The adult trans care pathway

Page last updated: 12 May 2022

The adult trans care pathway focuses on the care of people with:

  • variations of sex characteristics (VSC)
  • trans people aged 17 years and older and transitioning their gender
  • non-binary people aged 17 years and older and transitioning their gender

The trans care pathway refers mainly to patients transitioning gender medically, rather than socially or legally.

People with VSC, trans and non-binary people may be particularly vulnerable to receiving poor care. This may be for reasons such as a lack of training for staff, inefficient monitoring of trans status, and potential transphobia.

The General Medical Council (GMC) has produced guidance on trans care. It states that trans and non-binary people experience the same health problems as everyone else and that healthcare professionals must assess, provide treatment for and refer trans patients in the same way as other patients.


  • Transgender is usually shortened to ‘trans’. It describes people whose felt sense of gender (gender identity) is not the same as the gender assigned at birth on the basis of genital appearance
  • Non-binary is an umbrella term to describe gender identities that are not only masculine or only feminine. They are outside the ‘gender binary’ of male and female. Not all non-binary people identify as trans.
  • Gender affirmation is the process a transgender person goes through to change their physical sexual characteristics to match their gender identity. This typically involves a combination of surgical procedures and hormone treatment.
  • Gender reassignment (wording of the Act to mean trans status) is one of the nine protected characteristics under the Equality Act 2010. The Act recognises prejudice and discrimination that trans and non-binary people may face in receiving both services and employment.
  • Gender variance is an umbrella term to describe gender identity, expression, or behaviour that falls outside culturally defined norms associated with a specific assigned gender.
  • Cisgender relates to a person whose sense of gender identity corresponds with their sex assigned at birth.

When we assess health and care services, we consider equality and whether services are providing high-quality care for all people, including people on the trans care pathway. We judge whether services are meeting the equality aspects of the Health and Social Care Act regulations, particularly:

When we assess services, we will look at how they provide care for people who are on the trans care pathway, where this is relevant. This will take into account the local access arrangements to gender services.

Further information