Doctors 'refusing' UK gender dysphoria patients hormone treatments

LONDON -- Doctors are "failing to help patients with gender dysphoria," a leading British doctor has warned in the British Medical Journal. 

The need for hormone treatment has never been higher, but “as many as one in five GPs won’t prescribe for people with gender dysphoria, even after expert advice from an NHS clinic," according to James Barrett the President of the British Association of Gender Identity Specialists.

The NHS defines gender dysphoria as a "condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity." 

The Office for National Statistics does not produce estimates of the number of transgender people living in the UK, but trans rights organisation Press for Change estimated there were around 5,000 post-operative transgender people in the UK in 2014. And, the combined wait list for the UK's 11 gender identity clinics is in excess of 5,000 people, says Barrett, citing NHS England figures. 

Conservatism is at the heart of GPs' refusal to help patients, says Barrett, who is also a consultant psychiatrist at Charing Cross Gender Identity Clinic in London. 

"Currently, however, in the experience of those of us who work at gender identity clinics as many as one in five GPs won’t prescribe for people with gender dysphoria, even after expert advice from an NHS clinic," he writes. 

Barrett says that reasons GPs have given for refusing to treat patients with gender dysphoria range from it being against “deeply held Christian beliefs,” to statements like “we are trained to treat illnesses, not to change nature," as well as concerns about it being dangerous, difficult, expensive.

This refusal to provide care contravenes NHS England guidance, however. Barrett says that NHS England’s guidance stipulates that: “GPs are expected to care for people with gender dysphoria just as for any other group with an uncommon condition easily managed with a joint care model.”

“Patients are still [...] referred to by their old title or legal sex, sometimes years after hormone treatment or gender reassignment surgery.”

LGBTQ rights organisation Stonewall has also found widespread evidence of a lack of confidence among doctors when it comes to treating trans patients. 

"Our research found that a quarter of health and social care practitioners with direct responsibilities for patient care are not confident in their ability to respond to the specific care needs of trans patients and service users," a Stonewall spokesperson told Mashable.

"In fact, only one in 10 practitioners with direct responsibility for patient care said they received training on the health needs of trans people," they continued.

Stonewall says training providers at medical institutions, as well as schools and universities should provide teaching on how to be LGBTQ-inclusive. 

There are also serious issues with the way in which transgender patients are treated by doctors, according to Barrett. 

"Their transgender can be viewed as a psychiatric illness, which it never was, and can feature in every medical consultation and referral even if not relevant to the ailment in question, in a manner that would be unacceptable if the issue was that they were gay or black," writes Barrett. 

“People with gender dysphoria aren’t freaks. They are teachers and accountants, police officers and doctors, parents and taxpayers, and -- importantly -- patients as deserving of respect and decent, routine NHS care as anyone else. It’s about time they started getting exactly that.”

All registered UK medical practitioners will receive an email from the GMC (General Medical Council) with a document containing updated guidance for doctors on treating transgender and non-binary patients, according to a blog post by the Chair of the NHS England Gender Task & Finish Group, Will Huxter, on Thursday. 

The document: "reaffirms previous guidance published by NHS England on the responsibilities of GPs in the prescribing and monitoring of hormone treatment for transgender people."

We've reached out to the NHS for further comment.

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