In a groundbreaking step towards inclusive healthcare, new guidance on the peri-operative care of transgender and gender-diverse individuals has been published in the journal Anaesthesia. A team of experts, including Dr. Stuart Edwardson from the Royal Infirmary of Edinburgh and Dr. Luke Flower from the Victor Philip Dahdaleh Heart and Lung Research Institute, wrote the document with the intention of ensuring the safety and dignity of transgender and gender-diverse people during the perioperative period.
The number of people openly identifying as transgender and/or gender diverse has increased significantly over the past decade. Census estimates from 2021 identified 262,000 people in the UK who identify with a gender different from the one assigned at birth. This figure is considered a lower estimate, likely due to individuals’ hesitation to disclose their gender identity.
About 50% of transgender and gender-diverse individuals are undergoing some form of medical treatment for gender affirmation, such as hormonal therapy or surgical procedures. Another 25% are not currently accessing gender-affirming medical interventions but wish to. These interventions present specific considerations for anesthetists during the peri-operative period.
Dr. Edwardson and Dr. Flower emphasized the importance of addressing the unique healthcare needs of transgender and gender-diverse individuals. “Transgender and gender-diverse people comprise a significant and varied minority with specific health care needs that are often both poorly understood and met. It is our collective responsibility to address this inequity,” they stated.
The new guidelines are essential, as there has been no existing guidance covering the scope and focus of this document. The structured explanation of current evidence and practicalities is intended for anesthetists caring for transgender and gender-diverse patients in any hospital scenario.
Key Recommendations
- Respectful Address: Always confirm and use the patient’s preferred name and pronouns. This shows respect and reduces the risk of gender dysphoria.
- Confidential Disclosure: There should be a private and safe process for patients to disclose their sex at birth and gender during pre-operative assessments. Digital pre-assessment questionnaires are suggested for elective settings.
- Comprehensive Assessment: Identify all forms of social, medical, and surgical gender affirmation during pre-operative assessments. Anesthetists should understand that gender-affirming care details might not be present on health records.
- Pregnancy Testing: Offer pre-operative pregnancy tests to all patients with a uterus and ovarian tissue aged 12-55, regardless of contraception use.
- Team Communication: Communicate all specific peri-operative considerations, including preferred name and pronouns, during the surgical brief. Share transgender status only with the patient’s consent and if crucial for their safety.
- Chest Binders: Ideally, remove chest binders before anesthetic intervention, with the patient’s consent.
- Hormone Therapy: Continue hormone therapy throughout the peri-operative period unless contraindicated. Counsel patients on the risks and benefits to make a shared decision.
- Respectful Environment: Care for transgender and gender-diverse patients in an environment that respects their gender identity, which may sometimes involve providing a single room.
- Organizational Guidance: Organizations should have clear guidelines for transgender and gender-diverse patient care, including specific educational materials to increase awareness among healthcare providers.
- Inclusive Language: Use gender-inclusive language across all areas of peri-operative and perinatal practice to honor all identities.
- Antenatal Clinics: Pregnant transgender or gender-diverse patients should be seen in an anesthetic clinic during the antenatal period to inform and support decision-making and plan care before labor.
Significance of the Guidelines
The guidance marks a significant development in addressing the healthcare needs of transgender and gender-diverse individuals. The document is the first of its kind, produced independently of the NHS, to provide comprehensive advice for peri-operative care. Dr. Edwardson noted the existing “dearth of knowledge and confidence amongst anaesthetists when caring for transgender and gender-diverse patients,” highlighting the necessity of these guidelines.
The guidance emphasizes the use of gender-inclusive language and the consideration of whether a patient should be accommodated in a single room rather than on a ward. It is a response to the current NHS guidance issued in 2019, which states that a transgender patient should be accommodated in a ward aligned with their gender identity unless there is a legitimate reason not to.
The guidelines also recommend specific educational materials for staff to increase awareness of issues impacting transgender patients’ access to high-quality care. Using a digital pre-assessment questionnaire, patients can safely disclose their sex at birth and current gender, ensuring that sensitive information is shared only with consent and when medically necessary.
Empathy and Professionalism
The publication of these guidelines is a step towards creating a more inclusive and respectful healthcare environment for transgender and gender-diverse individuals. By addressing both the specific and general healthcare needs of this population, the guidance aims to improve the overall quality of care provided.
As Dr. Edwardson stated, “This guideline is significant because we know there is a dearth of knowledge and confidence amongst anaesthetists when caring for transgender and gender-diverse patients. Importantly, it seeks not to answer any of the legal or societal questions surrounding transgender people at the moment, but instead wishes to add to an evidence base to make sure their everyday healthcare is as safe and dignified as it can be.”
The guidelines underscore the importance of empathy and professionalism in treating transgender and gender-diverse patients, ensuring they receive care that respects their identity and meets their unique health needs. By adopting these recommendations, healthcare providers can contribute to a more equitable and compassionate medical system for all patients.
The Bottom Line
The new guidance on the peri-operative care of transgender and gender-diverse individuals represents a significant advancement in inclusive healthcare. By addressing the specific needs and ensuring the dignity of these patients, the guidelines set a new standard for best practices in anesthetic care. As the number of individuals openly identifying as transgender and gender-diverse continues to rise, it is imperative that healthcare providers are equipped with the knowledge and tools to offer the highest standard of care. The adoption of these guidelines is a crucial step towards achieving this goal.
