Born Identity

Social attitudes have changed considerably since the early 1990s when transsexual people first started to campaign for their rights to “respect and equality”. Now many people have friends, neighbours and work colleagues who are trans.

Hormonal and surgical reassignments are regularly sought, and it is estimated that about 300 genital reconstructions are now performed each year in the UK’s major centres. However, when faced with a client who is trans – and particularly in circumstances which demand personal care – many social care workers are challenged because of their lack of knowledge of the reality of trans people’s lives and, in particular, what their bodies are like.(1) The realities of transsexual treatments are that not everyone will undertake all the possible surgeries; this might be personal choice or for health reasons. There is little point in undertaking major surgery to live a better quality of life if you are going to die on the operating table.

The Gender Recognition Act 2004, which came into force this April, affords full legal recognition to the trans person’s acquired gender. This will not depend on an individual undergoing particular surgical processes. So, clients who are legal women may have a penis, and clients who are legal men may have a vagina.

The act means that trans people can apply for gender recognition and those born in the UK can obtain a new birth certificate. To qualify, a trans person has to show that:

They have been diagnosed as having gender dysphoria, or
They have had gender reassignment surgery, and have lived in their acquired gender role for two years and intend to do so for the remainder of their life.

Gender recognition will mean that trans people must be treated in their new sex for all legal purposes, including health and social care.

The act will impose new responsibilities to maintain client confidentiality. Care staff are now facing new challenges, as they are increasingly likely to come across trans people as clients and those clients will have new privacy rights.

Client confidentiality is taken as read within the social care profession, but it is generally considered good practice to discuss client needs and care plans within a team, which can be multidisciplinary.

However, section 22 of the Gender Recognition Act imposes new rules which would cause problems for workers seeking advice from their managers and co-providers. It makes it a crime, with a fine of up to 5,000, for any individual who has obtained the information in an official capacity to disclose that a person has a gender recognition certificate or to do anything that would make such a disclosure. This means that it will no longer be possible to identify a particular client, except with their express permission, as to do so will incur criminal liability.

Most medical and care workers who have worked with a trans person will know that a “sex change” is not just a case of nipping into hospital for a week, but they are often unaware of the real complexities of hormonal and surgical therapies, and the timescales over which they take place. In the NHS, it often takes up to seven years from when the person starts living in their new gender role to the completion of surgery. In the case of female to male, where surgery to create a penis is multi-staged, that may take many more years, and in fact may never be fully concluded to the point where the person has what resembles a normal fully functioning penis.(2)

We are also seeing for the first time an ageing trans population. There are now many people who underwent treatment in the 1960s and 1970s who are of retirement age or older and facing the ordinary problems that come with ageing. The 1990s have also seen a great increase in the number of people choosing to undertake some or all of the gender reassignment treatments available. Some of these people are seeking treatment in their middle ages. This means they are now approaching old age but will be “young trans people” in terms of their life management skills. And increasingly we are seeing people with disabilities, who would have historically been rejected from services, obtaining treatments.

Consequently, it is now common for care workers to find themselves working with a trans client and to discover that the client has complex needs relating to their gender reassignment treatments. These can range simply from dealing with a differently structured body to one with specific problems resulting from long-term hormonal treatment and several major surgical interventions. Seeking advice from a multidisciplinary team on how to meet these needs would appear sensible.

However, the new legal requirements of section 22 require carers to be meticulous about maintaining the trans person’s privacy. There is no obligation under the act for a trans person to disclose whether they have legal recognition (the whole point is to ensure that they can maintain their privacy) so a new worker may only discover that they are working with a client with a complex body when performing personal care.

The worker must then presume that the client has obtained legal recognition, and do nothing that would identify the specific client to anyone else. Trans people can be asked to approve further disclosure to help deal with any problems, but they have no obligation to agree. Many trans people will insist, unless this is a life-threatening medical situation, that they wish to retain their privacy.

Consequently, care workers need to be aware of the impact of the new legislation and agencies should now be developing policies and strategies to facilitate service provision, rather than leaving it until a trans person pursues the matter with the police.

Stephen Whittle is reader in law at Manchester Metropolitan University and vice-president of Press for Change, the UK’s campaign group for trans people. He was awarded an OBE for 30 years of social support for the trans community and his work with the government on the Gender Recognition Act. He has lived as a man since 1975.

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This article considers the impact of increasing numbers of trans people who will be approaching social care providers, and the new liabilities for carers that arise out of section 22 of the Gender Recognition Act. It is proposed that there is a need to address how to maintain client confidentiality, and policies and strategies developed to ensure the privacy that the act introduces for trans people.

(1) C F Hartley and S Whittle, “Different sexed and gendered bodies demand different ways of thinking about policy and practice”, Practice: A Journal of the British Association of Social Workers, 2003, vol 15, No 3, pp61-73
(2) S Whittle and T M Witten, “TransPanthers: the greying of transgender and the law”, Deakin Law Review 2004, Vol 4, No 2, pp503-522

Further information
Press For Change, the UK-based lobby group for trans people’s rights has a special section on the Gender Recognition Act. Go to
The FTM Network for female to male transsexual and transgender people. Go to

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