Trans Healthcare in the UK
In 2016, the Women and Equalities Commission in the UK found that:
‘The NHS is letting down trans people: it is failing in its legal duty under the Equality Act. Trans people encounter significant problems in using general NHS services, due to the attitude of some clinicians and other staff who lack knowledge and understanding – and in some cases are prejudiced. The NHS is failing to ensure zero tolerance of transphobic behaviour. GPs too often lack understanding and in some cases this leads to appropriate care not being provided.’
‘High levels of transphobia are experienced by individuals on a daily basis (including in the provision of public services) – with serious results. About half of young trans people and a third of trans adults attempt suicide.’
The Equality Act 2010 says that people must not be discriminated against because they are transsexual, when their gender identity is different from the gender which was assigned to them at birth.
And yet we see discrimination on a daily basis.
The role of pharmacy in trans healthcare
All patients deserve equal rights to medical and pharmacy services. The specific care of trans patients is covered in this article in the Pharmaceutical Journal,‘Transcending boundaries: the role of pharmacists in gender identity services’ which understands that, ‘With training and education, pharmacists in primary and secondary care would be an invaluable asset in helping transgender patients’.
In The Evolving Role of Pharmacists in Transgender Health Care it is described how, ‘TG [transgender] patients experience marked bias in the health care system, and this leads to numerous health care disparities as well as impediments to care. Pharmacy practice is not “immune” to the discriminatory behavior toward TG persons.’.
It is, however, reassuring to see that pharmacy colleagues are actively taking a role in improving awareness and education around this often marginalised group: https://www.everestpharmacy.co.uk/condition/gender-dysphoria/.
As a leading worldwide provider of trans healthcare we are looking for more service providers to join in this campaign of support.
What does the NHS say on the subject of prescribing for trans patients?
Despite the absence of clear guidelines in the UK for medical practitioners, NHS England did publish a Specialised Services Circular (SSC1417, March 2014) which is consistent with the General Medical Council’s good practice guidance in Prescribing and Managing Medicines and Devices 2013.
The circular clarifies 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. It is also reassuring to read her comments about the use of unlicensed medication for this patient cohort.
What about trans youth?
Transgender healthcare is an emotive subject fuelled by social, medical and regulatory politics and as a result, many trans people across the world find that their access to healthcare is limited. Nowhere is this more prevalent than in the care of trans youth.
The healthcare of young people with gender dysphoria is rarely far from the news and despite the treatment protocols being well established and standard practice in more progressive parts of the world, other countries are a long way behind.
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.
We follow the tenet outlined in 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.’.