Dr Helen Webberley MBChB MRCGP MFSRH is a GP specialising in the treatment of transgender patients on the NHS and via her private online clinic www.gendergp.com:
The first parliamentary report on transgender equality has revealed what many of us have known for some time: when it comes to equality for the trans community, Britain has a long way to go.
At the heart of the problem is that age-old condition: ignorance. A simple lack of understanding and a misplaced belief that people who dress in the clothes of the opposite gender, or take steps on the path towards gender reassignment, are to be ridiculed in some way.
The report reveals that, alongside the ignorance among the general population, this group of people faces a second, more significant obstacle: a lack of understanding among the medical profession, with serious deficiencies being reported in gender identity services and the health treatment of trans people.
One area which was highlighted as being of particular cause for concern was waiting times for first appointments and surgery – with recent reports indicating that some people wait between two and three years for access to some of the adult clinics. Under NHS guidelines, patients waiting for an initial appointment for hormone therapy and surgery should be seen within 18 weeks.
The report very succinctly highlights one of the main causes of the problem: “GPs too often lack understanding and in some cases this leads to appropriate care not being provided.”
Jess Bradley of Action for Trans Health, a campaign group seeking to improve trans people’s access to healthcare, said in a recent newspaper article: “A lot of GPs deny healthcare to trans people illegally, based on the fact that they do not agree with the choices that they [trans patients] have made.”
Shocking, isn’t it? To be denied the treatment you need to become the person you fundamentally are, on the basis that the healthcare provider you see doesn’t agree with your choices?
Gender Dysphoria, the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex, is currently a highly specialised area and it is a fact, that there is a lack of cultural competency and understanding around the subject among most health professionals – this has to change.
Because GPs often lack the specialist knowledge they need, they are under skilled when dealing with this group and nervous of making a mistake. Protocol is unclear and as such GPs don’t know where to refer, never mind how to treat patients. Throw in a little personal prejudice and the resulting experience on the part of the patient can be devastating.
Patients visiting their GP on a gender related premise are often referred to mental health services, which can be equally under-skilled or ill prepared to help, alternatively they are directed to gender identity clinics (GICs) where the waiting time to treatment can be as long as four years.
Patients summon up immense courage to ask their GP for help and then feel shunned which only compounds the feeling of isolation and ridicule that they encounter from the general public.
It’s no wonder then that suicide rates among the transgender community are so high. Current figures show that one third of transgender adults and half of young trans people attempt suicide.
Surely, this feeling of desperation is not so difficult for anyone, let alone a health professional, to understand? As I have seen from the countless patients I have supported over the years, for many all it takes at the first point of contact is a listening ear, a little kindness and, crucially, action.
At the very least, GPs should be able to comfortably identify those patients who are at greater risk of self-harm, suicide or suffering significant psychological distress due to delays in Gender Services and they should feel able to comfortably prescribe hormones to those patients where it is felt that their wellbeing would be greatly improved by doing so.
According to figures quoted in the report as many as 650,000 people in the UK are “gender incongruent to some degree”, though the truth is that this figure is likely to be far higher and the trans community is growing, with the demand for access to GIC clinics up 25-30% each year.
That is not to say of course that this is a new condition, it’s just that awareness is increasing, in part thanks to media coverage of transgender issues in recent years. As a result of this increased awareness people are, happily, no longer quite as willing to take the secret to their grave.
Further steps, including calls for the introduction of the option to record gender as “X” in a passport, as well as a movement towards non-gendering official records – with gender only noted where it is relevant, will go a long way towards demystifying the trans community which must ultimately lead to acceptance.
We have also had first hand experience of our country’s capacity for change – just compare the common approach to homosexuality in the 70s and 80s, to our approach today.
The transphobia from health professionals, which this community openly admits to experiencing, has to stop and our best chance of this is through education.
The care for children experiencing gender dysphoria is critical. The inquiry heard evidence that numbers of children and teenagers coming out as transgender have increased fourfold over the past five years and as many as 1,000 young people have transitioned to a new gender with the support of their parents. Ignoring the ‘problem’ in the hope that young people might grow out of these feelings can no longer be seen as an acceptable option.
Children can be safely and effectively treated with hormone blockers which prevent, what for some can be, the devastating and irreversible effects of puberty. Yet fear of prescribing such medication incorrectly, prevents GPs from doing so.
In reality, the prescription of such medication would give young people more time to consider whether they want to press ahead with gender reassignment before they develop adult sexual characteristics. Not to mention the fact that it would reduce the temptation for desperate people to access the counterfeit and often lethal ‘medication’ which is so freely available via the internet.
We have to see a significant increase in education and comfort amongst GPs in helping with transgender care. As with homosexuality, being transgender is not a mental health issue, it is a very real physical condition and no one should suffer as a result of having experienced sub standard support from their healthcare provider.
The report is well overdue but now that its findings have gone some way to revealing the truth of the challenges faced by the trans community, perhaps we are finally on the path to understanding and helping those who are doing their utmost to secure the best outcome for themselves so that they too can have that most basic of human rights: to feel comfortable in their own skin.
Perhaps in highlighting the plight of these patients the British population, starting with our NHS, can learn to treat them as they would anyone who is suffering: with dignity and respect.
A ‘root-and-branch review’ of the health service’s treatment of transgender people is expected by the summer and we will be watching closely to ensure that this translates into real tangible action.