A new Gender Identity Healthcare Protocol has been published for gender identity services in Scotland: https://www.publications.scot.nhs.uk/files/dl-2024-21.pdf

It replaces one that has been in place since 2012.

What is the Gender Identity Healthcare Protocol?

It’s the document that sets out the clinical pathways for gender identity healthcare in Scotland. It is like a roadmap for treatment options – so while people may take different routes, or have different destinations, it shows you all of the ways you can go!

What’s new?

• It makes it really clear that accessing many gender affirming treatments does not require two assessment appointments, only one. Some people may require more, but this should be about what the person needs to make a confident, shared decision with the clinician about their treatment. We think this is a positive move away from the one-size-fits-all approach taken in the past – people should be able to move through the pathway at a pace that suits them.
• The new protocol is much more individualised and inclusive of non-binary people. The new protocol acknowledges that ‘every person’s circumstance, goals and priorities for accessing a GIC will be unique to them’ and takes a person-centred and needs-led approach that will be delivered in a way that should ‘work with the spectrum of gender diversity and identity’.

What’s good?

• It is much less pathologised than the previous protocol. The language used is very different and focuses more on a collaborative approach taken between the person using the service and the clinician. For instance, there is an emphasis on considering someone’s ‘readiness’ to access the pathway, rather than an emphasis on diagnosing someone.
• The new protocol sets out the responsibilities every health board has for caring for trans and non-binary patients accessing gender identity healthcare. This includes health boards that don’t have a GIC. We hope this will mean that across Scotland, there should be more resources provided for support while people are on waiting lists, and for ongoing local care after someone has been to a GIC.

What’s not so good?

• We think that it is unfortunate that the flowchart in the protocol shows all non-surgical interventions coming after assessment at a GIC. In some health boards some non-surgical interventions, such as speech and language therapy, can be accessed prior to assessment at a GIC – which the protocol itself acknowledges. We worry this may lead to confusion and mean that health boards think an assessment at a GIC must take place before any other interventions, or discourage health boards that don’t currently facilitate referrals for these kinds of interventions before a GIC assessment from starting to do so.
• We continue to believe that to address the crisis these services are in, gender identity healthcare need to be delivered in a very different way than it currently is. While the new protocol leaves room for change in the way services are delivered, and is definitely a positive step forward, it is not as ambitious or forward thinking as we think it needs to be.

The updated protocol is one part of a wide range of work happening to improve gender identity services. You can find out more about that at our guide “What’s happening with trans healthcare in Scotland?”