Gender Identity and Transitioning
Why Are We Here?
The lecture aims to explore gender identity and transitioning, addressing health inequalities and barriers to healthcare faced by transgender individuals. (該講座旨在探討性別認同和過渡，解決跨性別者面臨的健康不平等和醫療保健障礙。)
Section 28:
This was a law in the UK between 1988 and 2003 that prohibited councils and schools from promoting or teaching about the acceptability of same-sex relationships. (這是 1988 年至 2003 年間英國的一項法律，禁止委員會和學校宣傳或教授同性關係的可接受性。)
It was purportedly for the "protection of children" but had the opposite effect, leading to a lack of information, bullying, isolation, and shame. (據稱這是為了“保護兒童”，但效果適得其反，導致資訊缺乏、欺淩、孤立和羞恥。)
Society and Gender:
Society is currently engaged in debating gender. (社會目前正在進行性別辯論。)
Gender identity is in the press because: (性別認同成為媒體關注的焦點，因為：)
Single-sex spaces are legally required. (法律要求單性別空間。)
Non-residential buildings must have single-sex bathroom facilities (with unisex facilities if space allows). (非住宅建築必須設有單性別浴室設施（如果空間允許，可配備男女通用設施）。)
There are employment law considerations. (有雇傭法的考慮因素。)
Safety concerns are also a factor. (安全問題也是一個因素。)
Health Inequalities:
Health inequalities exist, such as the North-South health divide in England as seen in life expectancy at birth: (存在健康不平等，例如英格蘭的南北健康鴻溝，如出生時的預期壽命所示：)
Females:
North East: 83.1 years (東北部：83.1 年)
North West: 81.6 years (西北：81.6 年)
Yorkshire and The Humber: 81.8 years (約克郡和亨伯郡：81.8 年)
East Midlands: 82.9 years (東米德蘭茲郡：82.9 歲)
West Midlands: 82.7 years (西米德蘭茲郡：82.7 歲)
East: 83.7 years (東部： 83.7 歲)
London: 84.0 years (倫敦：84.0 年)
South East: 83.8 years (東南部：83.8 歲)
South West: 84.1 years (西南：84.1 歲)
Males:
North East: 79.5 years (東北部：79.5 年)
North West: 77.9 years (西北地區：77.9 歲)
Yorkshire and The Humber: 78.1 years (約克郡和亨伯郡：78.1 歲)
East Midlands: 79.3 years (東米德蘭茲郡：79.3 歲)
West Midlands: 78.7 years (西米德蘭茲郡：78.7 歲)
East: 80.3 years (東部：80.3 年)
London: 80.5 years (倫敦：80.5 年)
South East: 80.1 years (東南部：80.1 歲)
South West: 80.2 years (西南： 80.2 歲)
Other health inequalities:
Black women in the UK are 4 times more likely to die during pregnancy or childbirth than White women. (英國黑人女性在懷孕或分娩期間死亡的可能性是白人女性的4倍。)
South Asians have a 40% higher death rate from coronary heart disease compared to the general population. (與普通人群相比，南亞人死於冠心病的死亡率高出 40%。)
Less than 5% of blood donors are from BAME backgrounds. (不到 5% 的獻血者來自 BAME 背景。)
People from BAME backgrounds are twice as likely to die from COVID than white people. (來自 BAME 背景的人死於 COVID 的可能性是白人的兩倍。)
Consent rates for organ donation are 42% in BAME communities and 71% in white communities. (BAME 社區的器官捐獻同意率為 42%，白人社區為 71%。)
LGBT health inequalities (Stonewall, 2018):
52% of LGBT people experienced depression in the last year. (52% 的 LGBT 人群在去年經歷了抑鬱症。)
LGBT people face widespread discrimination in healthcare settings. (LGBT 人群在醫療保健環境中面臨廣泛的歧視。)
23% have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. (23% 的人目睹了醫護人員對 LGBT 人士的歧視或負面言論。)
14% avoid seeking healthcare for fear of discrimination. (14% 的人因為害怕歧視而避免尋求醫療保健。)
19% aren’t "out" to any healthcare professional about their sexual orientation. (19% 的人沒有向任何醫療保健專業人員 「公開 」他們的性取向。)
Pharmacy professionals must provide person-centered care, including:
Obtaining consent. (獲得同意。)
Involving, supporting, and enabling every person in making decisions about their health and wellbeing. (讓每個人都參與、支持和幫助每個人做出有關其健康和福祉的決定。)
