In an effort to respond to Parliamentary criticism of their poor treatment of trans patients, health care bosses been trying to find ways to reduce the pressure on gender clinics. The General Medical Council and NHS England have issued new guidelines for GPs on management of trans patients. These include trying to get GPs to comply with long-standing instructions to provide life-time care for trans patients who have completed their medical transition and been discharged by the gender clinic, and more controversially to provide “bridging hormones” to trans patients who are waiting for appointments. The main reason for the latter policy is the large number of trans patients who are self-medicating. The GMC has taken the view that if people are going to take hormones anyway it is much better that they should do via trusted suppliers and under supervision.

I can’t see gender specialists agreeing to this unless they felt it was safe. They are fairly notorious for defending their specialisation, especially against people in private practice. Basically all GPs have to do is prescribe the hormones, take regular blood tests, and only if the results of those tests come back anomalous do they need to consult a specialist. That specialist will probably be an endocrinologist, not a psychiatrist.

Nevertheless, many GPs are outraged about this new development. An organisation called the General Practitioners Committee has written to the GMC to complain that this is requiring GPs to do something that is “clearly outside their expertise and competence”. It is clear that a significant number of GPs do not want to be responsible for providing health care to trans people.

The reason for this is fairly obvious from the comments on those two articles I linked to, which are from a doctors’ website called Pulse. One commenter compared trans people to heroin addicts. Another states:

What if they get PMT and commit suicide? Or testosterone fueled rage attacks?

The fact that trans people are committing suicide in large numbers because they can’t get treatment doesn’t matter to these people. What they are scared of is dealing with patients who, in their eyes, are insane and a menace to society.

Guess where they get that idea? Hello mass media, especially you, New Statesman. Which is why I think the training that The Diversity Trust, Gendered Intelligence and similar organisations do is so important. Sadly, while the NHS has been generally supportive of what we do, GPs themselves are extremely resistant to attending such training.

Fortunately there are GPs who are helpful and understanding. The trouble is that if you live in a country town or village you are unlikely to be able to find one. My own view is that the way forward in the short term is to establish regional centres of excellence, probably in big cities but also perhaps on a traveling basis in areas like Wales where travel is difficult, where trans people can go is they are denied healthcare by their local GPs. Long term, of course, we need proper training in medical schools.

In the meantime, some of those comments are going to find their way into my training slides.