I am an NHS GP with a specialist interest in sexual health and gender care. Understanding that transgender care in the UK is suffering from illegally long waiting times, prejudice from health care workers, and a lack of sufficient evidence to inform treatment pathways, I set up a free advice website for adults, parents and children needing medical help.
The response has been overwhelming and has uncovered a real need for compassionate medical care, something that as a GP I am well versed with, and my private clinic has developed.
My practice, GenderGP, offers free medical advice and help on how to access NHS pathways. For those who want private care, I offer diagnosis, assessments and safe reliable medication and monitoring. Many people use my service as a stop-gap between being referred for NHS treatment, and the long waiting lists to be seen.
In my clinic, each adult, teenager, child, person, patient is treated individually and their care plan is tailored to their needs and adjusted according to their response.
Many children from the UK have been travelling to Boston USA, or to Hamburg in Germany, to access medication and surgery that they are unable to access on the NHS due long waiting times and strict protocols which are not necessarily evidence-based.
Puberty brings irreversible and devastating changes for trans children and time is of the essence to give them the care they need. If children are given puberty blockers, then you can prevent trans girls from having broken voices, big Adam’s apples, large hands and feet, masculine faces and unwanted facial and body hair. For trans boys, you can prevent breast development and feminine hips, thighs and waists, and you can prevent the growth plates from fusing which then prevents them from reaching their equivalent male height.
The next step in treatment is cross-sex hormones, which allow the child to go through the puberty that matches the gender they identify with rather than the one that fits their biological sex.
For trans children, this is not a choice, this is a reality. It is not a ‘phase’ or ‘something they will grow out of’. Their true gender is not what society labels them as by looking at their genitals. Self-harm and suicide rates are startlingly high, and distress, anxiety and depression far too common. For children and families in whom the diagnosis is clear, and there has been a persistent and unwavering identification as the opposite gender then treatment options should be discussed and treatment given as necessary. Early intervention is not appropriate for all children, but each case should be taken on its merits, and a secure management plan negotiated and planned with all involved.
I have treated many children, usually those in their later teens who are absolutely desperate to halt the terrifying and unmerciful pubertal changes that are going to stay with them forever if the wrong puberty is allowed to progress. Once puberty has been stopped, then we have time to discuss the right timeframe for cross-sex hormones to allow them to achieve the right puberty.
The twelve year old discussed in The Guardian is an unusual case, and since starting treatment they have not looked back. Confidence has grown enormously and their distress, anxiety and low self-esteem have vanished. In this case, it was definitely the right thing to do. It may not be right for everyone, but for those it is right for, they should be allowed to influence and be involved in decision-making. Too many children who question the current NHS rules are told it is ‘because that is our protocol’, no reason, no explanation, just ‘that is how it is.’
It is unusual to treat younger children with hormones, but in some cases, after full discussion of the risks, benefits and side effects, then with family and psychological support, it is the right thing to do. We should not be dictating treatment by using age limits and strict protocols, we should be patient-centred and flexible. Young people kill themselves because of delays in treatment and this has to stop.
The NHS is struggling to cope with demand and I offer safe care for all who need it, however old they are.