Listening to the person and understanding their needs. (傾聽患者的意見並了解他們的需求。)
Giving all relevant information in an understandable way. (以易於理解的方式提供所有相關信息。)
Considering the impact of their practice. (考慮到他們實踐的影響。)
Respecting and safeguarding the person's dignity. (尊重和維護個人尊嚴。)
Recognizing and valuing diversity, and respecting cultural differences. (承認和重視多樣性，並尊重文化差異。)
Recognizing their own values and beliefs but not imposing them on others. (認識到自己的價值觀和信仰，但不將它們強加給他人。)
Taking responsibility for ensuring that person-centered care is not compromised because of personal values and beliefs. (負責確保以人為本的護理不會因個人價值觀和信仰而受到損害。)
Making the best use of available resources. (充分利用可用資源。)
Learning outcomes for person-centered care and collaboration include: demonstrating empathy, working in partnership, effective communication, adapting communication, supporting safe medicine use, treating people as equals, obtaining informed consent, assessing health risks, ensuring personal values do not compromise care, demonstrating consultation skills and considering factors affecting people's behaviors related to health and wellbeing. (以人為本的護理和協作的學習成果包括：展示同理心、合作、有效溝通、調整溝通、支援安全用藥、平等對待他人、獲得知情同意、評估健康風險、確保個人價值觀不會損害護理、展示諮詢技巧以及考慮影響人們與健康和福祉相關的行為的因素。)
What is Gender Identity?
Gender is not simply anatomical sex or chromosomes but also includes presentation/expression of self, psychology (sense of self), and attraction. (性別不僅僅是解剖學上的性別或染色體，還包括自我的呈現/表達、心理（自我意識）和吸引力。)
Gender is not binary; it's a spectrum. (性別不是二元的;它是一個光譜。)
Key concepts:
Gender Identity: Woman-ness, Man-ness, Non-gendered, Agender, etc. (性別認同： 女性性、男性性、無性別、無性別等。)
Gender Expression: Masculine, Feminine, Androgynous, Gender neutral, Hyper-masculine, etc. (性別表達： 男性化、女性化、中性化、性別中立、超男性化等。)
Biological Sex: Female-ness, Male-ness, Intersex, Female self ID, Male self ID, Nobody, etc. (生物性別： 女性、男性、雙性人、女性自我ID、男性自我ID、無人等。)
Attraction: Attracted to Men/Males/Masculinity, Attracted to Women/Females/Femininity, Straight, Gay, Pansexual, Asexual, Bisexual, etc. (吸引力： 被男性/男性/男性氣質所吸引，被女性/女性/女性氣質所吸引，異性戀，男同性戀，泛性戀，無性戀，雙性戀等。)
Society and gender norms are evolving. (社會和性別規範正在演變。)
Being Binary or Non-Binary
Anatomical sex is assigned at birth based on the appearance of genitalia. (解剖學性別是在出生時根據生殖器的外觀分配的。)
An infant’s genitals do not always align with the male/female binary. (嬰兒的生殖器並不總是與男性/女性二元對立一致。)
Intersex describes an individual whose chromosomes, hormones, or sexual organs are not in line with binary definitions of male or female (also known as Differences in Sexual Development, DSD). (雙性人 描述了其染色體、激素或性器官不符合男性或女性的二元定義（也稱為性發育差異，DSD）的個體。)
Being born intersex is relatively common (1 in 2000 UK births). (出生時雙性人相對常見（2000 年英國出生人數中有 1 人）。)
Surgery is often recommended, but outcomes are often poor. (通常建議進行手術，但結果通常很差。)
Some intersex individuals may not have been told they were intersex and were raised as their chosen sex. (一些雙性人可能沒有被告知他們是雙性人，而是作為他們選擇的性別長大。)
Biological basis of intersex varies, most commonly leading to a lack of production of testosterone or lack of response to it. (雙性人的生物學基礎各不相同，最常見的是導致睾丸激素產生不足或對睾丸激素缺乏反應。)
Example: Androgen Insensitivity Syndrome (AIS):
XY chromosomes. (XY 染色體。)
Testosterone is produced and measurable. (睾丸激素是產生和可測量的。)
A mutation in the receptor reduces or blocks any response to testosterone. (受體突變會減少或阻斷對睾酮的任何反應。)
Female appearance of genitalia (but with undescended testes). (外生殖器為女性（但睾丸未降）。)
