A Nurses' Guide To Transgender & Non-Binary Healthcare

Claire Carmichael talks articulately about her passion for transgender health, providing an invaluable and comprehensive guide for nursing professionals through her own self-led research and personal story.

My Passion For Transgender Healthcare

Hi everyone, my name is Claire Carmichael.

I'm a registered Nurse, and today's vlog is all about transgender health.

Firstly, why am I so passionate about transgender healthcare?

This is something I am very passionate about, which you will probably see throughout this vlog.

But I first fell in love with transgender healthcare as a GP Nurse.

My First Transgender Patient

So I started off, anybody that knows me, I started off as a GP Nurse in January 2020.

And it was there when I had my first transgender patient for the hormones.

And I suddenly realised that I'd never had any transgender patients. I've never given hormone injections to transgender patients.

I've never had any training, education, nothing on this.

So I dug a little bit deeper and I went to my GP partner at the time, the GP manager as well, and asked for specific training on transgender healthcare, specifically the hormones I'm giving, what it does to the body, endocrine sort of things because it works on the endocrine system.

And I was just referred to an LGBT webinar, very basic.

It wasn't what I needed, it's not what I really wanted.

Lack Of Training In The NHS

I took it upon myself and I advise everybody to do this as well, do your research, do your own research.

And it looks like that there is no training for NHS staff.

There's nothing out there at universities on transgender patients at all. So what did I do?

I took it upon myself and I advise everybody to do this as well, do your research, do your own research.

Informing Myself

So I spent the next two years researching every guideline policy, looked into signs behind things, looked into research papers, that sort of thing evidence that was out there, looked up a whole load of different government bodies and things like that to see if they had anything.

And found actually a lot, there is a lot of information out there that people either just don't use because they don't wanna use it or they just don't know it's there.

What Do Transgender Patients Think Of Our Healthcare System?

I also took to social media to talk to trans patients themselves, not my patients, but trans people in general.

So I went onto different social media platforms.

I set up meetings with people to talk to them to see what their lived experiences are of the healthcare systems.

And I looked up at the government statistics as well on hate crimes and things like that.

Discrimination, Inequalities And Lack Of Competent Care

There is a lot out there that's saying there's one, discrimination in healthcare against transgender people, and two, there's not enough training in education so a lot of doctors and Nurses don't have that information and competency and confidence to treat a transgender patient.

Or to give them hormones because they've never had training in education.

And it's actually really heart breaking to look at the statistics and look into the discrimination in trans patients in healthcare.

And this just shouldn't be happening anywhere.

And the more research I did, the more discrimination and inequalities I found within our healthcare system which just shouldn't be happening.

My Personal Story

So on the back of all of this, I started to set up with my partner George.

George, if you don't know, my fiancé, George is a proud trans man.

And together we set up some webinars to deliver to students, primary care, trust doctors, Nurses, anybody that will listen.

We started those in January, 2022 this year just to help educate people and get more information out there to help people give best care possible to trans patients.

And I'm really passionate about this.

George is really passionate about it because we wanna make a change in whatever way we can.

And this is why I'm here today doing this vlog to hopefully give you some tips, advice, and help to help you care for your patients.

So I briefly mentioned that there are a lot of guidelines out there so I want to put these here for you now.

Resources To Help You Care For Your Patients

• WPATH, Standards Of Care

I think of them as the gods, it's like the WHO of healthcare.

This is the first one, The WPATH guidelines or the WPATH I like to call it - they are the world Professional Association of Transgender Healthcare.

I think of them as the gods, it's like the WHO of healthcare.

If you think about the WHO, the World Health Organisation, these people are dedicated people, qualified professionals who have gone out there, they've done the research, they've got the evidence, they've done everything to set up standards of care for transgender patients.

• The NHS Guidelines

It's there, it's set in stone, these are the guidelines that the NHS themselves use for the NHS GIC clinics, gender identity clinics, and the GIDS, the Gender Identity Development Services for youth, adolescents.

And these standards of care, there is a version seven and there is a version eight.

The version eight update is the new version of the WPATH standards of care.

And that just gives little bits of updates and changes that they've made to their previous version.

But version seven is amazing as well.

It gives you all of the guidelines, guidance, and treatment protocols and the things that you should be doing to treat transgender patients.

• Using The Endocrine System

The next guideline we have here is our Endocrine Society.

That's right, even our Endocrine Society.

We know that all legitimate registered professionals, they're qualified in the endocrine system.

These are the top dogs.

If you are gonna go to anyone, you need an endocrinologist on your side.

They've created guidelines on the hormones, what we should be prescribing patients, what levels we should be checking, what the blood levels should be, what the ranges should be, they've got everything you need to treat and follow up and monitor your patient.

They have got everything there for adults and adolescents and how to prescribe.

• NHS Gender Identity Clinic

Next up, we have our NHS GIC.

