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Perfect. So, hi guys, my name is Millie. I'm the education co-lead for Stash. Um And we're joined here today for a really exciting talk by Dr Sally Jury. Um As always, we'll have our talk for 45 minutes and then we'll have AQ and a session at the end. So get thinking of your questions throughout and then um I will be able to share a feedback link at the end and if you will complete that, then you'll be able to get a certificate of attendance as well. So, first of all, just hand hand over to Helena. She's one of our pre specialty. Um No, our medical student, local ambassadors from Bristol University. Go ahead, Helena. Right. Hi, everyone. Good evening. Um So, yeah, today we've got doctor Sally Gbu who is a consultant in genital medicine at Manchester University Foundation Trust. Um She runs the Onyx Clinic which is a weekly designated sexual health and contraception clinic for trans and non binary people. Um She's also an associated director for medical Education at the Trust with a portfolio including specialty doctors and specialist grade doctors and ed as well. Um She's also the chair of the British Association of Sexual Health and HIV Specialist Interest Group on Gender and sexual minorities. So we're really lucky to have her speaking for us this evening and I will hand over to you, Sally. Thank you. Thank you so much for the introduction and great to be here. Um I will just try and share my slides. Hopefully you can see them. I can't see many of you now. So hopefully that's ok. II am very happy to take questions through the session or at the end. So if you do have something you want to ask, I might not see your hands. So just please um either put it in the chat or put your hand up and I think Milly and, and the team will just help coordinate that. Yeah. So I thought what's helpful today is to do a bit of an overview. Um in order to kind of understand when a patient comes to see us in the sexual health clinic as a trans and non binary person, what day they might have had to go through sort of leading up to that point? So it's a bit of an overview of trans healthcare generally because I think that's quite useful and I apologize if this is something you've already had teaching on before and just talking about HIV and trans health, sexual health and then just finishing on how we can improve some services. So I've got quite a lot of slides to get through. Hopefully we'll, I still have some time for questions. At the end. I always start by saying this. So trans is as you're aware, an umbrella term and it encompasses a lot of different things and people at sort of different ends of the spectrum will have different identities. But I'm kind of using transgender to encompass all of those identities. And I do think it's really important, this teaching is kind of delivered by the trans community as well. And I know you have had trans staff members doing these kind of talks I gendered. But I think it's still I still useful experience to share. These are quite old slides now. But I think we're going to see more and more people come into clinics who are trans and non binary. These are a couple of slides here. So the one on the left hand side is a number of people, young, young people, young girls and boys that were referred to the Tavistock Clinic up to 2019. So I said it's quite out of date, but I couldn't find a more up to date chart. But I think it shows quite clearly there has been a huge jump in referrals and similarly on social media, a big increase in the number of people looking online to search for transgender transition. And that was a 4000% increase up to 2018. So I imagine that is even higher and higher now. So we need to make sure that we are well educated in providing inclusive and safe care for the community. I'll skip past this quite briefly. I think what the point here is that we, we don't have huge or great data really on the number of trans, non binary people that there are in the country. There's most recent census data that did include a question about it. Whether that stays, I think we'll, we'll sort of see. But in somewhere like Manchester, it's estimated that about 0.3 of the population may be transgender and the majority of those are young people. And I think uh the community often faces quite a lot of challenges around healthcare and this certainly isn't something that is the same for everybody. You know, there's a very heterogeneous group of people we're talking about. But in general community do face a lot challenges. There's much higher rates of mental health concerns. You can see the statistic at the top there, 84% of trans people have thought about ending their life at some point, which is massive and nearly half of trans people have potentially made a suicide attempt. Health care is difficult. We often have quite gendered services. Unfortunately, there's lots of experiences of people coming to health care and getting transphobic sort of comments from people. And even if it's not intended to be transphobic, just the systems don't always fit. We, we very much live in a sort of binary sued environment. There's much higher rates of sex work and often that's tied to the fact that people maybe struggle with employment when they come out as transgender and have to turn to sex work for employment. We see higher rates of drug and alcohol use high rates of eating disorders and higher rates of intimate partner violence as well. One of the things that's really important and actually, I didn't say my pronouns at the beginning, but my pronouns are she here? I think it's so important when we are looking after people in the community. This is a really basic thing to make sure that you are aware of people's pronouns, introduce what your pronouns are and ask people what theirs are. Language really, really matters. I don't know if this is familiar to any of you if you've seen this before. Um Usually when I present this, some people have and some people haven't. So I just touched through it. Um briefly, it's the gender bread person. It's quite, in some people's view is quite a simplistic thing. I think it can be quite useful if this concept is new to you or people that you're looking after, just to share this about what these different things are. So gender identity is how you identify, you know, whether that is more towards being female or male or non binary, but it's how you sort of think about yourself and feel inside gender expression may be the same, but it might be different. And that's about how you kind of express yourself on the outside. So how you know what about clothes you wear hairstyles, that kind of thing. And these obviously aren't arrows. So they may change, it might not always be the same. Biological sex is generally speaking, what people are assigned to their biological sex at birth through things like their external genitalia chromosomes, hormones. And generally speaking, that is male female and there might be intersex as well. And then sexual orientation is who you are attracted to and that can be to men, to women, to both to nobody. There's lots of different variations there. But I think it's really important, we don't confuse these. So just because someone has a certain gender identity does not mean there will be certain sexual orientation and it may be quite obvious. But it's important that we are thinking about providing safe and close spaces for this community because we legally are required to the Equality Act of 2010 sets out these protected characteristics that it is unlawful to discriminate people against. And you can see their gender reassignment is in there. So is sex, sexual orientation. So there's lots of things there that should protect people from being discriminated against. And in the public sector, it sets out that it is it is unlawful to discriminate and that doesn't have to be intentional. Even unintentional discrimination is unlawful. And we've got to make reasonable adjustments. And I think that reasonable is really important because, you know, I'll come onto this in a little while. There's a lot of um difficult conversations going on around the media at the moment about trans people. As you're aware, we can't make everybody happy all the time. I think as long as we're making reasonable adjustments to make the majority of people have safe and inclusive space. So just very briefly, just going through the journey of how somebody might transition and we kind of talk about a social transition, which is where you kind of change how you might be outwardly and in your different communities, medical transition, more medicine based and then surgery as well. So in social change, this is probably quite obvious, but you know how you present in public may be different, you might come out to your spouse or workmates and it might not be that you come out to everybody. Some people might have one sort of outward gender at home, which might be difficult to at work. And for example, we hear quite a lot of young people that might not feel very safe to be out, say traveling on public transport. And so they might go to a community center and change clothes and that um when they feel that they can do safely, you can change your name by Depot when you're over 18. And if you're under 18, that needs to be done with parental consent and you can get a legal document and the GSC gender recognition certificate to change your birth certificate and sex. Again, this is all a little bit difficult to um at the moment because of the recent Supreme Court ruling and we'll see if there's changes to this in the future. Um And at present, people have been able to get a new GP number, sorry, a new NHS number with their GP if they've got that, um uh Sorry, they can change your gender marker with a GP and that will give you a new NHS number. So the transition process, generally an individual if you want to transition will speak to the GP, he'll then refer to a gender identity clinic. Often that's quite a lengthy wait. So at best, it's around 18 months, but at worst, it can be many years in some centers.