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Nurses working in gender health services support patients to access a range of care, both surgical and non-surgical. Find out about the role and the skills required
Gender services care for people with gender incongruence, the term used for a discrepancy between an individual’s birth-assigned sex and their gender identity, or how they feel about their gender.
Nursing Standard. 39, 1, 28-29. doi: 10.7748/ns.39.1.28.s15
Published: 03 January 2024
NHS guidance says that gender incongruence is frequently accompanied by the symptom of gender dysphoria, a strong and persistent cross-gender identification – such as stating a desire to be the other sex or frequently presenting as the other sex – coupled with persistent discomfort with one’s sex.
How are gender services provided?
Care within the NHS is provided through specialist centres and includes assessment, non-surgical care packages, certain surgical interventions and associated immediate after care.
There are also some privately run clinics that provide gender care services.
What kind of treatments do gender clinics provide?
A wide range of aspects of care are covered by gender health services. This can include hormone therapy, discussions about the impact of treatment on fertility, masculinising or feminising surgery, hair removal, supporting people to speak with a voice that reflects their gender identity, and psychotherapy.
NHS England has set out two main adult care pathways, one for those who are having surgical interventions and the other for those who are not.
The NHS is creating new services for children and young people with gender incongruence, following controversy that led it to announce the planned closure of the Gender Identity Development Service, based at the Tavistock and Portman NHS Foundation Trust.
What is a gender nurse specialist?
Gender nurse specialists work in gender services at all levels and in a variety of roles. Nurses working in gender identity care may also work in other services, including children and young people’s mental health services.
Many nurses who work in these services are non-medical prescribers, or are training to be, with titles varying across services and depending on nurse seniority.
What does the role involve?
While the roles can vary, nurses in gender services will often undertake initial patient assessments, discuss the options service users may want to pursue, carry out ongoing reviews and oversee hormone treatment.
Laura Garner, a transgender health clinician (senior clinical nurse specialist and lead clinician) works at the Nottingham Centre for Transgender Health Network, a large centre that employs 13 nurses and a range of other staff.
‘Nurses within our team undertake the majority of the case management for patients, so they will be the people that see patients throughout their time and carry out their regular review appointments,’ says Ms Garner.
‘They will also oversee prescribing advice to GPs, so they’ll be reviewing blood results and responding to any issues or questions that come from the patient or their GP, acting as that central point of contact for each patient as well.’
How is the gender nurse specialist role developing?
Many nurses who work in these services will be, or will be supported to become, non-medical prescribers so that they can oversee the prescribing of suitable hormone treatment.
Nurses may also be supported through training and master’s programmes to further enhance their skills.
‘We want our nurses to be the best they can be,’ says Ms Garner. ‘We support them to develop professionally in whatever direction they want to go, as long as it’s going to benefit the patient group. Some of our team have used this opportunity to become nurse psychotherapists.’
Ms Garner recently trained to be a lead clinician as part of a pilot programme at the trust, and is able to diagnose patients with gender incongruence. She can now care for a patient throughout their journey, from assessment, diagnosis and prescribing, to starting hormone treatment and providing surgical opinions. There are plans to roll out this role more widely across the country, she says.
What band is the role?
The pay for specialist nurses working in gender identity services varies depending on the role and experience, but generally ranges from band 6 to 8.
Which professionals do gender identity specialist nurses work with?
Gender identity services are truly multiprofessional, with teams generally comprising doctors, nurses and allied health professionals. This can include surgeons, endocrinologists (doctors who specialise in hormones), pharmacists, psychologists, psychiatrists and speech and language therapists.
Waits for these services can be long, with patients often waiting two years or more for their first appointment.
What skills and background do you need for the role?
Nurses come into gender services from a range of different backgrounds, and this diversity of experience adds to the strength of the team, says Ms Garner.
The team at the Nottingham centre where she works has nurses with backgrounds in mental health, sexual health, care of older people, intensive care and drug and alcohol services.
‘The main criteria is an interest in transgender health, and we use people’s backgrounds in terms of providing really individualised care for our patients,’ she says. ‘There is no background that would stop someone coming into this field. We constantly share our knowledge formally and informally.’
Gender service nurse Polly Zipperlen supports trans patients to get care near their homes in rural west Wales.
Ms Zipperlen and her colleague, a consultant endocrinologist, are referred patients who want to start hormone treatment after they have been screened and assessed by the Welsh Gender Service, based in Cardiff.
She speaks to the patient, checks their medical history and can then oversee the beginning of their hormone treatment and the blood tests that go with it, or support them to receive that care from their local GP.
‘Providing support to patients is an essential part of the job,’ says Ms Zipperlen, who works one day a week in the role for Hywel Dda University Health Board in west Wales.
‘It is really important to find out how patients are feeling and whether they have good social support from friends, family or peers. I work in a rural area, where some patients may not feel comfortable presenting in their true gender. Part of my role is to support these patients to find peer groups where they can truly be themselves.’
‘People have had a long wait to get care’
Some patients have been on waiting lists for up to 24 months before they are assessed and hormone treatment can be started, she says.
‘It is a wonderful service to work in. People have had a long wait to get care and perhaps a difficult journey, in some cases taking decades to access services,’ says Ms Zipperlen.
‘By the time patients see me, they are very relieved to be commencing treatment and to feel they are making some progress on their transition journey, whether that be hormone treatment or surgery.’
Ms Zipperlen, who hopes to become a nurse prescriber, has worked in sexual health for a decade and says this is a useful background for the role. ‘Sexual health and the gender specialist nurse are autonomous roles that give you the chance to diagnose, treat and manage patients.
‘Through my work in sexual health, I have become accustomed to establishing an instant rapport with patients, which is essential for the personal nature of the consultations around sexual health and gender care.’
What skills and attributes are helpful?
Being open, non-judgemental and able to quickly establish a good, trusting relationship with patients is essential.
‘Nurses need to be accepting and want to learn and develop in terms of professional practice,’ says Ms Garner. ‘A key part of our job is to build rapport and demonstrate understanding.
‘Really listen to the patient and make them feel like they’ve been properly listened to, so they get the most out of their appointments,’ she adds. ‘Listen to any questions they have and take the time to answer so it’s not a tick-box exercise.’
What is great about working in these services?
Trans patients are a wonderful cohort to work with, and there is strong morale among a team motivated to provide the best care, says Ms Garner.
But hearing what some service users have gone through can be hard, she adds. ‘It can be distressing to hear the experience of some of our patients. It is such a marginalised and targeted group, and a lot of them are heavily affected by the way they are spoken about in the media and increasingly by the government.
‘It affects them quite deeply. We do our best to provide a safe space.’
Caring for trans and non-binary people: overcoming the fear of ‘getting it wrong’ rcni.com/trans-NB-care
