one for a Mr Frank Walker. Fran explained that she should now be referred to as Fran as she had requested all records be updated to reflect her gender reassignment. The receptionist explained she was unable to do that until the medical records were updated. Fran was asked to take a seat in the waiting area. Fran was in discomfort but before taking a seat explained again it was Fran or Ms Walker, not Frank or Mr Walker.

While Fran was waiting for her appointment she heard a member of staff calling for a Mr Frank Walker. Fran sat where she was, angry, frustrated and embarrassed that she was still being referred to in the wrong gender. Eventually after a repeat call she stood and walked into the treatment room. She was still very upset and asked why, despite explaining she wished to be called by her new name, staff insisted on calling her by her previous name. The member of staff explained the name on her record was Frank Walker, not Fran, and until they heard otherwise, she would continue to be addressed as Frank or Mr Walker.

Fran tried to remain calm and explained that if she was referred to as Frank again she would make a formal complaint. The member of staff reiterated the position so Fran explained that staff were in breach of legislation protecting trans people. They were deliberately disclosing her previous birth gender and so could be held liable and receive a significant financial penalty under UK law. Fran stated that if it happened again she would take formal action.

The equality Act protects trans people in a number of ways, one of which is to ensure previous birth gender is only disclosed to another party when necessary with appropriate controls in place and then only with the expressed permission of the trans person.

Support and Resources

Gender Reassignment

What is Gender Reassignment?

Fran’s Story

Publications

Websites