Supporting your trans patient: a guide for professionals and patients alike.
Gender variance is no longer a super specialised area of medicine and the treatment protocols are well within the capabilities of the Primary Care Team who are adept at supporting patients with hormone-related treatment. This downloadable guide combines best practice from leading centres of excellence worldwide with our own significant experience of providing affirmative care to this patient cohort.
This document is relevant to: GPs, family doctors, hospital consultant, specialists, physician assistants, nurses, nurse practitioners, social workers, therapists, psychologists, counsellors, researchers and more.
Prescribing for trans patients
In 2014, NHS England published a Specialised Services Circular which is consistent with the General Medical Council’s good practice guidance in Prescribing and Managing Medicines and Devices 2013.
The circular provides some clarification on the treatment of trans individuals by stating that: ‘general practitioners are responsible for the prescription of hormone therapy as recommended by the specialist gender identity clinics; for patient safety monitoring procedures; for provision of basic physical examinations within the usual competences of GPs; and for blood tests as recommended by the specialist gender identity clinics.’
In a letter from Susan Goldsmith of the GMC written to the BMA in 2016, she wrote: ‘we do not believe that providing care for patients with gender dysphoria is a highly specialised treatment area requiring specific expertise.’ She went on to say that this was particularly the case once the patient has been seen by a gender clinic and the prescribing and monitoring could be carried out in primary care.
In the absence of clear guidelines in the UK for medical practitioners, we must take our lead from the information that is available to help support this patient cohort.
In order to make healthcare as affordable as possible, and to provide the widest range of options to its users, GenderGP works both as an independent service and collaboratively with the patient’s doctor. Patients can choose whether to have blood tests privately or through their doctor. Medication can also be prescribed by their family doctor, under a shared care agreement, or via a private prescription.
Gender dysphoria is NOT a highly specialised field that involves dangerous medication requiring comprehensive monitoring. Indeed, the medication used and the monitoring required for gender affirming treatment is no different to that given to patients who are being treated for menopause, endometriosis, prostate cancer, precocious puberty, constitutional delay in puberty.
While these medicines are unlicensed for use in trans healthcare. You can read more about this here, the benefits of having access to care far outweigh the denial of care, particularly in light of NHS waiting times that are in breach of the NHS constitution.
Read more about the safe use of unlicensed medication in the treatment of trans individuals here.
What about trans youth?
In countries, such as the UK, where there is a lack of evidence-based, peer-reviewed guidance, we must turn to international best practice including the Australian Guidelines on the care of trans youth to inform the care we provide.
GenderGP believes, in line with the Australian Guidelines, that: ‘with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.’
GenderGP multidisciplinary team of gender specialists includes doctors, counsellors and psychotherapists from various countries including the UK, the EU, Egypt and the USA.
Doctors working with GenderGP support thousands of patients in their capacity as gender specialists. As there is no recognised training or qualification in this field all learning is by personal professional development. GenderGP’s doctors follow best practice and guidelines set out by World Professional Association for Transgender Health (WPATH) and the Endocrine Society.
All of GenderGP’s medical specialists are regulated in their own country, by their individual regulators. GenderGP operates entirely within the law and follows international published guidance on the care of transgender patients of all ages.
The UK has a long and successful working relationship with non UK-based doctors and nurses who have provided a very welcome extra pair of hands when the UK’s own NHS services have been under-staffed.