This chapter will discuss the healthcare needs and experiences of older trans and gender diverse (including non-binary) people in the UK, drawing upon empirical qualitative data collected through the Integrating Care for Trans Adults project, conducted at the Open University from 2019 to 2021. This project included an exploration of the unique health challenges faced by older trans people with transition-related and non-transition-related healthcare. These data comprise 33 semi-structured interviews with participants ranging in age from 51 to 82 years old. A major theme we unpacked was the concept of waiting – especially waiting for gender-affirming care and managing a sense of ‘time running out’. A wide range of overlapping and specific considerations for the healthcare of trans elders were explored, including hormone replacement therapy, healthcare screening programmes, hair removal limitations, surgery later in life and plans and concerns about social care. Consideration of trans elders requires a nuanced consideration of time, as an individual trans elder may have transitioned historically, or recently, such that one is young in ‘trans time’. Most of the participants in this study transitioned relatively recently and so reflected on the mental, physical and social challenges transition as an elder specifically created. The participants in this study discussed the factors posing barriers to transition earlier in life and lack of access to information. All participants reported transition as a positive life step, and although many wished they had transitioned sooner, this was not a universal sentiment.

Background:This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. Objectives:The main objectives were to understand: Which factors make services more or less accessible and acceptable to the variety of trans adults? How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved? Design, data sources and participants:An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Six case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed. Results:The following undermine person-centred co-ordinated care and can lead to experiences of harm: lack of respectful treatment of trans people by general practitioner practices; inadequate funding of services; lack of support during waiting; the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; lack of National Health Service psychological support for trans people. Case studies indicated ways to improve care, although each has significant unresolved issues: training in trans health care for general practitioners; third-sector peer-support workers for trans people who come to National Health Services; gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; psychology services that support trans people rather than assess them. Limitations:Some contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation. Conclusions and future work:The findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations. Study registration:This study is registered as Research Registry, no. 5235. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

While non-binary gender identities have become increasingly visible in recent years, little research currently exists on the experiences that non-binary people have in sport, where most opportunities to participate are limited to two, mutually exclusive female and male categories. This article provides a starting point for addressing this gap, by reporting findings from a participatory scoping study that explored the barriers that non-binary people face in accessing sporting spaces, communities, and competitions. This study also identified strategies through which these barriers could be overcome, and non-binary inclusion facilitated. Taken together, these strategies suggest that genuine inclusion entails not only new ways of thinking about how gender operates in sport but also alternative ways of thinking about the meaning and value of sport itself.

The British Student Doctor Journal is a high quality, open access, biannual, peer-reviewed, general medical journal, which publishes articles written primarily by medical students. In addition to publishing original research and systematic reviews, we also provide a platform to medical students to express original thought and reflections on clinical practice, student life and medical education.All of our content is fully open access, available without subscription and with no authorship charges. All articles published in The British Student Doctor Journal go through a rigorous peer-review process, led by our student editorial team. The governance of the journal is overseen by our faculty advisory board, and we are published by Cardiff University Press and funded by Cardiff University School of Medicine.For more information, please visit our homepage at www.bsdj.org.uk.

Methodologically innovative in its use of mixed-media diary research, this timely book offers a focused sociological study of non-binary people's identities and experiences in the UK. From negotiating a sense of legitimacy when 'not feeling trans enough' to how identities can shift over time, it reveals important nuances of diverse gender identities while offering crucial insights into trans-related healthcare inequalities. The findings of this ground-breaking research mark an important contribution to the wider fields of gender studies, LGBTQ scholarship and medical policy.

Chapter three begins by outlining the project’s design, in order to ground the data in research practices, and introduce the participants and their demographics. The chapter then highlights a striking commonality amongst participants – insecurity in relation to gender. This could manifest as an internal uncertainty in being ‘trans enough’, or anxiety over not being seen as trans enough by other people. This chapter explores this phenomenon, whilst considering how hegemonic gendered expectations impact not only the ability to socially exert, but also the ability to internally formulate a non-binary gender identity.

Chapter one maps out the scholastic terrain relevant to a sociological consideration of non-binary gender identities. This is divided into three main areas. The first of these covers the relationship between gender diversity and medical practice, the second re-examines older sociological research which didn’t have the specific concept of non-binary, but acknowledged and engaged with people and identities (though often only implicitly) that challenged the gender binary. The third section covers interdisciplinary, 21st century recognition of non-binary people.

