Synopsis
Provide respectful general healthcare, distinguish identity from distress and diagnosis, assess immediate physical and mental-health needs, and use age- and nation-specific NHS gender pathways without unsupported prescribing.
- Use the person’s name, pronouns and terms for body parts, and ask only clinically relevant questions about sex characteristics, organs, fertility and treatment.
- Gender identity is not itself a mental disorder; assess distress, physical health, mental health, neurodevelopment, family and social context without assuming one causes another.
- Provide ordinary preventive and acute care according to relevant anatomy, exposures, medicines and individual risk. In England, cervical screening eligibility depends on having a cervix and being aged 25 to 64, while invitation also depends on GP registration; check the responsible programme in other UK nations.
Key red flags
Active suicidal intent, escalating self-harm, psychosis or inability to maintain safety requires same-day mental-health assessment.
A child or young person with abuse, exploitation, family violence, homelessness or unsafe online or unregulated treatment needs safeguarding action.
Chest pain, dyspnoea, unilateral leg swelling, severe headache or focal neurology while using hormones requires urgent assessment for vascular disease.
Fever, wound breakdown, urinary obstruction, heavy bleeding or severe pain after surgery needs urgent surgical review.
After gonadectomy, interruption of endocrine treatment can produce hypogonadism; arrange prompt clinical and specialist review rather than advising unsupervised stopping or restarting.
Suicidal intent, severe self-harm or inability to remain safe requires urgent crisis assessment and a concrete safety plan.
Fever, bleeding, urinary obstruction, wound breakdown or severe escalating pain after gender-related surgery requires urgent specialist care.
Reasoning priorities
Identify what support is requested and the exact social, medicine, fertility or surgical context.
The patient’s priorities guide care; previous steps do not imply consent to any further intervention.
Worked reasoning
A trans adult attends with abdominal pain and worries the record will lead to dismissal.
- Use the requested name and pronouns, establish the acute history and explain which anatomy, pregnancy and medicine questions are relevant.
- Assess abdominal and reproductive emergencies according to organs and pregnancy potential without assumptions from the gender marker.
- Reconcile prescribed and non-prescribed hormones for interactions while treating pain and time-critical disease promptly.
- Agree confidentiality, follow-up and any desired referral for ongoing gender or reproductive care separately from the acute episode.