Understanding some key terms
People experience and express gender in many ways. You may come across some of the following terms when reading about gender and health.
- Trans and gender diverse is an umbrella term used for people whose gender is different from their sex presumed at birth.
- Cisgender describes people whose gender aligns with the sex they were assigned at birth.
- Gender dysphoria refers to the psychological distress that results from a mismatch between one’s sex presumed at birth and one’s gender.
Follow this link for more information related to non-binary people.
Understanding Gender, Anatomy and Healthcare
Gender and anatomy are not the same thing. Some trans and gender diverse people have anatomy that differs from what clinicians might assume based on their name, appearance or gender markers in medical records.
This matters in IBD care because investigations, procedures and treatments are often guided by anatomy rather than gender.
Your healthcare providers should:
- Use your correct name and pronouns
- Record your gender accurately
- Ask respectful, relevant questions about your anatomy only when clinically necessary
- Explaining why an examination, test or procedure is needed
Sharing clear information about your medical history, gender and anatomy can help your healthcare professionals provide safer, more affirming, and appropriate IBD care.
Intimate examinations and procedures
Some IBD assessments and complications can involve physical examinations of the anus, and sometimes the genitals. For example, your clinician might need to examine these areas if they need to assess a fistula.
If these examinations feel distressing or dysphoria-inducing, you can tell your IBD team ahead of the procedure. You can ask for the examination to be explained clearly, taken slowly, paused or stopped at any time, done with a support person present, or done by a clinician of a particular gender, where possible. You have the right to ask questions and share any concerns before, throughout and after the procedure.
IBD medications and gender-affirming hormone therapy
Some trans and gender diverse people take gender affirming hormone therapies, including:
- other gender-affirming hormone options.
To learn more about gender-affirming hormone therapy, see the TransHub webpage on hormones or the fact sheets available from Transcend.
IBD treatment often involves medications such as steroids, biologics, or other immune-modifying medicines. Starting a new medication can raise important questions about potential side effects or drug interactions.
If you are taking gender-affirming hormones, it’s helpful to let your gastroenterologist and GP know.
Practical steps that may help with this include:
- Keeping an up-to-date medication list on your phone or in a written care plan (such as our management plan).
- Asking your gastroenterologist or pharmacist directly whether there are any interactions between your IBD medications and gender-affirming hormones.
- Making sure each member of your healthcare team knows what medications you are currently taking.
Anatomy and surgery
Some gender-affirming surgeries involve the bowel. For example, part of the intestine is sometimes used in vaginoplasty. This can add complexity if an IBD diagnosis is made after surgery, or if you already have IBD and are considering gender-affirming surgery.
Crohn’s disease can affect any part of the gastrointestinal tract, so a surgical history involving bowel tissue may be relevant when planning investigations or treatment. Ulcerative colitis affects the colon, so surgery involving the colon may also be important for your healthcare team to know about.
At present, there are currently no formal IBD guidelines specific to trans and gender diverse people who have had bowel-involving gender affirming surgery. This means care is often individualised, with communication between gastroenterologist and the surgical team being especially important.
Mental health and healthcare stress
Mental health concerns and IBD can negatively affect each other. Trans and gender diverse people experience higher rates of mental health difficulties and some chronic physical health problems than cisgender people. This is not due to individual factors, but is often linked to experiences of discrimination, stigma, misgendering, barriers to affirming care, and the cumulative strain of navigating healthcare systems that may not always feel inclusive.
Living with a long-term condition such as IBD can add another layer of stress, particularly when healthcare settings feel unsafe, invalidating, or difficult to navigate.
It is important to consult your GP and/or your gastroenterologist team so that you can access appropriate support when and if required.
Gender Dysphoria and IBD
Living with IBD can involve changes to your body that feel difficult or unexpected. For trans and gender diverse people, some of these changes may interact with gender dysphoria in different ways such as:
- Weight loss or weight gain
- Changes in body shape or fat distribution
- Changes to menstrual cycles
- Fatigue or reduced physical strength.
The changes are often a normal part of IBD or its treatment, but they can feel more complex when they impact how you see or experience your body. Not everyone will experience gender dysphoria in the same way, and not all changes will feel negative. Recognising this intersection can help you and your healthcare providers better understand what support may be needed.
Social Health
IBD can also have negative implications on a person’s social health and relationships. Some treatments that involve dietary adjustments or immunosuppressant medications can make socialising feel stressful. Common IBD symptoms such as fatigue can also make social connection difficult. While isolation and social disconnect can affect all people with IBD, maintaining strong friendships and community support are particularly essential for the wellbeing of trans and gender diverse people.
This experience does not take away from your trans journey, and whatever that journey looks like, it is still valid.
Toilet Access
Urgent and frequent toilet access is a major issue for many people with IBD and can be a significant source of stress when away from home.
For trans and gender diverse people, using public toilets may be even more difficult because of discrimination, lack of gender neutral options, or fear of harassment. Access to safe and inclusive toilets is an important part of reducing distress and supporting health.
You may like to consider a Can’t Wait Card or Master Locksmiths Access Key which allows people with disability 24/7 access to accessible public toilets and facilities.
Your rights when accessing healthcare
The Australian Charter of Healthcare Rights specifies that all individuals have a right to:
- Access to healthcare and services and treatments that meet your needs.
- Safety and high-quality healthcare that meets national standards.
- Respect for your culture, identity, beliefs and choices.
- Partnership in your health care and being able to ask questions so that you are fully informed and can make decisions that suit your needs.
- Information that is easy to understand about your condition and the benefits and risks of different tests and treatments.
- Personal privacy and confidentiality of your health information.
- Give feedback or make a complaint without it affecting how you are treated.
If you are not happy with how you are treated in a healthcare setting, you can make a complaint. You can speak directly to the healthcare professional, to their practice manager (or similar), or ask a family member or carer to do it on your behalf. If you are not satisfied with the response, you can escalate the complaint to the Australian Health Practitioner Regulation Agency (AHPRA). If you live in Queensland or New South Wales, you can complain to the relevant state service before contacting Ahpra. For more information on the process, visit the Aphra website. You can also choose not to complain but ask to change doctors.
Finding an affirming IBD healthcare service
Some signs that a healthcare service may be more welcoming and informed include:
- Visible signs of inclusion, such as rainbow stickers, flags, or affirming staff lanyards
- Forms that include space for your pronouns, affirmed name, and non-binary gender options
- Staff who can explain what training or policies they have in place around inclusion
- Willingness to discuss how your gender and anatomy may affect IBD care in a respectful and practical way
- Clinicians with experience caring for trans and gender diverse people with IBD, especially where hormone therapy, surgery, or intimate procedures are relevant
To find a supportive and informed healthcare professional who is committed to the health, rights and wellbeing of all trans people, visit the Australian Professional Association for Trans Health (AusPATH) provider directory. You can also contact the clinic before an appointment to find out if they have experience and practice working with trans and gender diverse people.
Resources
- Royal Children’s Hospital Melbourne has a Gender Service (Victoria only): aims to improve the physical and mental health outcomes of children and adolescents who are trans or gender diverse.
- QLife is a free and anonymous peer-support and referral service run by LGBTIQA+SB people for LGBTIQA+SB people. QLife provides support by phone and webchat and also has helpful information on their website.
- Transcend Australia offer non-judgemental, compassionate and evidence-based information and support services to any family member who may have a trans, gender diverse or non-binary child or (trans) young person.
- TransHub is a digital information and resource platform for all trans and gender diverse people in Australia, their loved ones, allies and health providers.
- Trans Pride Australia provides support group services and other social support for trans and gender diverse people and their loved ones.
