Trans and non-binary people have been found to experience health inequalities in primary care, including more negative experiences of care and higher rates of long-term health conditions.

A survey conducted by GP surgeries and funded by the National Institute for Health and Care Research (NICE) found significant healthcare inequalities, with adults who identify as trans or non-binary more likely to develop long-term health conditions. These include mental health issues, dementia and learning difficulties, and a higher frequency of autism.

The study, published in BMJ Open, found that while trans or non-binary people did not experience any differences in access to primary care, they reported more negative experiences of interpersonal communication, such as involvement in decision-making over treatment and poorer confidence or trust in their care.

The team of researchers led by Cambridge University analysed 850 000 survey responses from the annual GP Patient Survey conducted by NHS England in 2021. The data included 6 300 responses from patients who identified as trans or non-binary.

Higher numbers of young people identified as trans or non-binary, with nearly a quarter of people between the ages of 16 to 24 in this category, almost double the proportion in older age categories. Trans and non-binary participants were also more likely to be from Asian, Black, Mixed or Other ethnic groups and were more likely to live in more deprived parts of the country.

After adjustment for age, ethnicity and deprivation, trans and non-binary adults reported a higher prevalence of 10 out of the 15 long-term conditions. They were found to be three times as likely to be living with dementia or to have a learning disability, twice as likely to be experiencing mental health difficulties and six times more likely to be autistic.

Dr Katie Saunders from the University of Cambridge said that these differences in health outcomes are likely to be complex and could include a mixture of stress, experiences of discrimination, socioeconomic status and the biological effects of hormone treatments.

She added: ‘If you are trans or non-binary, then every time you see a new GP, you are forced to decide whether or not to come out to them. It shouldn’t be too surprising that these communities experience higher rates of mental health problems, given media reporting around issues and the increasing levels of transphobia that many individuals face on a day-to-day basis.’

When the researchers looked at the experiences of trans and non-binary adults in primary care, they found that they were less likely to be involved in decisions about care and treatment. 15% of trans and non-binary people felt they were not involved compared with 6% of other respondents, and 12% of trans and non-binary respondents felt their needs were unmet compared to just over 5% of the rest of the population.

Dr Saunders said there was a preference for continuity of care with a specific GP amongst trans and non-binary patients. She added: ‘Once you find a GP who understands your needs, you will want to see them each time you have an appointment.’

There are currently very few guidelines for GPs on how to care for trans or non-binary patients, and the researchers hope their work will change this and improve treatment and care.

Dr Saunders said: ‘Knowing that a trans or non-binary patient is more likely to be autistic or to be experiencing mental health difficulties, for example, could help GPs prepare for seeing their patients.’