I am somewhat ashamed at some of the comments I hear from my GP colleagues regarding their role in trans care. The issues of ‘not knowing enough’ and ‘not having enough time’ are just indefensible, and in the current era of litigation-happiness, it will be interesting to see the results of such cases.
We are the ultimate generalists, and treating trans people should be just part of our every day bread and butter. Those who guide us (The GMC and NHS) have issued clear guidelines on what we should be doing yet doctors still feel able to refuse to do blood tests on patients wishing to start hormone therapy, or who are already taking it. They feel justified in not referring people to Gender Identity Clinics because they feel that trans issues are ‘cosmetic’. They feel justified in not providing people access to medical support and guidance, because they ‘don’t know enough about it’.
Gender Variance is a condition where the birth gender does not match the individual’s perceived gender. Gender dysphoria occurs when there is psychological distress because of this variance. I see far too many cases of dysphoria which are highly exacerbated by the medical profession, and the statistics of self-harm and suicide are spine-tingling. How much of this do we actively contribute to?
You don’t need a mental assessment before you are allowed to marry your life-long same-sex partner, you don’t need a mental assessment if you are born female and would like breast enhancement, you don’t need a mental assessment if you ask for an HIV test because of your intra-venous drug use. But if you are trans it seems you might do, and so many patients tell me of the discrimination they face from the medical profession once they have mentioned the ‘trans’ word.
Our Gender Clinics are bursting, and with more and more trans people summoning up the courage to seek help, let’s start helping them in Primary Care. We are good at it – every day we deal with patients’ problems related to families, workplace and friends. Every day we are on the alert for severe mental illness which may be clouding judgement. Every day we prescribe hormone therapy and do tests to make sure hormone replacement therapy is as safe as possible. We are not talking about medication that is unknown to us, we are talking about medications such as estradiol and testosterone.
If we lack knowledge, we should seek it. If we have personal, ethical views then we should set them aside. Maybe we don’t have ‘time’ to do it all, but to do nothing is wrong. Small steps go a long way to help this vulnerable group of patients.
1. http://www.gmc-uk.org/guidance/ethical_guidance/28851.asp(accessed 8th April 2016)
2. http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf (accessed 8th April 2016)
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: Dr Helen Webberley offers gender specialist care in her NHS work and on a private patient basis.