In 2016, there was excitement as the healthcare magazine ‘GP Online’ proudly announced that ‘GPs should consider prescribing ‘bridging’ hormone treatment to transgender patients attempting to self-medicate while they await specialised gender identity treatment, GMC guidance recommends.’
With waiting times for specialist appointments increasing rather than decreasing, this was real positive news for trans people.
In 2020, the GMC advice continues to make the following recommendation to doctors:
‘Bridging prescriptions’
It may be that the risk of harm to your patient of self-medicating with hormones bought from an unregulated source is greater than the risk of initiating hormone therapy before the patient is assessed by a specialist.
A harm reduction approach is advocated by the Royal College of Psychiatrist’s current guidelines and it would be in line with our guidance if judged it to be of overall benefit to your patient. We have highlighted the most relevant parts of guidance, for you to consider when making this judgement, in the related guidance section of this page.
But you should only consider issuing a bridging prescription in cases where all the following criteria are met:
- the patient is already self-prescribing or seems highly likely to self-prescribe from an unregulated source (over the internet or otherwise on the black market)
- the bridging prescription is intended to mitigate a risk of self-harm or suicide, and
- the doctor has sought the advice of an experienced gender specialist* and prescribes the lowest acceptable dose in the circumstances.
*An experienced gender specialist is someone who will have evidence of relevant training and at least two years’ experience working in a specialised gender dysphoria practice such as an NHS GIC.
Many feel that this guidance is still limiting, and doesn’t supply the patient with the full scope of care that they are entitled to on the NHS, but for many it was seen as a potential lifeline. Now, it appeared, there was a safer option than the black market.
Of course every doctor, when interpreting advice, should take the overall health and wellbeing of their patient into consideration, as well as acknowledging one of the key ‘Duties of a Doctor’ laid out by the GMC: ‘Make the care of your patient your first concern.’
So, how many doctors are following the guidance? How many are prescribing Bridging Hormones, how many trans people feel that their doctor makes the care of their trans patient their primary concern?
In July we asked you to share the response you received on asking your doctor to prescribe for you while waiting for the NHS specialist services. Even we were shocked at the results.
Of those who responded in the affirmative to the question have you asked your GP to prescribe bridging hormones for you, this was the response they received…
There has to come a time when GPs are held accountable for their own actions. They can refuse to help their trans patients, but not without good reason, and not without making the care of their patient their first concern.
We need to stand together and raise the expectation that GPs put some time aside to read guidance for Primary Care doctors. There is ample information available, such as the excellent Guidelines from the University of San Francisco and California.
We need to raise our expectations: GPs should not be able to refuse to provide basic hormone therapy to patients who are fit and healthy, without concurrent health problems that could raise cause for concern, without very good reason. Trans people need to know their rights and they need to push for the care they are entitled to.
By refusing to follow the guidelines, which are so clearly set out by the GMC, GPs are either stating that they are unwilling to accept that their patient is trans, or that they cannot do so without a specialist clinic validating that person’s gender. Or, worse, they are saying they haven’t got the time (or inclination) to learn and increase their knowledge in this area. Neither of these options would be acceptable in any other avenue of healthcare and it should not be acceptable when it comes to supporting people with their gender.
To put this in perspective, for those who are reading this article and are still not confident that they should be able to access their healthcare via their GP, picture this scenario:
Mary Foster tells her GP that she has all the symptoms of diabetes. The GP, an educated medical professional, can see that based on Mary’s symptoms this looks like it may indeed be the case. The GP refers Mary to the specialist diabetic clinic. Three years later, Mary gets an appointment. The clinic agrees, in line with the patient and the GP’s suspicions, that Mary does indeed have diabetes and recommends she has insulin injections for the rest of her life. The GP is not sure about his knowledge of diabetes and refuses to prescribe for her. The specialist clinic does not have a policy in place for prescribing, only advising, so Mary goes without her treatment for her diabetes.
I am 76 years young and know what I want from the rest of my life. Refered to Leeds a year ago and apart from initial phone chat nothing. Been to my GP and they will only deal with Leeds and will not entertain dealing with with Gender GP. This I find totally wrong as surely the NHS can run a similar system to yourselves when it comes to assesing patient’s needs. My wife may well have to go into a home or at least have full-time care at home therefore making it very hard for me to pay for medicine.
I was a patient at Leeds Gis over a 3 year period, and was diagnosed with gender dysphoria, I’m back now on the priority list, and have not heard anything for some time, I’m 70 years old, I may see about bridging hormones, I would like to share with anyone else who might be in the same position,
Fear – that is my experience of why GPs won’t prescribe.
I have had two GP’s in the 5 years since I started to transition. Both said they would not prescribe hormones unless directly instructed by the NHS Gender Clinic I am with. Reasons: 1 x “This is completely out of my comfort zone as a GP. I do not want to get it wrong”. 1 x “Because other GPs have been taken to court in the UK by the parents of young people with Gender Disphoria for prescribing hormone treatments, I am not prepared to prescribe for you. I hope you understand.” I’m over 50…
Do you want the truth?
My GP told me straight up that the blocker is the insurance company of any practice/surgery if they don’t do shared care or bridging prescriptions or a functional diagnosis of gender dysphoria.
They (insurance companies) will refuse to cover a practice/surgery if they offer that to their patients.
They (my GP) didn’t know if its because of liability questions or other factors.
The GPs are often not at fault, they are being held hostage by the insurance companies.
I’ve had this told twice by two different GPs from different surgeries, and the GPs themselves were incredibly friendly and sympathetic to my problem.
One of them straight up told me to go private if I can afford it because the waiting times around here were between 5-7 years, and how he thought it was a travesty that their hands were tied like this.
I believe the problem to be systemic, not personal, and the GPs are merely between a rock and a hard place.
Hi
It’s a terrible situation in this country considering we’re ament to be so open minded. I made the decision when I was 32 to look into it correctly. Utter disappointment. My gp was not interested in helping me at all instead said he would refer me which is fair enough. I’m now 42 and you have guessed got nowhere. So I thought private and used gendergp services. Initially I had to tell a white lie to my gp asking just for a general health check Inc hormone levels etc. It also shows I was in good health etc. So I sent the results to gendergp and after a few weeks and important measures put in place they helped me out. It was a very professional setup and I always felt safe. Unfortunately I just got no where with the NHS and after 2 years I lost all faith and thought what is the point so I gradually stopped. So now I live life pretty much unhappy but at the same time just get on with it. I am tempted to self medicate but am so worried about the actual medication I would potentially receive. Hopefully the future will be better but for now there are a lot of people living life in limbo.
Nobody is really to blame its a young industry and the UK is just far to behind the times. Anyway take care.
The issue is that there is absolutely nothing we can do about it at the moment. Unless you win the trans lottery and get a good doctor you are stuck until you win the actual lottery and can afford to go fully private. If Bojo was told he couldn’t get his lil blue pills for 5+ years he’d change the system in the blink of an eye but he sees us as a political punching bag that his base will pay to see stomped on so he’ll do sweet nothing.