NHS algorithms failing to recognise needs of trans patients, experts warn

Stock photo of a doctor and a patient

Medical experts have warned that algorithms used by the NHS to assess the risk of certain diseases could be inappropriate for the needs of trans patients.

The group of doctors and medical students, who have launched a research initiative called Trans Gap Project, claim a lack of research into the trans community has led to a “significant gap” in access to medical care. 

Speaking to The Guardian, the group pointed specifically towards disease risk algorithms used by healthcare professionals to help decide on treatment, which are reportedly based on metrics that can often vary by gender, such as body weight and kidney function. 

They explained that due to a lack of evidence as to whether trans patients should be evaluated based on their lived gender, their gender assigned at birth or an alternative method, these algorithms could put trans patients at risk of receiving inappropriate care – for example, being offered the wrong dose of medication.

“When scores that haven’t considered trans people are used, patient autonomy is impaired for trans and gender-diverse patients, as they can’t make true informed decisions on their care – which is one of the bioethic pillars,” Dr Michael Niman, a junior NHS doctor and chair of the project, told The Guardian. 

“Clinicians are currently faced with uncertainty regarding the best clinical practice to address these scenarios, owing to a lack of evidence-based guidance.”

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Dr Niman explained that while some medical professionals have brushed off the need for further research into the trans community’s medical experiences, the Trans Gap Project’s interrogation of medical algorithms is vital.

“Trans patients are often forgotten about or not considered in the medical world, leading to a significant gap in their access to appropriate medical care,” he said. 

“Common responses I get from clinicians are ‘oh, I hadn’t thought about that’, ‘does it make a difference?’ [or] ‘there’s not that many [trans people] anyway’.

“The use of inappropriate scores has real-world implications and can result in trans patients being denied access to necessary medical care, being underdosed for antibiotics [or] incorrectly anticoagulated.”

Trans Gap Project has so far carried out a series of studies into the gender-based algorithms, and told The Guardian that the next stage would be surveying trans people about their experiences with the NHS. 

Dorian Wolfe, a medical student and social media lead for Trans Gap Project said that he had experienced transphobia within medicine firsthand. 

“As a patient, much like the majority of the trans community, I have experienced first-hand the transphobia and mistreatment that occurs when healthcare professionals aren’t educated on trans health and inclusion,” Wolfe said.

“Making healthcare a safer, better-informed, more inclusive space for my community is my main motivation for being involved in this project.

“I don’t want healthcare professionals to just be aware of trans issues, I want them to be able to advocate for their trans patients.”

The NHS has previously been urged to improve healthcare for trans people in the UK, with a recent push to fix “deadly” years-long waiting lists for trans masculine bottom surgery

Activists at Transgender Action Block (TAB) have warned that, if referred today, trans and non-binary people could be waiting “as long as four years” for phalloplasty or metoidioplasty (forms of lower surgery for trans masculine people) due to long waiting lists and delays, some caused by the Covid-19 pandemic. 

“The NHS’s response to the situation has been completely inadequate,” TAB said. 

“Waiting four years is not acceptable, people die on these waiting lists. Dysphoria can be deadly, and through the NHS’s incompetence, vital healthcare has been withheld from over 1,000 people on the masculinising genital surgery waiting list.”

PinkNews has contacted NHS England for comment. 

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