Pre-hospital care of the transgender patient

The term transgender has recently gained traction through social strata and entered cultural consciousness following high profile figures ‘coming out’ and undergoing public transition into their authentic gender identity. There is a need to understand and promote health within the transgender community holistically through social support and affirmation of their gender identity (Bockting et al, 2016). Being transgender is not a lifestyle choice and it is therefore critical that ambulance clinicians validate and engage with the patient appropriately (Atkinson, Russell. 2015). This article, drawing on academic literature and personal experience, therefore seeks to educate pre-hospital clinicians and the wider ambulance community in the very basics of gender dysphoria through reviewing recent research into the aetiology of gender dysphoria, common terminologies, treatments, and specific considerations when faced with a patient who identifies as transgender.

The Royal College of Psychiatrists Working Group, which comprises a multidisciplinary team collectively define gender dysphoria as ‘the distress associated with the experience of one's personal gender identity being inconsistent with the phenotype or the gender role typically associated with that phenotype’ (Wylie, Barrett et al, 2014). Historically it was believed to have existed on the mental health continuum and was known as Gender Identity Disorder in the World Health Organization's 1994 ICD-10 (JE Cooper, World Health Organization, 1994); however, growing evidence within biomedical research implicates a more neurobiological basis for gender dysphoria. A 2000 study found that when looking at the bed nucleus of stria terminus (BSTc), regardless of sexual orientation, men had almost twice as many somatostatin neurons as women, and that male-to-female transsexuals was matched to that of the biological women (Kruijver et al, 2000)