Transgender: making the transition

As the CSP prepares new professional guidance, Janet Wright hears a transgender physio’s own story.

Looking back over the past few years, Zackary Jepson says ‘It’s been a long, stressful process, but I’m happy where I am now. I wouldn’t change it for the world.’
Five years ago he was a physiotherapy student, but not only facing the transition from university to work. Ahead lay a much less charted transition, from female to male. Zackary had thought long and hard about whether he could be happy as a woman, and was certain he could not. Doctors were not encouraging, at least initially. ‘When I first went to see my GP, he said to speak to other lesbians and I’d find they probably feel exactly the same way,’ Mr Jepson recalls. 
But by then he knew he wanted to make this change. His partner Amy Dolling, also a physio, gave him solid support. Still, at times the prospect was daunting. ‘When you look ahead, it seems overwhelming,’ says Mr Jepson. ‘Many people assume transitioning is a one-day thing. But it’s a long, stressful process. Some people still aren’t where they want to be after years.’

Seeking and offering support at work

For Mr Jepson the process was eased by the support of colleagues at East Sussex healthcare trust, where he started working after graduating in 2011. Already living as a man and using the name Zackary, he discussed his planned treatment with his seniors, who knew he would need time off work for medical appointments. He began hormone treatment in 2014.
‘Being in the same trust throughout transition has been nice, because everyone has known I’m Trans from the start,’ he says. ‘It may be difficult if you’ve started work under one name and gender, and start transitioning to another. But it’s not impossible, people do it successfully.’ His advice to other trans people at work is to build relationships with colleagues. ‘If you’re having a bad day it helps to have someone to talk to,’ he says. ‘And it’s good to know someone’s got your back!’
Transgender people – including those who live permanently as a member of the other sex without any medical or surgical intervention – have legal protection under the Equality Act 2010, which forbids harassment or discrimination. It’s illegal to disclose a trans person’s status to anyone unnecessarily without his or her consent, for example. But it can still be a lonely path.
Mr Jepson found colleagues’ help invaluable in dealing with other people’s attitudes or awkwardness. Although his physio colleagues always knew Mr Jepson as ‘he’, some of the hospital’s nurses were using female pronouns in speaking about him.
‘If you’ve never had to consider your own gender identity, you may not realise the effect of using wrong pronouns,’ he says. ‘It’s not because people mean to be rude, they’re just not aware, it’s not anything that’s been raised with them before. Gender-neutral pronouns are useful if you’re not sure of someone’s sex,’ he adds.
One close colleague asked if she could help, and was able to defuse the problem by speaking to people who had concerns. Other staff’s curiosity could have been a problem, but Mr Jepson used it as an opportunity to raise awareness. ‘I’ve had quite a few non-physio staff asking me inappropriate questions,’ he says. ‘When I came back from top surgery, someone asked me if I was going to have lower surgery. I try to be open in answering questions because I hope that will help other people in the future.’
When people ask how they can support a colleague who is in transition, Mr Jepson recommends doing a bit of background research ‘just to have the basic knowledge of what happens. And if someone’s happy to talk, ask questions. Saying “If you need me I’ll be there for you” can help a lot.’

Transgender patients

Up to 650,000 people in the UK ‘are estimated to experience some degree of gender non-conformity’, according to the Gender Identity Research and Education Society.
They may express this in various ways, from simply living as a member of the other sex, to hormone treatment and gender reassignment surgery. Some buy hormones without consulting their doctor, so their status may not be clear from their medical records. Physios can provide practical help with some of the health problems Tran’s people may encounter. 
Taking female hormones such as oestrogen, for example, may cause joint pain as the patient’s hips rotate slightly forwards. Oestrogen also reduces the ability to build muscle. The male hormone testosterone may cause weight gain and bone thinning, and possibly increase the risk of diabetes, although it also helps build muscle. ‘What you ask someone to do in outpatients might be affected if they’re transitioning,’ warns Mr Jepson. 
Physios are well aware of the need for extra sensitivity with some groups. Transgender patients may have issues with body image or may wear body-contouring clothing. Privacy is exceptionally important, and it’s helpful to let patients know in advance that they may need to undress. 
‘Notice if someone seems anxious, not happy about undressing,’ Mr Jepson says. ‘You could suggest they might wear something more appropriate next time, perhaps a vest.’ Women’s health physios may see transgender men for problems relating to their female anatomy, making privacy even more important. 
‘One of my friends ended up having a hysterectomy so he was seeing a women’s health physio,’ says Mr Jepson. ‘That could have been difficult if he hadn’t been seen in a private space.’ 
A majority of Tran’s people responding to surveys say they have been bullied, attacked or harassed. They have a high rate of depression, mental health problems and suicide. In addition they may develop conditions such as heart disease and cancers connected with their hormone use.
A trusted physiotherapist is well placed to give healthy-living advice. It’s also useful to be aware of local trans support services, support groups and referral pathways. 

Other resources

Here to help you

CSP resources are on hand for members with gender concerns.
  • The CSP’s Equality & Diversity Toolkit is a user-friendly resource to guide you through law and best practice and help you raise awareness. 
  • If you’re encountering discrimination, ask your CSP steward for help. Trained to deal with members’ problems, they can also call on the society’s negotiating officers and legal services. 
  • The CSP’s lesbian, gay, bisexual and transgender network helps members support each other. Membership is confidential, keeping in touch through iCSP, email, newsletters and meetings. 
  • The CSP’s Physiotherapy treatment of transgender patients guidance.

Janet Wright

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