I am willing to bet one of the main reasons women avoid it is due to lack of trust in HCP, based on national scandals and due to previous experience due to poor care or bedside manner. And there are more women potentially doing avoidant behaviour as a result of 'trans inclusivity' than transmen who would be avoidant due to sticking to sex based descriptions.
The lack of recognition of this is, a scandal in its own right.
Women who have been able to build a good relationship with a HCP are far more likely to trust them with their care. And this goes the same for anyone trans identifying.
The fact that indulging the nonsense that sex is gender is part of the problem and should be stressed by medical professionals in any transition, with failure to acknowledge or accept this, being a barrier to further medical transition - because it points to an inability to demonstrate that they understand what they are consenting to. Such behaviour is a red flag in its own right, which should be acted upon - it is suggestive of other, unaddressed issues.
Women who have had birth trauma and ask for an ELCS are recommended to be immediately granted on, but it should be taken as a red flag to recieve extra appointments and emotional support regardless. Upon doing this, it was found that women are much more likely then to revert to a VB without pressure - because the fear is more about the relationship with HCP and a feeling of not being in control. It centres on the idea of 'not being listen to' and 'being forced into x, y or z'. THIS IS PART OF THE NATURE OF SUCH MEDICAL BASED TRAUMA AND IT IS (OR WAS) BEGINNING TO BE RECOGNISED.
The onus, in this scenario can't be on women to 'chase' help. Part of the point is that these women, are often too vulnerable or traumatised to be able to do this without proactive support from medics who recognise these women can't just be shroved through a sausage factory of care and come out the other end ok. The default needs to be upon identifying women who have a trauma background in any such scenario. And they be treated accordingly with women centred care - and yes that would include excluding males if this is requested and not putting them into a situation where they fear they could be forced into a situation with one against their wishes. Or in the care of transmen, exploring further underlying reasons for being in denial about their sex because this doesn't simply disappear because pronouns are used in the way required.
Female patients should not be asked to uphold the fantasy of others and to stop the hurty feelings of male employees or other patients. They should not be collateral damage to other people's issues. They should be centred. Care should be provided that understands this. Any staff member who doesn't understand this, isn't fit to practice. Any patient who thinks their right to uphold gender beliefs should trump others biological, emotional and differing beliefs shouldn't get preferatial treatment. They should be treated with sensitivity away from other patients to prevent potential conflicts - the onus being on trans patients being a minority versus women.
But ultimately we can not ignore that the 'trans' bit means 'I am the opposite sex to the one I wish I was' and that gender is not sex. We should NEVER be conflating gender with sex in a medical setting because it produces risk to trans patients and has potential to harm to vulnerable patients.
And thats ALSO why the default in healthcare should reflect sex - with those struggling with that, treated in other channels in parallel to other issues. Transmen who transition with hormones and surgery, aren't the type of patient who rocks up to a GP having never seen one for years. They will have been frequent flyers and repeat attenders - probably more than other females. The opportunities for HCP to engage are therefore much more numerous than with say a woman who doesn't speak english and struggles with healthcare messages which aren't really clear.
For me this highlights a real issue: that medical transition isn't fully addressing psychological needs and promotion of social transition isn't recognising there is an inherent psychological problem with conflating sex with gender thats being effectively swept under the carpet.
You can't just ignore the fact that sex isn't gender without doing harm - whether thats to women and transmen or men and transwomen. However there is also a bunch of evidence that females are coming out much more negatively in this, regardless of their beliefs.
Saying we should change language and everyone should just suck up the fall out, does exactly this - ignores the harms to everyone concerned.
Its a cop out. Its a failure of properly individualise care centred on differing needs. Its NHS sausage factory care at the expense of real people who aren't robots.