The gender reassignment process

Understanding the gender reassignment process, including the need for time off

There are many factors relating to gender transition under medical supervision which are outside of the control of the employee concerned. Understanding how the process usually unfolds, and the requirements this imposes on an employee transitioning in the workplace, is essential to achieving a successful outcome.

From an employer’s point of view the important points to note are that:

  • Gender reassignment is a process that takes several years in many cases.
  • Assessment and exploration of the individual’s feelings and needs can take several months and a number of consultations before a path is decided. On the other hand some individuals can be far more certain and can begin living in their new role immediately. An employee may decide that they will only disclose their intentions to their employer when they have decided to begin living in the opposite gender role.
  • Most UK clinicians wish to see people live successfully in their desired gender role for an extended period of time – being able to maintain their employment and have successful social relationships in and out of work. This includes doing all the things that a member of that gender would normally do.
  • Some clinicians go as far as to request evidence of this from employers even before they will begin prescribing cross sex hormones and the ‘blockers’ that will halt the effects of the sex hormones the patient’s body normally produces. Such a request should only ever properly come with the consent of the employee concerned.
  • The period of cross-gender living is referred to as a ‘Real Life Experience’ (RLE) and is supposed to be for the benefit of the individual to be able to determine that a permanent change of role is going to be right for them. However, some clinicians also regard the experience as a ‘Test’ to determine whether they feel comfortable about referring the individual for irreversible surgeries. This means that any failure by managers and colleagues to accept the individual during this phase of treatment can have a damaging effect on the progress of their treatment. This is why it is important that people undergoing medically supervised transition should be enabled to work normally, socialise and use workplace facilities in the same way as others of the intended gender. 
  • It is not a foregone conclusion that someone will undergo any particular surgeries. People seeking gender change are generally more concerned with being able to function in the role where they are comfortable. A lot of the pressure for genital conformity comes from others. Some surgeries may be clinically contraindicated for certain individuals too – perhaps through age, family medical history or factors such as obesity which add to the risks of lengthy anaesthesia. It is for these reasons that genital surgery is not an absolute pre-requisite for legal recognition – the emphasis is instead placed upon medical diagnosis of the need for transition. Most transsexual people do seek surgery of some kind though, particularly to aid in ‘passing’.
  • Both assessment and surgeries will require the employee to have time off from work.
  • For assessments it should be borne in mind that many NHS Primary Care Trusts currently only offer a single option for referral – often to the UK’s largest gender identity clinic, at Hammersmith in London. This means that employees may often have far to travel – increasing the amount of time off required.
  • The recovery time from surgeries will depend on the procedure, the individual and any complications that may arise. Trans people generally make comparatively rapid recoveries because they are physically healthy and also because the surgery is a positive event for them. Nevertheless, major surgeries like genital reassignment can require several weeks. Male to female genital surgery is usually accomplished in a single step. Female to male surgery is often more complex and can involve 4 to 5 separate surgeries, each requiring a period of recovery before returning to work. Time off may also depend on the kind of work the individual does. Someone doing physically strenuous work may need a longer absence, for instance.

Any reasonable absence because of the effects of treatment for gender reassignment should not normally be taken into account for the purposes of formal action for unsatisfactory attendance. Careful account should be taken of the requirements imposed by the clinicians treating the individual, the distances travelled to appointments, plus the differences that can occur between different people recovering from surgery. Discuss with the employee concerned how they might make the best use of paid leave entitlement as part of the process.

Last Updated: 27 Oct 2009