This article uses a duoethnographic approach to explore the intersection of lesbian and queer sexualities and transgender identities in intimate relationships. By comparing experiences of gender and sexual identity negotiation within transgender relationships, the authors document how sexual identity borders are traversed, and how gender is negotiated and interrogated in and through these relationships. We argue that our differential experiences of ‘queer’ as an identity, our relationship challenges and how we express/relate to gender are heavily shaped by feminist politics, and how social interactions are gendered.

. . . while I’m reluctant to call trans activism a ‘cult,’ I’m aware of many disconcerting similarities: the absolute refusal to allow anyone to criticize issues; silencing, smearing, and ostracizing those who do ask questions (in this case, labeling them ‘transphobic’) about the ideology of transgenderism; and pressuring individuals (from parents to health professionals) to blindly adhere to the view that some people are ‘born in the wrong body,’ and that the only way to ‘fix’ this error is through medical intervention.

Chapter six looks into gender affirming medical interventions, the vast majority of which occurred in the context of the NHS GICs (although some private practice and non-UK examples are also present). There exists a wide body of literature addressing access to medical services for gender transition. Whilst much of this literature was reviewed across chapters one and two, there is a significant lack of empirical sociological consideration of non-binary experiences of GICs, which this chapter addresses through attention to participant perceptions.

This chapter draws attention to times and places that recur as sites of significance for non-binary people, and the negotiation of identity. It argues that the symbolic meaning ascribed to particular times and/or places will be fundamentally informed by the interactions had within them. The author uses time and space as concepts to collectively consider and connect aspects of lived experience through a sociological lens, rather than to specifically construct postmodern theory.

The emergence of trans-exclusionary movements raises many questions for feminism and transgender studies. Challenging the framing of 'transgender activists versus feminists', this bold collection engages with both historical and contemporary hostility within and across trans/feminist movements. It examines the politics of trans, feminist, and trans-exclusionary movements, and imagines a future of collaboration, rather than conflict. This book delivers a range of essays on topics including sex, gender ideology, education, community mobilisation, autogynephilia, 'rapid onset' gender dysphoria, detransition, migration, sex work, and public toilets. The authors examine questions of solidarity and difference from European, African, North and South American perspectives, emphasising the intertwined, intersectional politics of gender, sexuality, disability, and race that shape our lives. Together they rigorously unpack topics that have been subject to popular misinformation and moral panic, to inform lines of feminist inquiry that are emancipatory for all.

Chapter two continues by covering the methodological details of the project, including an autoethnographic reflection. More broadly the chapter addresses how methods were chosen, adapted and executed, in addition to the management of ethics, rapport, recruitment and analysis.

Chapter five scrutinises accounts of primary care services for the most part (with some mention of secondary care), focusing on the experiences and views participants reported of interactions with doctors and other staff. Experiences are subdivided into ‘gendered medicine’ – healthcare which is differentiated in gendered terms, such as smear tests – and generalizable healthcare experiences, such as arm pain. The chapter also addresses how clerical administration in medical institutions may affect non-binary patients. This includes discussion of how names and pronouns are used and recorded, and medical forms specifically discussed by participants – including feedback forms and documentation related to tertiary care. Whilst this chapter is structured around primary care, the cross-practice nature of administration renders a general discussion that cuts across all forms of care appropriate. Discussion of the key administrative process of referral brings this chapter to a close.

Introduction: This systematic review assessed the impact of race/ethnicity, education, and income on transgender individual's lifetime experience of suicidal thoughts and behaviors (SITB) in gray and published literature (1997-2017). Methods: Sixty four research projects (108 articles) were identified in WorldCat, PubMed, and Google Scholar. Articles were included if they were published in Canada or the United States, included original quantifiable data on transgender SITBs, and had ≥5 participants, at least 51% of whom were ≥18 years. Results: Across all projects suicide ideation averaged 46.55% and attempts averaged 27.19%. The majority of participants were Caucasian, whereas the highest rate of suicide attempts (55.31%) was among First Nations, who accounted for <1.5% of participants. Caucasians, by contrast, had the lowest attempt rate (36.80%). More participants obtained a bachelor's degree and fewer an associate or technical degree than any other level of education. Suicide attempts were highest among those with ≤some high school (50.70%) and lowest among those with an advanced degree (30.25%). More participants made an income of $20-$50,000/year and less $10-$20,000 than any other income bracket. Conclusion: SITBs, among the transgender population, are both universally high and impacted by race/ethnicity, educational attainment, and income. These findings may be useful in creating culturally and factually informed interventions for transgender individuals experiencing SITBs and in informing future research on this topic.