Lack of response to testosterone means that a person with AIS has less muscle or other "male" physical characteristics, more like a "woman." (對睾丸激素缺乏反應意味著患有 AIS 的人的肌肉或其他“男性”身體特徵較少，更像“女性”。)
Intersex Athletes in Sport:
The rate of intersex is 140x higher in elite female athletes than in the general population. (精英女運動員的雙性人比率比普通人群高 140 倍。)
Intersex athletes have been subjected to physical examination (60s), genetic testing (1968-1990s), and testing for hormone levels. (雙性運動員接受了身體檢查（60 多歲）、基因檢測（1968-1990 年代）和激素水平檢測。)
Current rules are based on self-identification of gender and hormone levels (typically <10 nmol/L testosterone for women’s events) or a lack of response to testosterone. (目前的規則基於性別和激素水準的自我認同（女性賽事通常為 <10 nmol/L 睾酮）或對睾酮缺乏反應。)
It is not always easy to distinguish between the "benefits" of testosterone, training, and natural ability. (區分睾丸激素、訓練和自然能力的“好處”並不總是那麼容易。)
South African runner, Caster Semenya, found out she was intersex when her gender verification test results were leaked. (南非跑步者 Caster Semenya 在性別驗證測試結果洩露時發現她是雙性人。)
In 2009, Semenya won the 800m World Championship title at age 18. (2009 年，18 歲的 Semenya 贏得了 800 米世界錦標賽冠軍。)
Race officials insisted she undergo gender verification tests within hours of her win. (比賽官員堅持要求她在獲勝后的幾個小時內接受性別驗證測試。)
Tests showed that she had no womb or ovaries but had internal testes producing testosterone. (測試顯示她沒有子宮或卵巢，但有內部睾丸產生睾丸激素。)
She had known that she was different from age 5 but was not aware she had testes. (她知道自己與 5 歲不同，但不知道自己有睾丸。)
Her testosterone levels are 3 times higher than for women but not as high as seen in men. (她的睾丸激素水準比女性高 3 倍，但沒有男性高。)
Has to take medications to lower testosterone levels to compete. (必須服用降低睾丸激素水平的藥物才能參加比賽。)
Gender Identity & Transitions
Gender identity is not as simple as male or female (e.g., may be agender, non-binary, gender fluid). (性別認同並不像男性或女性那麼簡單（例如，可能是無性別、非二元、性別流動）。)
Gender identity is not necessarily associated with sexual orientation. (性別認同不一定與性取向有關。)
“Transgender” describes a person who lives all or part of their time in a gender not the one they were assigned at birth (0.5-1% population). (“跨性別者 ”是指一個人全部或部分時間生活在性別中，而不是他們出生時被分配的性別（0.5-1% 的人口）。)
Trans Mental Health Survey 2012:
Lack of visibility and acceptance of transgender individuals in our society contributes to high suicide risk. (在我們的社會中，跨性別者缺乏可見性和接受度，導致自殺風險高。)
48% of transgender people under 26 years have attempted suicide (6% of 16-24-year-olds). (48% 的 26 歲以下跨性別者曾企圖自殺（6% 的 16-24 歲人群）。)
59% of transgender people under 26 years have deliberately hurt themselves (9% of 16-24-year-olds). (59% 的 26 歲以下跨性別者曾故意傷害自己（16-24 歲人群的 9%）。)
Stonewall's Unhealthy Attitudes report on health services indicates that a significant percentage of practitioners are not confident in responding to the specific care needs of trans patients:
Advice worker: 34% (諮詢工作者：34%)
Social worker: 31% (社工：31%)
Doctor: 28% (醫生：28%)
Support worker: 24% (支援人員：24%)
Care worker: 22% (護理員 ： 22%)
Nurse: 21% (護士：21%)
Health care assistant: 15% (保健助理：15%)
The perfect storm:
Fear of discrimination and lack of trust from those seeking help. (害怕受到歧視和尋求說明的人缺乏信任。)
Lack of knowledge and confidence in those providing help. (對提供說明的人缺乏知識和信心。)
Education is needed for healthcare professionals. (醫療保健專業人員需要教育。)
Asking about gender:
“If you don’t need to know, don’t ask,” but if you have to… (“如果你不需要知道，就不要問”，但如果你必須......)
