The availability of timely, compassionate healthcare provided by the NHS for transgender patients has been under scrutiny for some time. The NHS has been criticised for treating transgender people as second class citizens and failing to meet legal requirements under the equality act.
The notion of whether your gender identity can differ from your outward secondary sexual characteristics should no longer be a topic for debate. The medical profession has long accepted that some people need medical assistance to help them prevent the long term negative effects on their mental well-being which can be caused by their naturally produced sex hormones, and to replace these with the opposite hormone to induce characteristics that match their gender identity.
When the gender identity of a person is clear, providing access to this treatment can be lifesaving, because as we know, many transgender people are murdered or commit suicide, and the delays in accessing the medical help they need is a contributing factor.
The concept of self-medicating was not one that I encountered before I started my work with transgender patients. People with diabetes or high blood pressure, angina or epilepsy would not look to the Internet or local gym to source their medication. They would go to their GP and they would get the help they needed. If the condition in question was outside the knowledge and skills of their GP, then they would be referred to a hospital consultant. The NHS constitution states that you should start to receive specialist treatment within 18 weeks, but it is well known that the waiting times for accessing help for gender variance is far in excess of this.
So is it any wonder that children and adults are self-medicating? Obtaining medication that should be prescribed and monitored by a trained medic, from any source that they can so that they can prevent the mental anguish of knowing they have the wrong hormones, and replace them with the right hormones. Desperate people are buying them from unregulated drug stores. Being prescribed by online pharmacies after bending the truth on the medical history form. Borrowing their sister’s oral contraceptives. Obtaining body building injections on the black market.
As a doctor, I shudder at the thought. As someone who is privileged to know, and to have met, so many transgender people, I understand why. My concern is that by taking matters into their own hands patients are putting their health at serious risk of harm.
The GMC has clear guidance for doctors to help their patients who have resorted to self-medication, so that they can prescribe bridging prescriptions to help keep their patients safe. In reality, though, many people who come to me for help and advice have found their doctor reluctant to offer help of this kind.
The chatrooms and forums that discuss the medication regimes and monitoring are in many cases well-informed and correct. But each person’s needs are individual and should be managed on a case by case basis. As with all medication: one size does not fit all.
Forums offer first hand experience and advice for those who are desperate. They offer information and treatment plans that people should be getting from their GP, but they are not. They help to inform and educate which is invaluable for people who feel they are entirely alone. But they are not written by medical experts and should not be treated as a guide on circumventing essential medical input.
There is clearly a desperate need for further education and acceptance around the subject of transgender children, with greater access to support for all the family. That any child feels desperate enough to embark on physically transitioning without parental support is deeply concerning and something that needs to be addressed as a priority.
I do not support self-medication, I urge people to seek advice and prescriptions and monitoring from a doctor. If your GP lacks the knowledge and skills to help you then they should make it part of their continuing professional development to increase their understanding in this area of medicine, or refer you to someone who can help. If you have waited longer than 18 weeks from referral to treatment as set out in the NHS constitution, then you should complain and ask that the NHS take all reasonable steps to offer a range of suitable alternative providers if this is not possible.
It is crucial for young people to be psychologically evaluated by a qualified professional before undertaking treatment – whether on the NHS or privately. A multi-disciplinary approach to patient care is essential, and is a model that should be applied by any practitioner involved in treating transgender people of any age.
At GenderGP we encourage self-identification of gender and offer thorough psychological and medical evaluation with appropriately trained and qualified professionals before commencing any treatment. We only work with established and authorised pharmaceutical dispensers.