Within the interdisciplinary field of Transgender Studies, a perennial problem is the differing understandings which scholars (and more broadly, social actors) have of the ontologies of sex, gender and transgender – correspondingly shaping their readings of texts. In this work, Pearce brings theoretically constructive discussion to bear on how trans people, their communities, and the healthcare services and practitioners which centre them inform and relate to each other discursively. The book results from a 7-year (2009-2016) ethnographic doctoral project in the UK, focused on online community spaces. The intersectional content creates motives for interest from many readers, including scholars of Transgender Studies, sociologists of health and illness, and gender studies with interest in service user/provider power dynamics. There is also great reflexive potential for medical practitioners – both the “gender experts” (p. 92) working within Gender Identity Clinics, and service providers working in general practice. The text opens with an autoethnographic passage to situate the origins of the research. Chapters 1, 3, 4, 5 and 7 open with a first-person vignette, drawing upon Pearce's personal experiences of community, healthcare and scholarship. The autoethnographic accounts benefit the work by interlacing a deeply relatable sincerity which complements the genealogical approach taken to contextualising the field. As Pearce puts it, the genealogical approach “acknowledges and examines how subjectivities are constructed through social processes” (p. 20, italics original) – the well-developed contexts for these processes provide a robust foundation for the sociological consideration of subjectivities in relation to (shifting and evolving) trans discourses. I argue (in a manner analogous to feminist standpoint theory) that the strength of Pearce's analytic clarity and dedicated reflection on community inter- (and intra-) actions would not have been possible without her positionality. Further, Pearce's insider status has not only equipped her to access the community forums which partially comprised her data set, but also the growing “sophistication of informal theorisation” (p. 39, italics original) in some digital trans spaces. Drawing upon ideas of value produced outside the academy adds to the originality and sophistication of the material reviewed in the first section of the book (chapters 1-3). The book aims to answer how different understandings and experiences of trans are “produced, reified and legitimised through health discourses and practices” (p.8). Further, it considers how such health discourses are negotiated, disseminated and contested between trans community groups, activists and professionals – while recognising that these groups are heterogeneous and overlapping. Exceptional attention is given to unfolding the language used to communicate central technical concepts – notably discourse, cultural and professional cisgenderism (Kennedy, 2013), and key theoretical contributions through the conceptual vehicles of ‘trans as movement’ and ‘trans as condition’. The social processes which both inform and constitute a person being diagnosed with gender dysphoria (or other diagnostic terms, dependent on what guidelines were followed, and when) simultaneously “make trans lives possible and limit the liveable scope of those possibilities” (p.29, italics original). The second section of the book (chapters 4 and 5) addresses research findings, while the third section (chapters 6 and 7) looks to the future and possible changes to address problems in trans healthcare. These problems are depressingly predictable and familiar to many insider group members in particular – at least in descriptive terms. The value of this work lies in the theoretical nuance displayed in answering the research questions it sets out. In arguing that trans identities undergo co-construction between health professionals and trans service users, Pearce shows that “condition-oriented definitions of trans… can also limit the scope of trans possibilities, thereby rendering trans conditional” (p. 90, italics original). This occurs through the impact of interactions within clinical space, and the indirect impact that clinical discourses have on how trans people reflexively engage with their genders. The limitation of trans possibilities is discursively richer than how options are navigated within gender clinics. The flattening of trans to transition is also addressed, with important discussion on both the lack of trans health research beyond transition (i.e, accessing hormone replacement therapy or gender-related surgeries), and the impact on trans people when their health needs are reduced to transition. The conditionality of trans undergoes further theoretical development in chapter 5, through the consideration of temporality. The ways in which trans embodiment, expression, and beliefs can be opened up or closed down based on how (and if) healthcare interactions are navigated are framed as “strategic futurities” (p. 133).The range of theoretical conversations which are developed across different chapters is impressive. Ultimately, this book offers sophisticated yet clear explanations of the terrain of trans health in the UK, with superb analytic purchase – made all the more impressive by its accessibility and candour.