Commonly ask as a guide to what title or pronouns to use (she/her, he/him, they/them, etc.). (通常詢問使用什麼頭銜或代詞（她/她、他/他、他們/他們等）作為指南。)
Other gender identities:
There is diversity in gender identity. (性別認同存在多樣性。)
Genderqueer – neither male nor female, possibly a combination of both. (性別酷兒 – 既不是男性也不是女性，可能是兩者的結合。)
Agender – no gender. (Agender – 無性別。)
Bigender – both male and female. (雙性別 – 男性和女性。)
Gender fluid – switching between male and female or in between. (性別流動 – 在男性和女性之間或兩者之間切換。)
Two-spirit – cross-gender in Native American culture. (雙靈 – 美洲原住民文化中的跨性別。)
Acceptance of non-binary or cross-gender identities is more common in other cultures. (接受非二元或跨性別身份在其他文化中更為常見。)
Gender Dysphoria:
Gender dysphoria is the distress experienced when a person’s gender identity is not the same as their gender assigned at birth. (性別焦慮症是當一個人的性別認同與其出生時被分配的性別不同時所經歷的痛苦。)
Treatment for gender dysphoria aims to help people live in their preferred gender. (性別焦慮症的治療旨在幫助人們以自己喜歡的性別生活。)
Treatment pathway:
Referral by GP to gender specialist or gender identity specialist clinic. (由全科醫生轉介至性別專家或性別認同專家診所。)
Confirmation of gender dysphoria by a multi-disciplinary team. (由多學科團隊確認性別焦慮。)
If appropriate, hormone therapy: (如果合適，激素治療：)
Oestrogen and anti-androgens for Male to Female (MtF). (男性對女性 （MtF） 的雌激素和抗雄激素。)
Testosterone for Female to Male (FtM). (女性對男性的睾丸激素 （FtM）。)
Gonadotrophin-releasing hormone analogue (GnRH) to block puberty in children. (促性腺激素釋放激素類似物 （GnRH） 阻斷兒童青春期。)
Mental Health Support. (心理健康支援。)
Hair removal (if required). (脫毛（如果需要）。)
Speech and language therapy. (言語和語言療法。)
Surgery (i.e., mastectomy). (手術（即乳房切除術）。)
Treatment of children and young people (<18 years):
Referral to gender identity development clinic (GIDS) for assessment (3-6 months). (轉診至性別認同發展診所 （GIDS） 進行評估（3-6 個月）。)
Initial psychological treatment (e.g., psychotherapy, family therapy, parental support). (初始心理治療（例如心理治療、家庭治療、父母支援）。)
Gender-variant behavior or feelings typically stop at puberty, but if not, puberty blockers might be considered to pause sexual development. (性別變異的行為或感覺通常在青春期停止，但如果不是，可能會考慮使用青春期阻斷劑來暫停性發育。)
From 16 years of age, cross-sex hormones might be considered if they have used puberty blockers for at least 12 months. (從 16 歲開始，如果他們使用青春期阻斷劑至少 12 個月，則可以考慮使用跨性別激素。)
Caution that cross-sex hormones can cause irreversible changes (e.g., breast development, voice deepening) and can lead to infertility. (請注意，跨性別激素會導致不可逆的變化（例如乳房發育、聲音低沉），並可能導致不孕症。)
Cass Review:
Investigated Gender Identity Services for Children and Young People and published report in 2024. (調查了兒童和青少年的性別認同服務，並於 2024 年發表了報告。)
Found that there is not enough evidence on the longer-term impacts of puberty blockers for children and young people to know whether they are safe or not, nor who benefits from their use. (發現沒有足夠的證據證明青春期阻斷劑對兒童和年輕人的長期影響，無法了解它們是否安全，也不知道誰從使用它們中受益。)