And anyone that's got these guidelines would be able to treat a transgender patient.

It's got emails as well for healthcare professionals if you're struggling with your patient, you don't know what to prescribe, you don't know what you should be doing with them, they've got a dedicated email and phone number for healthcare professionals to ring and ask what they should be doing.

Our NHS has got a guideline, they've got many guidelines but people aren't seeing it.

People don't know it's there.

I don't know what's going on with these guidelines but nobody knows about them.

But when I research, I found them all.

I mean, I'm not gonna lie, it took me days of research in trying to find guidelines, but once I found them, I found the gold standard.

And anyone that's got these guidelines would be able to treat a transgender patient.

And I know as Nurses, we're not prescribers so we wouldn't be doing this, but I'm hoping that giving you these guidelines you can pass them on to a doctor, Nurse prescriber, and show that the guidelines are there for them to treat their patients.

And the whole NHS GIC website itself has guidelines for everything.

It's got emails as well for healthcare professionals if you're struggling with your patient, you don't know what to prescribe, you don't know what you should be doing with them, they've got a dedicated email and phone number for healthcare professionals to ring and ask what they should be doing.

• CQC Care Quality Commission

Next up, we have our very own CQC Care Quality Commission.

They have even produced a transgender pathway for people to look at and follow.

Medical Professionals Need To Educate Themselves

The guidelines are there, the research is there, but yet GPs, Doctors, Nurse Prescribers, Nurses just aren't seeing it, they aren't looking it, looking at it, they're not following the guidelines, they're not doing their research, they're just fobbing patients up saying I can't treat you because I don't know anything about you.

It's not good enough, the guidelines are there.

Do the research.

Anyway, not gonna vent because this is what usually happens when I talk about this. I start venting about people.

Anyway, CQC have a pathway.

'How Would You Like To Be Addressed?'

Now, if you are a transgender patient, go into your GP, you do not need any legal documentation to change your name on the system.

CQC says so I'm going by the CQC and I'm going by what's right for my patient.

It's no different to if you had a patient saying I wanna change my name on the system, I don't wanna be called John, I like to be called Jack so you'd put preferred name Jack.

We do it for cisgender patients.

It's the first thing I learned as a student Nurse, first year, first module, professional values, communication, all that jazz, first thing we were taught and I'm assuming everyone else has been taught this.

We should be introducing ourselves to our patients.

We should then be asking what is their preferred name to our patients?

We do it for every patient regardless of what gender they are, sexuality, race or disability, anything like that.

We should be asking that to our patients from the get go and we should be documenting that.

The Royal College of Psychiatrists again registered legitimate healthcare professionals have produced guidelines for transgender healthcare and how we should be treating trans patients. It's all there.

Have a look at the guidelines because it's amazing what you find when you start searching these things.

The Equality Act Applies To All

And lastly, I'm gonna end this resources guidelines bit with the Equality Act.

I'm gonna remind everybody, if you don't take anything away from this video, remember your Equality Act, it does include transgender patients and people. It's a protected characteristic.

You should not be discriminating against any transgender person.

I get it, we all have our own opinions about everything in the world, you might not agree with something, but the minute that leaves your mouth in front of people that's gonna harm somebody, it becomes a hate crime.

And I get people freedom of speech and all this, people always bang on about it.

I saw it the other day on something like ‘This Morning’ or something like that, where the TV shows are available.

But there was this debate about freedom of speech.

And I was just like, yeah, you can have freedom of speech but the minute you are hurting somebody, that the minute you cause offence to somebody, that's when it turns hate crime, is when it turns into bullying.

You can't just say, oh, it's my freedom of speech to call you this and harm you in this way.

That's not okay.

I'm gonna remind everybody, if you don't take anything away from this video, remember your Equality Act, it does include transgender patients and people. It's a protected characteristic.

We've all got healthy debates that we can have on social media.

We've all got healthy conversations that we can have in a professional manner but we should not be using our freedom of speech to put other people down and hate on people for who they are.

That's not okay.

Anyway, enough of that, the dos and don'ts.

So my best tips and advice as best as I've got to help you when you are with transgender, non-binary people.

The Do’s

• Showing Respect Includes Getting Pronouns Right

This person is a safe person to talk to about LGBTQIA issues and I can be myself around them. That is when that message is given.

First up, the do’s.

So it's common sense, but treat everyone equally.

Treat everybody as in a nonjudgmental way.

Please, please, please preserve their dignity and respect them.

Please, please, please use people's pronouns. Just be respectful. And another thing on pronouns as well.

A lot of people think pronouns are about you, and it is not about you, it's about the people in front of you feeling safe.

I know I've seen it on social media quite a lot.

People just going off on one about pronouns saying, I'm not gonna use that on my email, I'm not gonna put it on my social, she/her because everyone should just know that I'm a female.

