(1) How did you first get interested in treatment of transgender people?
I have always been interested in equality and diversity – it has always appalled me that anyone should be bullied due to their size, colour, hair, gender, preferences, religion etc. I got very interested in Sexual Health in the 90s and did lots of specialist training in this area, and then taught widely on how the medical profession should not judge differing sexual behaviours.
When I became a GP in Wales, I had a transgender person asking me for help, and the nearest clinic was in London. I made it my business to find out more about gender issues and how to treat them, and how to help this person who could no way travel to London. It was fascinating, and very rewarding.
(2) What made you decide to pursue it as far as you have (the website, etc)? Why not just treat patients in your own area?
I love technology, and was intrigued as to why healthcare was so far behind the rest of business when providing services online. I made my own website www.mywebdoctor.co.uk offering free advice to those who couldn’t get in to see their GP. I thought it would sit at the bottom of the huge pile of websites in the sky, but I was surprised at how many people asked for help.
I had an idea to offer specific help for transgender people, so I made a special dedicated Transgender page. When I woke up the next morning, I realised just how big a need it was!! From here it has progressed to GenderGP.
(3) Do you still have a normal GP practice?
Until April 2016 I was the senior partner in a GP practice in Wales. My interest and work with the transgender community has meant that I have had to let this go, as I no longer had time to do both. After a brief spell of ill health, I decided to pursue my current interest and now I am a freelance GP and a full-time gender specialist.
(4) What opportunities exist for other doctors who want to specialist in the treatment of transgender people?
With access to the Internet, there is now endless opportunity for doctors to read policies, guidelines and research to help them to understand more about the needs of the trans community and how best to help them.
I really believe that gender care should be a routine part of General Practice, just as contraception and menopause treatment is. GPs are good at dealing with stress, family issues, workplace problems and hormones. These are the nuts and bolts of gender care and GPs should be offering this routinely.
(5) I find myself concerned about transgender children. How does one determine whether it’s ethical to treat children for transgenderism, especially since no long-term studies have been done looking at the outcomes?
The children I have met have been amazing. The diagnosis is often so clear cut, and by allowing them to go through a life changing puberty that so clearly doesn’t match their true gender, is bordering on inhumane.
By blocking puberty and giving them time to mature and understand what they want and need for their future, you are preventing them from having to have life-threatening surgery in the future, and a life of mismatch and potential humiliation.
We need more research in this area, that is true, but we need to prevent transgirls developing into big hairy men, and transboys developing into shapely, delicate females. There is a reason why the suicide rate is so high in this group, and we must stop their bodies developing wrongly.
(6) If you could wave a magic wand, and change one thing about the treatment of transgender people, what would it be?
Allow them to help shape and dictate their care. If they want to try hormones, take hormones, have an operation, change their bodies – make it easy for them, not the huge struggle they seem to face at the moment.
(7) It seems that transgender issues seem to have burst onto the public stage in the last couple of years. Do you have any thoughts about why this might be? And where it might all lead?
The true prevalence of transgenderism of any degree (remembering that gender is a spectrum on which we all lie, somewhere between 0 and 100%) is massively underestimated I expect. In the 80s people felt more confident to come out as gay, and the same is happening now for the trans community. We are about to see the true extent of exactly how common it is to have some variance with your gender. Is ‘male’ and ‘female’ a human generated idea – and have we got it all wrong?
(8) Do you ever refuse to treat someone? How do you determine if a person is suitable to be treated or not?
I would be very concerned about someone whose gender issues seemed to stem from a bad experience in earlier life. For example a person who wanted to hide from their genitals and sexuality due to a previous history of sexual abuse.
As my service is a remote service, I do not treat anyone who is shown to have manipulated the system in order to get medication.
Most people are absolutely straight and genuine and so grateful to have the chance to get the care they need, but sometimes I have to signpost people back to their GP.
(9) Have you ever come under criticism from colleagues or the public for what you do?
Oh yes, in one year I have been reported to the GMC twice (but they have found no concerns) and threatened to once – all by leading doctors in this field in the UK. These doctors are supposed to be caring and helping the trans community, but the stories I hear of people’s experiences in the GICs make my toes curl, so I am not surprised that they do not treat me with any respect. I wonder whether they are just keeping the GIC waiting list so long to fuel their private practice. I can’t see any other reason that they would not welcome an experienced GP who is helping relieve the burden of their work.
One of them publically wrote about how gender care that is straightforward should be delivered by people’s GPs, and in the same month I received a letter of concern from him via the GMC for doing just that!
The public have been great, I have received so many letters, cards, reviews, testimonials – and every one has been truly complementary. I have changed many lives for the better, and I expect saved a few desperate lives of people who thought they had nowhere else to turn.
(10) Do you have any thoughts about the autogynephilia model of Bailey and Blanchard?
I had never heard of it so I just looked it up. The majority of transgender patients I have had the pleasure of treating could no way fit into this model. I guess that these ideas could be made to fit some people, but to generalise and say this theory explains gender issues is outright wrong.
(11) Which famous person would you most like to meet, and why?
My family and friends laugh at me because I just have no interest in ‘famous’ people. I would like to be famous for really transforming gender care in the UK and the rest of the world. I would like to shake hands with my future self for helping trans people to access safe and easy healthcare without fear of humiliation, prejudice or judgement.