The concept of gender identity

Gender identity is understood to refer to each person’s deeply felt internal and individual experience of gender, which may or may not correspond with the sex assigned at birth, including the personal sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other expressions of gender, including attire, speech and mannerisms’ (International Commission of Jurists, 2007).

A person’s gender identity can change over their lifetime, can be expressed in a number of ways and forms. It is subjective and self-defined. Some people may express different gender identities in different situations. Gender identity cannot be used to predict a person’s sexual orientation. It also cannot be predicted by someone’s recorded sex.

The workplace

BSUH  NHS Trust welcomes all trans staff and patients. It collaborates with local and national gender identity organisations to develop policies and processes which are inclusive of trans and non-binary identities. The Trust regularly participates in events to raise awareness of gender identity issues.

Staff responsibilities

Our individual identity determines how we see ourselves, how others perceive us and how socio-cultural-economic-political institutions, structures and histories define and reflect us. Identity is our core and it is recognised as such by equality legislation.

It is the responsibility of all staff to:

  1. Treat all colleagues with dignity and respect, regardless of gender identity.
  2. Be familiar with inclusive language and terminology.
  3. Challenge and report acts of discrimination, bullying, harassment and victimisation.
  4. Ensure they do not disclose or discuss a person’s transgender status with any third party, without explicit permission from the individual.


For transgender people, the sex recorded at birth and their gender identity differs.

Trans is often used  as an umbrella term for those who describe themselves using a variety of terms such as Transgender, Gender Queer, Gender Fluid and Non-binary (those whose gender identities do not fit into the gender binary of male or female). It should be noted that some non-binary people identify as trans, while others do not.

Sex is biologically determined and is based on chromosomal and physical attributes.

Gender is often expressed in terms of masculinity or femininity. While we may have been taught that gender means boy or girl, man or woman, many of us realise that gender is far more complex with different and related identities and expressions. Gender is largely socio-culturally determined, within an economic, political and historical context, and expectations tend to be assumed from the sex recorded at birth.

Gender expression is the outward display of one’s gender identity as presented by vocal tenor, body shape, hairstyle, clothing selection, behaviour etc.

Transitioning is when a trans person takes steps to live in their gender identity. It may involve social transition, legal gender recognition and/or medical transition. There is no single way of transitioning, nor is transition defined by medical steps someone has or has not taken.


A person’s name and pronoun that matches their gender identity should be collected on admission forms and used consistently by front desk staff and clinicians during visits, as well as in telephone, email and letter communications as requested by the patient. Names and pronouns may not always appear to match a person’s gender identity so it is important to ask the patient for the name and pronouns they use.

Workplace policies & guidelines

All workplace policies should use inclusive language and terminology which covers trans and non-binary people. As far as possible, try and use gender neutral terms. Staff should be familiar with ‘Guidelines for Supporting Trans Staff and Patients’.

Coming out

This is a process that can be difficult. It is often the case that a person will  need to come out more than once (e.g. accessing health services, talking to family, colleagues). Respect a person’s dignity, privacy and right to choose  how, when and if they want to come out.

The Trust is committed to supporting staff who express an intention to transition and will work with the member of staff to ensure as smooth a transition at work as possible.

Bullying and harassment

The Trust does not tolerate any form of bullying and harassment. Examples of misbehaviour include:

  • Refusing to treat a trans person.
  • Failing to address a person by their preferred name and correct gender pronoun.
  • Verbal, visual (e.g. eye-balling) or physical abuse.
  • Refusing to provide suitable changing and restroom facilities.

Gender neutral terminology

Boyfriend/girlfriend = partner

Son/daughter = child

Husband/wife = spouse

Brother/sister = sibling

Mum/Dad = parent

He/she = they

His/her = their

Why does the Equality Act 2010 consider gender reassignment (gender identity) as a protected characteristic?

Many societies hold to rigid binary gender identity structures. Those who identify as transgender have historically been unable to challenge this because of how transgender people are viewed across different societies and cultures.


What does the law (England, Wales and Scotland) say?

You must not be discriminated against because you are transgender, because you are perceived to be transgender or because you associate with someone who is transgender.

Intersectional identities and the workplace

BSUH recognises that staff and service users come from diverse backgrounds, and many face the possibility of multiple discrimination. It strives to ensure that they do not face discrimination on the grounds of their gender identity or in relation to other aspects of their identity, for example age, disability, ethnicity (nationality), religion or belief, sexual orientation, marriage or civil partnership, pregnancy or maternity.