Physiotherapy Treatment of transgender patients

No individual undertakes the journey to live as the opposite gender lightly. Trans people are twice as likely to suffer anxiety and depression than the general population.  The guidelines below are to help ensure that trans patients have a positive and welcoming experience when accessing your services.

Addressing your patients

Accidental or deliberate misuse of personal pronouns (he, she) or titles (Mr, Mrs, Ms) has been identified as one of the most distressing and undermining experiences that trans patients experience.

If you are unclear on how a trans patient would like to be called then ask “how would you like to be addressed?”. Then ensure that you use this requested form of address and refer to them appropriately (in their chosen gender / title) even if you are not with them.

Write this preference clearly on their notes.

Assessment and treatment

When carrying out a subjective assessment in all settings, make sure your questions are both essential and relevant to the reason for referral. Asking any questions about a patient’s transgender status out of curiosity, however well intentioned, is inappropriate and can lead to a breakdown in trust.

If you are already aware of a patient’s trans status, consider asking if they would like to carry out the subjective assessment in a confidential space/room (if available) rather than behind curtains or in an open gym or ward.

Be aware that trans patients may be wearing body contouring garments. Do not ask them to remove body contouring clothing unless they offer to do so, or it is absolutely essential and they consent for assessment and treatment purposes. The presence of a body shape which does not reflect the patient’s gender identity can be another source of significant mental distress.

If the removal of clothing is not possible or appropriate, you may have to discuss alternative approaches to hand placement and treatment with the patient.

The CSP has extensive best practice guidance with regard to the removal of clothing for physiotherapy treatment. You can find this here in “Chaperoning and related issues”. This advice applies equally to trans patients.

Confidentiality of records

The Gender Recognition Act (2004) introduced an enhanced right to privacy for trans individuals.

If you acquire information about someone’s trans status, (such as within a subjective physiotherapy assessment) and then pass that information on to a third party without the express consent of the individual involved, you are liable for criminal proceedings.

The bottom line is: unless you have an individual’s specific consent, do not reveal or confirm their transgender status.

Use of gender specific facilities

Trans individuals should always be directed to the facilities which accord with their chosen gender. It is offensive and unlawful to insist that a trans individual uses toilets or changing facilities designated for their sex assigned at birth.

If concerns are raised by other patients then, in the first instance, you should speak to the trans individual in private. Remember that it is illegal to reveal or confirm someone’s transgender status without their consent. 

If you have the consent of the trans patient, it may be appropriate to speak to the other patients and reiterate the employers position in supporting transgender rights.  It is important that everyone can access healthcare free from discrimination.

Tackling harassment and discriminatory/ offensive behaviour

If you hear any inappropriate or offensive language from other patients related to someone's trans status, challenge it immediately.  Treat it in the same way as you would racist or sexist language..

If the behaviour does not stop or you have concerns about the treatment of a trans patient, please talk to your line manager or CSP steward.

Further information and training 

For further information and a more in-depth explanation of these points, please download our supporting publication below.

Also included is a short training activity which can be used by managers or stewards. It aims to promote discussion and to help in developing an action plan to make individual work places more welcoming to trans staff, patients and carers.