Need for clinical trials. (需要臨床試驗。)
Publication of the review resulted in a temporary and then permanent ban on prescribing of puberty blockers for gender dysphoria in children. (該評論的發表導致暫時和永久禁止開具青春期阻滯劑治療兒童性別焦慮症。)
Puberty blocker ban:
The ban on prescribing, sale, and supply of puberty blockers DOES NOT apply to: (禁止開具、銷售和供應青春期阻斷劑的禁令不適用於：)
Individuals aged 18 and over. (年滿 18 周歲的個人。)
Children or young people who started treatment before June 3, 2024. (在 2024 年 6 月 3 日之前開始治療的兒童或青少年。)
Those being treated as part of an approved clinical trial. (那些作為批准的臨床試驗的一部分接受治療的。)
Those being treated for a medical condition other than gender dysphoria (e.g., precocious puberty). (那些正在接受性別焦慮以外的疾病治療的人（例如，性早熟）。)
Hormones for a trans man:
Parenteral testosterone (i.e., testosterone enantate or undecanoate) or transdermal testosterone (i.e., gel). (腸外睾酮（即烯酸睾酮或十一酸睾酮）或透皮睾酮（即凝膠）。)
Testosterone results in: (睾酮導致：)
More body and facial hair. (更多的體毛和面部毛髮。)
More muscle. (更多的肌肉。)
Periods stop. (經期停止。)
Increased libido. (增加。)
Voice may become deeper. (聲音可能會變得更低沉。)
Masculinizing Effects in Transgender Males
| Effect | Onset | Maximum | |
|---|---|---|---|
| Skin oiliness/acne | 1-6 mo | 1-2 y | |
| Facial/body hair growth | 6-12 mo | 4-5 y | |
| Scalp hair loss | 6-12 mo | | |
| Increased muscle mass/strength | 6-12 mo | 2-5 y | |
| Fat redistribution | 1-6 mo | 2-5 y | |
| Cessation of menses | 1-6 mo | | |
| Clitoral enlargement | 1-6 mo | 1-2 y | |
| Vaginal atrophy | 1-6 mo | 1-2 y | |
| Deepening of voice | 6-12 mo | 1-2 y | |
Hormones for a trans woman:
Oestrogen: Estradiol (oral, transdermal patches) or estradiol valerate or cypionate (parenteral). (雌激素：雌二醇（口服、透皮貼劑）或戊酸雌二醇或環戊丙酸酯（腸外）。)
Anti-androgens: cyproterone acetate, spironolactone. (抗雄激素藥物：醋酸環丙孕酮、螺內酯。)
Oestrogen and anti-androgens result in: (雌激素和抗雄激素藥物導致：)
Genital shrinkage. (生殖器萎縮。)
Less muscle. (肌肉減少。)
Fat on hips. (臀部發胖。)
Lumpy and enlarged breasts. (乳房腫塊和增大。)
Less facial and body hair. (面部和身體毛髮較少。)
Feminizing Effects in Transgender Females:
| Effect | Onset | Maximum | |
|---|---|---|---|
| Redistribution of body fat | 3-6 mo | 2-3 y | |
| Decrease in muscle mass and strength | 3-6 mo | 1-2 y | |
| Softening of skin/decreased oiliness | 3-6 mo | Unknown | |
| Decreased sexual desire | 1-3 mo | 3-6 mo | |
| Decreased spontaneous erections | 1-3 mo | 3-6 mo | |
| Male sexual dysfunction | Variable | Variable | |
| Breast growth | 3-6 mo | 2-3 y | |
| Decreased testicular volume | 3-6 mo | 2-3 y | |
| Decreased sperm production | Unknown | >3 y | |
| Decreased terminal hair growth | 6-12 mo | >3y | |
| Scalp hair | Variable | | |
| Voice changes | | None | |
Adverse outcomes of hormonal therapy:
Transgender female (MtF) on oestrogen:
Very high risk: Thrombosis (極高危：血栓形成)
Moderate risk: Breast cancer, Stroke, Coronary artery disease, Hypertriglyceridemia, Pituitary adenoma (benign), Gallstones (中度風險：乳腺癌、中風、冠狀動脈疾病、高甘油三酯血症、垂體腺瘤（良性）、膽結石)
