Healthcare experiences of transgender and gender-diverse people in the UK: a scoping review.

Abstract

To map the existing literature on transgender and gender-diverse (TGD) people's experiences of healthcare in the UK, summarising key findings and characteristics of current research. This scoping review was guided by the Arksey and O'Malley framework and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, PsycINFO and Web of Science were searched on 29 October 2024. Reference lists of included studies were searched to identify further relevant literature. Primary research of any design reporting the healthcare experiences of TGD people in the UK from 2019 onwards was included. Relevant data were extracted using a data charting form guided by the research questions and the Arksey and O'Malley framework. Results were narratively synthesised to provide a comprehensive overview of the literature. 52 studies were included, comprising qualitative (n=38), mixed-methods (n=12) and quantitative (n=2) designs. TGD people reported varying experiences across general and transition-related healthcare settings. Positive experiences were often attributed to individual clinicians. Negative experiences were common, including transphobic discrimination, insufficient clinician knowledge and barriers to effective transition-related care. Strategies for navigating healthcare, such as information sharing within the TGD community and educating clinicians about trans health needs, reflected adaptive responses to systemic barriers. The findings highlight a need for greater recognition of diverse gender identities, more inclusive approaches in healthcare education and practice and further targeted research. This is especially urgent in light of the recent UK Supreme Court judgement regarding definitions of 'sex' under the Equality Act 2010, the emerging implications of which risk compounding existing barriers by reinforcing exclusionary practices within healthcare settings and further limiting recognition and protections for TGD people in the UK.