But actually what that person is saying is society has taught us what a female should look like.

So everyone should just assume that you are female based on how you look, which isn't actually right.

You know, society has, it is learnt behaviour.

Society in TV, film, in TV shows, in films, in documentaries, that sort of thing, it's always portrayed transgender people as the villain, as this comedy act, as this thing that we should laugh at, as mainly it's normally, from what I've seen from shows, is a man dressed up in a dress and it's all this comedy like ha-ha thing, like we should be mocking transgender patients, people, sorry.

And this is learned behaviour.

The world around us for years and years and years has taught us that it's not okay to be transgender when actually it is.

Not only that, the world has also taught us that to be female, you should have long hair, you should have makeup, you should look this way, you'd have the colour pink, you should like glittery things, and women should be cooking in the kitchen, and all these really outdated terms.

And then for the men, it should be things like men should be tall, men should be strong, men shouldn't cry, they shouldn't show emotion, they should play with cars, they should be rugged, they should have short hair.

Who said so? Who said what a man and a woman should look like?

Who created that rule?

Anyway, back in the room, pronouns.

Just the pronouns, the thing is the best thing to do, the best thing that you can do with pronouns is when you first meet a patient is sit down, say, my name is Claire, my pronouns are she/her.

Obviously say your own name and pronouns, not mine 'cause that's weird.

What are your pronouns?

Just do it for every patient and then it just creates this normalised standard across the board.

But what this does and what this says, which is the main point, is if you've got somebody who is part of the LGBTQIA community, you might not know that they're part of that community.

You don't know what that person looks, should look like or whatever, whatever perception people have in their mind of what an LGBTQIA person should look like.

You don't know who's gonna be sat in front of you so you need to be really mindful of that.

And what you are doing by saying, what is your pronouns?

This person is connecting because pronouns is well used in the LGBTQIA community.

And you saying that to somebody is saying, wow, this person knows about pronouns.

This person is a safe person to talk to about LGBTQIA issues and I can be myself around them.

That is what that message is given.

It's not about you and your gender or sexuality, it's about the person in front of you and making them feel comfortable and safe.

Next do, if you make a mistake, just apologise and move on. Don't make a big song and dance out of it.

You know, we all make mistakes and people understand that, but it's when we're continuously going, he, he, he, he, when actually this is a trans woman in front of you going by she and her and you're constantly, oh, he, he, just, no.

• Listen To The Person In Front Of You

This is the biggest thing because everybody is different.

Everyone in the world is unique, amazing, wonderful people and no two people are the same.

This is the same for transgender and non-binary people.

They will be on different journeys, they will want different outcomes from their transition, for example.

They'll be going through completely different things so it's really important that you sit down with a person, listen to the person, that is the biggest tip I can ever give you.

Listen to who's in front of you, because they are the experts on their health.

• Be Responsible For Informing Yourself

And lastly for dos, like I said, do the research. If you don't know something, look at the guidelines, look at the research, talk to the person in front of you and you'll be well away.

The Dont’s

•  Be Mindful Of What You’re Choosing To Ask And Why?

Now for the don'ts section.

So do not ask somebody what genitals they have.

Don't talk about invasive procedures that they might have had, surgical procedures, inquisitive, like that sort of thing.

It's none of your business.

Unless you are a Sexual Health Nurse that needs to check somebody's genitals or body it's nothing to do with you, it's not none of your business, and it's gonna make someone feel really, really uncomfortable.

Please don't ask somebody what they look like before their transition, again, irrelevant, really offensive.

And it'll bring up some really painful trauma for that patient.

• The Impact Of Using A ‘Dead Name’

Never, never, never, I have to say this, is one of the biggest, biggest things that you could ever do that you should never do, mention somebody's dead name.

Do not call someone by their dead name.

This is not okay.

The emotional impact and mental impact and the trauma that that brings up for someone is horrific.

And I have two stories here to show you the good side of calling someone by their name and the bad side when you call someone by their dead name.

So the first story I have is an amazing, amazing patient that I had.

They were very, very young, 15 year old.

They were transgender, he's a transgender boy, and they come in with their mum, and on the system before they come in, I could see the name hadn't changed or anything but I could see preferred name was different to the birth name.

So I kind of clicked then that this person's probably transgender young boy.

So I listened to that, and I picked up the Tannoy to call the patient, we're gonna name him David for confidentiality reasons, this is not his real name.

And I picked up the Tannoy and said, David, could you please come to room one?

And when that patient and his mum come into my room, they were beaming, they were so happy.

And just seeing how happy it made them for me to call them their real name and not their birth name or their dead name was incredible.

And the mum, especially the mum more than the boy, the mum was ecstatic.

The mum was beaming.

And she actually said to me, thank you so, so much for using his real name because so many people keep calling him his dead name and it really does affect him.

