Dear Ms Appleby,
I was surprised to see my name appear as such a large part of the reporting of your tribunal proceedings, it seems you have long had thoughts about my approach to trans healthcare, but you never thought to discuss these with me directly.
In 2016, I started an information website to help transgender people understand their options in relation to healthcare. Before long, ‘a drizzle, then a trickle, then a stream’ of patients came to me and told me of their concerns about a lack of access to safe, caring and effective care on the NHS. From this, GenderGP was formed, a service which has developed into a global organisation providing healthcare, education and advocacy to the trans community.
There is great debate about the correct approach to the care of young trans people and adults. Some favour a gatekeeping model of care, others an informed consent model of care and some prefer no care at all! In my case, the approach I favour is one of harm-reduction and as such, in line with an evidence-based approach, best practice and international guidance, I put the patient’s needs and safety at the core of all I did.
As the Daily Mail reports, the GMC received a number of complaints from UCLH and GIDS clinicians, alleging that I did not follow their model of care. I would have welcomed discussions with any and all of you around my approach, which does indeed differ from that favoured by the NHS, at any stage. Sadly this dialogue was not welcomed.
It is true that GIDS service users were crying out for help, with long waiting lists and assessment processes and rigid treatment protocols resulting in distress and dysphoria, which was having severe repercussions on mental wellbeing.
Some were asking me to help them with medications to suspend the progression of puberty and the development of physical changes to their body, that did not fit with their gender identity and which had the potential to openly identify them as trans for the rest of their lives.
Others were asking for help with gender-affirming hormones so that they could go through puberty at the same time as their peers, rather than wait until the UK’s preferred protocol-driven age restriction of 16.
Others still were coming to me in considerable distress that they were required to adhere to the GIDS protocol that forced them to have puberty blockers for a year, before being able to start gender-affirming hormones.
Many young people were telling me that, after years of waiting for GIDS, they were simply told they were now too old, and had been transferred to the adult waiting list.
I was faced on a daily basis with stories of anxiety, distress, self-harm and suicide, young people saying that their needs were not being met and their families were being torn apart. That was a true safeguarding risk that I could not ignore.
It seems that there was a concern that I was prescribing medication ‘off-license’. Of course, as recognised by the GMC in their ethical hub, ‘Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes.’ There seems to be a suggestion that off-license in some way denotes illegal or unsafe. This suggestion is untrue and worse, harmful to this patient cohort.
GenderGP has saved the lives of many young people by facilitating their access to much needed care. The service has allowed hundreds of trans teenagers to have a happy and fulfilling adolescence, one of exploring youth, developing their identity and succeeding in education and relationships. I am very proud of the organisation that I founded back in 2016.
For myself, the road has not been easy. Aside from the immense professional satisfaction of working with this patient group, I have suffered greatly both reputationally and personally.
I have been prevented from working as a doctor since May 2017 and this has severely impacted myself and my family. The GMC has been investigating the complaints made by the GIDS and UCLH clinicians, and this July a hearing is scheduled for the case to be heard by the Medical Practitioners Tribunal Service (MPTS).
This will be my chance to share my version of events and for the patients involved to have their say. Experts in the field will come together to look at the various arguments about gender-related healthcare and balance them with the needs of the patients. The question of whether my practice could cause harm to patients, as is alleged, or whether I fulfilled my duties as a doctor will be determined.
GenderGP will continue the good work it does, regardless of the outcome of my case. The team of gender specialists will carry out their duties with pride, diligence and care. GenderGP will happily advise any trans person who needs help, whether that is in the form of hormones, support or simply by providing a caring ear to anyone impacted. They will share education and inform debate. The health and wellbeing of trans people is the organisation’s number one priority.
I wish you well in your case, whatever the outcome. I am saddened that you never felt professionally able to share your concerns with me, as I am sure that, while our approach may differ, you also have the best interests of the patients in mind.
I will leave you with one thought, in the quoted words of Professor Simona Giordano: ‘Indeed, it is unethical to let children suffer, when their suffering can be alleviated.’
Dr Helen Webberley