Transgender male (FtM) on testosterone:
Very high risk: Increased RBC volume (極高風險：紅細胞體積增加)
Moderate risk: Severe liver dysfunction, Stroke, Coronary artery disease, Hypertension, Breast or uterine cancer (中度風險：嚴重肝功能障礙、中風、冠狀動脈疾病、高血壓、乳腺癌或子宮癌)
Medicines are licensed for "transition." (藥物獲得「過渡」許可。)
Challenge of the transition:
Ria, born Brad, began wearing heels and makeup at the age of 12. (Ria 原名 Brad，12 歲開始穿高跟鞋和化妝。)
Ria started to transition at 15 but struggled with hormone therapy and puberty blockers. (Ria 在 15 歲時開始過渡，但在激素治療和青春期阻斷劑方面苦苦掙扎。)
At 18, she stopped the hormones and lived as a gay man. (18 歲時，她停止了荷爾蒙，過上了男同性戀的生活。)
At 23, she is starting the transition again. (23歲的她再次開始過渡。)
Detransitioning:
There is a lack of large-scale studies that measure the success of gender transitioning care. (缺乏衡量性別轉換護理成功與否的大規模研究。)
It is estimated that between 1-25% regret transitioning with time. (據估計，1-25% 的人後悔隨著時間的推移而過渡。)
Reasons for regret or detransitioning include:
Gender fluidity. (性別流動性。)
Not understanding sexuality, e.g., transitioning to avoid being in a homosexual relationship. (不瞭解性行為，例如，為避免處於同性戀關係中而過渡。)
Response to assault or sexual abuse. (對攻擊或性虐待的反應。)
Impact of neurodiversity on sense of identity. (神經多樣性對身份感的影響。)
Impact of mental health issues. (心理健康問題的影響。)
Failure of genital reassignment surgery. (生殖器複位手術失敗。)
Unwanted side effects from hormones, e.g., male pattern baldness. (荷爾蒙的不良副作用，例如男性型禿髮。)
Stigma in society, abuse, and violence. (社會恥辱、虐待和暴力。)
Recognizing Gender (UK):
A Gender Recognition Certificate allows the affirmed gender (male or female only) to be legally recognized in the UK. (性別認可證書允許確認的性別（僅限男性或女性）在英國得到法律認可。)
UK birth or adoption certificates can be updated. (UK 出生證明或收養證明可以更新。)
Marriage or civil partnership formed in affirmed gender or UK certificates can be updated. (以確認的性別或英國證書形成的婚姻或民事伴侶關係可以更新。)
Death certificates include affirmed gender. (死亡證明包括確認的性別。)
Gender Recognition Certificates DO NOT:
Change legal status as father or mother of a child. (更改孩子父親或母親的法律身份。)
Recognize non-binary. (識別非二進位。)
Application for a Gender Recognition Certificate requires people to meet all of the following:
Age 18 or over. (年滿 18 周歲。)
Diagnosed with gender dysphoria (diagnosis and treatments confirmed by 2 UK medical doctors or a UK doctor and clinical psychologist, one with expertise in GD). (被診斷為性別焦慮症（診斷和治療由 2 名英國醫生或一名英國醫生和臨床心理學家確認，其中一名具有 GD 專業知識）。)
Living in affirmed gender for 2+ years (evidence from ID documents, bills). (在確認的性別中居住 2+ 年（來自身份證文件、帳單的證據）。)
Intending to live in affirmed gender for life (confirmed by medical report). (打算終生生活在確認的性別中（經醫療報告證實）。)
OR
Age 18 or over. (年滿 18 周歲。)
Have documentary evidence that affirmed gender is legally recognized in an approved country. (有書面證據證明確認的性別在獲批准的國家/地區得到法律認可。)
No Gender Dysphoria Diagnosis?
