The National Lesbian Gay Bisexual Transgender and Intersex+ Inclusion Strategy 2019-2021 commits to ensuring LGBTI+ people, including intersex people, can fully and equally avail of mainstream health services. It seeks to eliminate barriers that may prevent LGBTI+ people, including intersex people, from accessing health and social services due to a lack of understanding of their specific needs and a lack of targeted service promotion.The actions in the strategy aim to reduce barriers to access to health services and to improve health outcomes for the LGBTI+ community, including intersex people. A specific objective is that better data should be available on the prevalence of intersex conditions and that consideration should be given to appropriate clinical governance in the context of international evidence and guidelines.The development of the strategy was underpinned by a robust consultation process, with a series of regional and thematically focused workshops facilitated by leading LGBTI+ experts and researchers. In addition, specific workshop sessions were organised for intersex people and other groups to ensure that the voices of the more marginalised members of the LGBTI+ community were adequately heard.With regards to the clinical pathways for intersex people, it is important to note that the term intersex is used differently by different people. In clinical practice, it was a term previously used to describe what are now termed disorders or differences of sexual development (DSD). DSD covers a wide range of clinical conditions with a wide range of needs, all of which are very different to each other.
People with DSD, when diagnosed, will usually be referred to their local Endocrinology Department. At present, most Endocrinology Departments around the country see people with DSDs on a regular basis. For every DSD there will be specific needs. Some will be associated with intellectual disability that require multidisciplinary support, some with mental health issues that require liaison psychiatry support and some with complications that require specific specialist medical or surgical support. The needs vary significantly between different DSDs and so the concept of a single DSD service or a working group directed at DSD service provision as a whole is unlikely to be feasible. At present, most people with DSDs are managed by their local Endocrinology Outpatient Department with input from other clinical services as needed.
