Working With Diversity, Northern Ireland Section 75 Equality Scheme Advice

People with gender dysphoria or gender identity disorder live with a conviction that their physical anatomy is incompatible with their true gender role. They have an overwhelming desire to live and function in the opposite biological sex. Some people become aware of their transsexualism as children while others discover their feelings later in life. Once experienced these feelings are unlikely to disappear.

The cause of the condition remains obscure. Many transsexual people benefit from counselling and others live happier lives following hormone treatment and gender reassignment surgery.

The main NHS centre providing specialist care for adults in England is at Charing Cross Hospital in London. There are smaller services in Leeds, Leicester, Newcastle and Bristol. The Gender Identity clinic at Charing Cross Hospital saw almost 470 new cases last year and has roughly 1,000 active patients. Data on the number of gender reassignment operations performed in the NHS is collected as part of the Hospital Episode Statistics. In 1997/8 there were 44 male-to-female operations and 4 female-to-male operations. A study of private-public mix of acute hospital care published by the Association of British Insurers recorded 104 gender reassignment operations in the private sector in 1997/8.

Gender reassignment is commonly termed a sex change, but in reality it is an alteration only in a person's physical characteristics. The biological sex of an individual is determined by their chromosomes, which cannot be changed. What can be achieved through the transsexual person's own efforts, and with counselling, drugs and surgery is social, hormonal and surgical reassignment.

At present, in certain circumstances, a transsexual person's acquired gender is recognised but only where the issue is one of identifying the individual rather than determining their legal status. Thus, on the production of evidence that a person is living as a member of the opposite sex (e.g. a letter from the medical practitioner) documents such as a driving licence, passport, car registration document, National Insurance and medical card may be issued in the new identity. This has eased some of the difficulties faced by transsexual people.

The most frequently mentioned concerns of transsexual people are the wish to have a birth certificate showing their new gender, to marry in that gender and, most importantly, the grant of legal recognition of their acquired gender for all purposes.

(Source: Home Office Report of the Interdepartmental Working Group on Transsexual People)

In the United Kingdom a person is allowed to change their name and personal details and to live as a member of the sex opposite to that recorded at birth. The majority of transsexual people also undergo medical treatment, which can include hormone therapy and reconstructive surgery. This is only provided following careful assessment by medical professionals, and may take some time.

The current legal position in the United Kingdom is that a person remains throughout their life (the sex recorded at birth). For transsexual people this means that their legal status cannot be amended to reflect their current identity, despite medical treatment and / or a change of social gender.

This is the first report to focus specifically on the transgender population in Northern Ireland. It was commissioned by the Equality Directorate at the Office of the First Minister and the Deputy First Minister to provide an evidence base to assist bodies in effectively considering transgender issues in the development of policy and practice.