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06 May 2021

Better healthcare guidance needed for trans people

Clinical practice guidelines for treating the physical and mental health of transgender people highlight the current lack of a solid research base.


A team of researchers from King’s and Anglia Ruskin University searched world literature for all international clinical practice guidelines on the healthcare needs of gender minority and trans people.

Results published in the journal BMJ Open showed that higher quality guidelines tended to focus mainly on HIV, and most others were on transition-related interventions. There were noticeable gaps in the topics of guidelines, with none addressing primary care or more general health needs of gender minority and trans people. There was little information on mortality and quality of life, and there was no patient-facing material.

Sex hormones in trans people can affect susceptibility to some conditions, including various cancers. However, the authors found little research on how much these hormones affect rates and treatment regimens. There was also no advice on how these hormones affect rates, hospitalisations and mortality due to COVID-19.

Researchers concluded that gaps can be filled by better research, resulting in improved healthcare guidance for gender minority/trans people.

This was the first review of its kind to examine international clinical practice guidelines addressing gender minority/trans health.

Catherine Meads, Professor of Health at ARU and senior author of the paper, said: “We were pleased to find high quality guidelines on HIV from the World Health Organisation, but disappointed there was little else on the long term physical and mental health of trans people.

“There are clear gaps in clinical practice guidance related to gender minority and trans people, and as such clinicians should proceed with caution and explain any uncertainties to patients, who should also be engaged in the process of updating practice guidelines. More needs to be done to ensure that patient-facing material relevant to trans people is made available.

“We've presented the study at the main international specialist societies, who are due to update their guidance, and we hope this will encourage them to aim as high as the WHO.”

Sara Dahlen, from King’s, who co-ordinated the project, said: “We didn't know what we'd find until we looked. We hope future guidelines for trans and gender minority people will look to the examples of high-quality so they can improve healthcare.”