And just seeing that one thing that I did, just using the right name for somebody and the difference that that made, that impact was, it hit me hard, like it really made me feel up to see that.

It makes me feel up when I think back to that.

And that is a memory that I've always got logged in my brain, because when you're speaking to patients just knowing that that small thing, that really tiny thing doesn't take much to call someone by their name, but it can make a real big difference.

So now the not so good story.

• A Personal Story

So my partner George is a proud trans man. And he unfortunately had somebody ‘dead name’ him recently.

It was a couple of months ago.

He was on the phone to a company who had been misgendering and getting his name wrong for, yeah, for a number of reasons.

I don't know why, because it is on the system, he did submit everything to change his name and everything with them, and apparently they didn't listen to it.

And unfortunately, his birth name and things like that were was still on the systems.

So they were dead naming him.

And I was in the next room and I was listening to the conversation when he was on the phone to them.

It was hard as a partner to witness that and to see how much that really, really affected him.

It really affected him mentally just hearing that birth name because that's a reminder of who he's not.

That's a reminder of somebody that's dead to him.

So to hear that is a massive, massive, massive effect and it was hard to watch and listen to as a partner.

So please just don't dead name anybody.

• Be Mindful Of Your Responses

Don't act shocked when you look at somebody and they say to you, I'm transgender, don't go, oh my God, you'd never know you are a trans person.

And I absolutely, wholeheartedly had have my hands up for this, I know I've absolutely done this in the past because at the time I wasn't aware of things, I wasn't aware of the impact that that might have on somebody.

But what that saying to somebody is if you are saying to somebody, oh, you'd never tell you were a transgender person.

That's saying that in your head, you have an idea of what a trans person should look like.

There's no way a person should ever look in this world regardless of what gender, sexuality, race, anything like that so we shouldn't be passing that judgment and it's like a backhanded compliment to somebody.

It's not even a compliment, it's a backhanded comment, sorry to somebody.

And I held my hands up.

I thought that it was like a compliment, like, wow, you never tell your trans and this is because of society.

Like I said, TV shows, documentaries, all of this learnt behaviour thrown at us from the beginning of time has said this is what a trans person should look like.

You should be able to tell that somebody's trans.

You would never tell, I bet you've all met a transgender patient without even realising it in the street, in the shop, walking past somebody, you would never know because there is no right way to look.

It's the same with I have transgender friends.

My partner George, he's transgender.

If anyone passed George in the street you would never know he was a trans man.

Not a clue, because in society, he passes for a cisgender male what that should ever look like to society.

So if you can, please avoid using those sort of words or you would never tell.

Just say, okay, that's great.

Is there anything I can do to support you?

That would probably be better than saying those sort of reactions or looking shocked from it.

• A Definition of Hate-Crimes

And lastly, for the don'ts, please, regardless like we've said of your opinions, do not tell a trans person, do not put it out there publicly that a trans woman is not a woman and a trans man is not a man.

Regardless of your opinions, regardless of whatever scientific facts and biology you're gonna bring into it, do not say that to somebody.

It is hateful, it's harassment, it's not nice, and the amount of trauma you will cause from that one comment could literally end somebody's life.

And I think that's the thing that people don't realise.

Suicide In The Transgender Community

So imagine having all of that and then coming to you as a healthcare professional, one of the most trusted professions in the world, and you are gonna misgender them.

Suicide rates are much higher in transgender community over the general population because probably because of the amount of hate crimes that are happening, the amount of discrimination, inequalities that they have to face every single day from their family, from their friends, from strangers in the street, from themselves, they hate themselves looking at themselves in the mirror because they don't see who they really are in the mirror.

It doesn't reflect that.

So imagine having all of that and then coming to you as a healthcare professional, one of the most trusted professions in the world, and you are gonna misgender them.

You are gonna start telling them they're not a real woman, they're not a real man.

You're gonna start not using their pronouns.

You're gonna get things wrong.

The Importance Of Getting It Right

All of those years of hate crimes, discrimination, feeling like utter rubbish, and then that final comment might be the nail on their coffin.

Do not be the statistics.

Do not commit hate crimes.

Please, please, please do not be that final nail on the coffin.

Get it right, try and get it right out there, please.

And you know what? Just by acting kind to somebody, using people's names, not misgendering somebody, getting it right could literally save a life.

So on that happy note, I am going to end this video on that note but I hope that you've taken something away from this video.

Look at the guidelines and research that I've shown and just have a little research into things yourself and speak to people and speak to the patients as you get them.

It can really, really make a massive difference.

We're here as Nurses to treat patients.

We should be treating everyone equally and we should just spread more love, spread more kindness out there and save lives.

Claire's Top Areas For Research

• WPATH Standards Of Care

• The NHS Guidelines

• Using The Endocrine System

• NHS Gender Identity Clinic

• CQC Care Quality Commission