Investigating the outcome of the initial assessment at a national transgender health service: time to review the process?

Background: Globally there is a lack of standardised assessment process prior to the initiation of physical interventions and consequently there is a discrepancy in this process among different transgender health services. Aim: The main objective of this study is to investigate the outcome of the assessment process at a national transgender health service. Method: The outcome of people assessed at a large national transgender health service in the UK during a two years period was categorised into: 1) recommendation for hormone treatment, or: 2) no recommendation for hormone treatment. In addition, 200 case-notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process. Results: During the studied period a total of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for hormone treatment and leaving 237 (38.4%) patients requiring a longer assessment period or being discharged. The factors associated with being recommended for hormone treatment were: having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case-notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88 % (n= 176) of the cases. Discussion: Although the results of the study may not be generalizable to other international centres, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the inclusion of two assessors needs to be reviewed