Gender Dysphoria: Respectful Support Guide for Care Staff

Gender dysphoria is a topic where care and support staff often want to do the right thing but are unsure what to say or do. The NHS describes it as a sense of unease or distress that a person may have because their gender identity does not match the sex they were registered at birth. This guide explains the NHS information on gender dysphoria in plain language and sets out practical ways for staff to provide respectful, safe and lawful care. It sits alongside our guide to LGBTQ+ inclusive care training for care staff, which looks at inclusive practice more widely.

What is gender dysphoria?

NHS information describes gender dysphoria as the distress some people feel when their gender identity differs from the sex registered at birth. The mismatch itself is called gender incongruence. Being transgender or gender diverse is not a mental illness. Gender dysphoria is the term used for the distress that may come with the mismatch, and not every trans or gender-diverse person experiences it.

The experience varies. For some people it is a long-standing source of distress, while for others it is mild or comes and goes. The most important thing for staff to remember is that the person is the expert on their own identity.

How people get NHS support

The NHS explains that the usual first step is a conversation with a GP, who can refer the person on. The route is different depending on age:

• Adults (18 and over): a GP can refer the person to an adult gender referral support service, which can then arrange an appointment at an NHS gender dysphoria clinic.
• Young people (17 or under): referral is usually through a paediatrician or children and young people's mental health services to an NHS children and young people's gender service.

The NHS is clear that waiting times for specialist gender services are very long. Arrangements for under-18s in particular have been subject to change, so staff should check the current NHS website rather than rely on older information. Where someone is waiting, supporting their wellbeing in the meantime is important.

What support may be offered

According to the NHS, adults may be offered a range of support after assessment, including hormone therapy, voice and communication therapy, talking therapy and, for some people, surgery. For young people aged 17 or under, support usually begins with talking therapy or counselling. The NHS can also refer people for fertility preservation before treatment where this is appropriate. Decisions about any treatment are made by specialist clinicians together with the person, and staff should not suggest or push particular treatments.

A safety point on unprescribed hormones

The NHS strongly advises against buying hormones that have not been prescribed, because they may not be what they claim to be and can be unsafe without monitoring. If you learn that someone you support is doing this, do not shame or threaten them. Respond with care, record what you have been told in line with your policy, and encourage them to speak to their GP, who can discuss safer options and support while they wait for specialist care.

Respectful day-to-day care

Good practice in everyday care often makes the biggest difference to how safe and respected a person feels.

• Use the name and pronouns the person asks you to use. If you are unsure, ask politely and privately. If you make a mistake, apologise briefly and carry on.
• Protect privacy and confidentiality. A person's gender history is personal information. Share it only where it is necessary for their care and with their consent, following your organisation's policy and data protection duties.
• Avoid intrusive questions. You do not need to ask about a person's body, surgery or medical history unless it is directly relevant to their care.
• Keep care plans and records accurate and respectful. Record the person's name and the information they have chosen to share, and agree with them how it will be recorded.
• Challenge discrimination. Harassment or hostile remarks from other staff, residents or visitors should be addressed under your policies.

The legal and policy context

Under the Equality Act 2010, gender reassessment is a protected characteristic, which means people who are proposing to undergo, are undergoing or have undergone a process to change their gender are protected from discrimination. Our guide to equality and diversity training for care and healthcare staff explains the wider duties of providers. Questions about single-sex spaces, accommodation and intimate care can be complex. Staff should follow their organisation's policy and seek advice from a manager or their legal or HR team rather than making decisions alone.

Mental health and wellbeing

Distress linked to gender dysphoria, along with discrimination and long waits for care, can take a toll on mental health. The NHS notes that people can self-refer to NHS talking therapies for anxiety and low mood. If someone talks about wanting to harm themselves or end their life, take it seriously and follow your safeguarding and risk procedures. Our guide to suicide and self-harm awareness for care staff explains how to respond. In a mental health crisis, the NHS advises getting urgent help through NHS 111 or, if there is immediate danger, 999.

Frequently asked questions

Is gender dysphoria a mental illness?

Being trans is not a mental illness. Gender dysphoria describes the distress that some people experience, and it is recognised as a condition that may need support.

Do I need to know someone's medical history to care for them?

Only what is relevant to their care. Ask for what you need in a respectful way and keep the information confidential.

What if I am worried about getting the language wrong?

Be willing to ask and to learn. Most people appreciate a genuine effort to be respectful more than perfect wording.

Where can staff build their knowledge?

The NHS website has clear information, and the health and social care learning available through Learnsignal CPD can help you keep your knowledge current.

This article is general information for care staff, based on NHS information, and does not replace the advice of a person's own clinicians or your organisation's policies. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.