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Trans, the state of identifying with a gender other than one assigned at birth, dates back into pre-history. Indeed, many cultures have had, and still have, specifically accepted, and many times ho...

Transgender is a broad term, coined by Virginia Prince, an activist (King & Ekins, 2000), and used to refer to a diverse group of individuals who cross or transcend culturally defined categories of gender, including transsexual people; people who cross-dress, drag queens and kings; non-binary people; and gender-variant or transgender people (Bockting, 2009). Non-binary gender identities - those that identify outside the binary gender of male or female — may include genderqueer, bigende r, pangender, gender less, agender, neutrois, third gender, and gender-fluid people (see Barker & Richards, Further Genders, this volume). The term transis a self-identifying label that is commonly used and will therefore be used here.

AIMS AND METHODWe conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.RESULTSEighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.CLINICAL IMPLICATIONSThere are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.