Doctors are not being trained well enough to provide adequate medical care to transgender people, NHS officials have warned parliament.
MPs were also told on Tuesday that transgender patients were not being treated equally by the NHS.
Dr John Dean, the chair of NHS England's Clinical Reference Group for Specialised Gender Identity Services, told a Commons committee that doctors were "hampered by a lack of knowledge" when it came to trans issues.
"Overall people working in the service try to be empathic, they are certainly sympathetic, but they lack a great deal of background knowledge about gender incongruence and dysphoria. It is something which is not covered in any detail in medical training," he said.
He said that while medical students were interested in the needs of transgender people, they received "very little information" about it during training.
And he warned that many doctors and other NHS staff found it "very scary" when they did not even have a proper understanding about which pronoun to use when addressing a transgender patient. "That can cause deep offence to patients if that issue isn’t properly addressed," he said.
Dr Dean was giving evidence to the Commons women and equalities committee, which is conducting an inquiry into transgender equality.
He added that given the "dramatic" rise in the number of people seeking care, it was "no longer appropriate" for doctors to palm transgender patients off to specialists physicians. "Trans people are people and must be treated like people," he said.
Steve Shrubb, the chief executive of West London Mental Health NHS Trust, also told MPs that transgender people were not treated equally by the health service. "Transgender individuals really do suffer stigma," he said. "I don't believe there is equality."
Shrubb added: "Whether it's through lack of knowledge or people's own views I think service users tell me it can feel as if they are not being treated equally"."
Announcing the inquiry in July, committee chair and former cabinet minister Maria Miller said there needed to be "true equality for everyone".
"many trans people still face discrimination and unfair treatment in their work, schools, healthcare and other important services," she said.