We explore the emerging role of including an OT in the transgender healthcare setting
Before a baby is even born, the first thing that is often asked is “Is it a boy, or a girl?” When it’s born, and before you’ve even left the hospital with your little wrapped up bundle of joy, a box is ticked, a gender is assigned based on what lies beneath their nappy and their life is lived.
Many live their lives based upon the gender and social norms that are associated with the sex, and therefore gender they are assigned at birth. But gender and sex are not the same. Sex is about your biology; based on your body and your hormones. Gender identity is based on what you think of yourself, how you feel inside and how you want to be known to others. Only you can define your gender identity. Gender is not binary- it is not one or the other and in fact there’s a whole spectrum upon which you can fall, with many possibilities.
GLAAD (Gay & Lesbian Alliance Against Defamation) states that: ‘Transgender (adj.) is an umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.’ If your gender identity and assigned sex match up this is known as cis-gender, but if they don’t match, you might describe yourself as a whole array of terms; transgender, trans, non-binary or gender-fluid. This is by no means exhaustive and you could fall anywhere at all outside of the two genders set by societies expectations and norms.
People under the transgender umbrella may describe themselves using one or more of a wide variety of terms like those mentioned. Many transgender people are prescribed hormones by their doctors to change their bodies, some undergo surgery as well. But not all transgender people can or will take those steps and a transgender identity is not dependent upon medical procedures.
Now that you’re aware of the terms, and the dissonance that can be the result of societal pressures, what does all of this have to do with being an OT?
Currently in the UK there are around seven NHS Gender Identity Clinics (GIC) in England and four in Scotland. Generally, people are referred to a clinic through their GP. Despite increasing problems within these clinics across the UK; with difficulties around waiting times and poor information, and issues with trans healthcare generally, occupational therapy has become an emerging role within the setting and talking to those who access this type of healthcare, it’s easy to see where an OT would not only fit, but bring an array of benefits that the current staff line up doesn’t always offer.
James Morton, manager of The Scottish Transgender Alliance (STA) spoke to us about the current situation in the trans-health environment and how he saw an occupational therapist fit within this.
“There’s been a bit of a shift within these clinics and this has seen the recruitment of psychologists, nurses and some occupational therapists. This is about trying to give the opportunity for people to get a bit of help thinking through their strategies for managing their transition. For example, I would see an occupational therapist as having a very useful role in helping trans people to build their confidence to tell their work place they are transitioning or using their problem solving skills towards improving the dynamic of a poor family reaction perhaps.”
The STA found during a mental health survey that 80% of trans people were avoiding going places because they were worried how they may be treated. This could mean avoiding partaking in sports with concerns regarding changing rooms, or even not going to the supermarket to partake in self-care with worries about being mis-gendered.
“I think occupational therapists would be really useful as sometimes they can be easier to talk to. When the only person you see is someone that’s going to sign off on your hormones or surgery it can be really daunting to share worries or concerns.” James went on to note the person-centred aspect of an OT.
“Staff like occupational therapists that are used to putting people at ease and broaching difficult subjects means people can chat things through, with less of a hierarchical feel and not as much of a power-dynamic.”
Just as with any major change in your life, there are a number of practicalities to consider, for trans people these can pile up.
“Some people use binders or wigs or things like that and occupational therapists are used to the psychological dynamics of relying on an aid and they can bring a really useful perspective there.”
Whilst a transgender identity is not dependant upon medical procedures, many transgender people will choose to undertake surgery. An OT’s experience in dealing with limited mobility is also applicable here, helping people adapt after surgery, for example after skin grafting or stitches.
“Occupational therapists can bring a lot of skills and knowledge where other clinicians may not have previously.”
When you examine how the trans-health system works, you’d be as surprised as we were to find out they weren’t a regular fixture within these clinics. But James explained the reasons why the system currently has so many problems and why indeed occupational therapists are not seen situated within these settings:
“I think it’s very much that the GICs are underfunded and understaffed so they’re mostly getting along with only one or maybe a few clinicians. So fighting for extra funding has been tricky. As extra funding comes into place, some GICs have started recruiting OTs as part of embracing multi-disciplinary teams and hopefully the others will soon follow.”
If you have a client who has presented as gender questioning or trans, think about how your skills as an OT could be utilised to improve their experience of the healthcare system.