A Gender Recognition Certificate can be applied for with evidence of being in a marriage or civil partnership and living in England, Wales, and Scotland before “same-sex marriage” was legalized (December 2014), living in affirmed gender for 6+ years prior to the relevant dates (before December 2008), and having had gender affirmation surgery. (可以申請性別承認證書，但要證明自己處於婚姻或民事伴侶關係中，並且在“同性婚姻”合法化（2014 年 12 月）之前居住在英格蘭、威爾士和蘇格蘭，在相關日期之前（2008 年 12 月之前）以確認的性別身份居住 6+ 年，並且接受過性別確認手術。)
What if these requirements cannot be met?
A gender recognition certificate is not needed to change gender on: (在以下情況下更改性別不需要性別認可證書：)
UK driving license (英國駕駛執照)
UK passport (英國護照)
Employment records (就業記錄)
Bank account (銀行帳戶)
Medical records (病案)
Can request that change is made and sex assigned at birth can be erased from these records. (可以要求進行更改，並且可以從這些記錄中刪除出生時分配的性別。)
What could go wrong?
Missing sex-based disease prevention or screening. (缺少基於性別的疾病預防或篩查。)
Prescribed medicines that are not appropriate due to sex-specific cautions (e.g., teratogenicity). (由於性別特異性注意事項（例如致畸性）而不合適的處方藥。)
Patient requests to see HCP of a particular sex. (患者要求見特定性別的 HCP。)
The new record would delete prior history and could affect treatment. (新記錄將刪除先前的病史，並可能影響治療。)
Might not consider sex-specific risks to health. (可能不考慮性別特異性的健康風險。)
Gender Identity and the NHS: Patients and Staff:
Remember: a Gender Recognition Certificate is not required to change medical or employment records. (請記住：更改醫療或就業記錄不需要性別認可證明。)
Under current NHS guidance (consultation ongoing), transgender patients are entitled to be accommodated in single-sex wards that match how they self-identify. (根據目前的 NHS 指南（諮詢正在進行），跨性別患者有權被安置在符合他們自我認同的單性別病房。)
Provision of single-sex accommodation is based on the Equality Act 2010, and both biological sex and gender reassignment are protected characteristics. (提供單性別住宿基於 2010 年《平等法》，生理性別和性別重置都是受保護的特徵。)
The NHS strives to be a workplace where staff are treated fairly, equally, and free from discrimination, in an environment free from harassment, bullying, or violence. (NHS 努力成為一個員工得到公平、平等、無歧視的工作場所，在一個沒有騷擾、欺淩或暴力的環境中。)
Scottish Health Board vs. Nurse Sandie Peggie:
A transgender doctor was given permission to use female changing rooms. (一名跨性別醫生被允許使用女性更衣室。)
The nurse complained about feeling uncomfortable and embarrassed when using the changing room with them and was forced to leave. (護士抱怨說，和他們一起使用更衣室時感到不舒服和尷尬，被迫離開。)
The nurse was suspended for bullying, a “hate incident,” and a disciplinary investigation was started. (這名護士因欺淩、「仇恨事件」而被停職，並開始進行紀律調查。)
The nurse is taking legal action on grounds of sexual harassment and breach of the Equality Act 2010. (這名護士正在以性騷擾和違反 2010 年《平等法》為由採取法律行動。)
The transgender doctor stated that while colleagues might have felt uncomfortable with women’s facilities being used by a transgender person, that (這位跨性別醫生表示，雖然同事們可能對跨性別者使用女性設施感到不舒服，但)