Gender specialists can come from any medical specialty – In the NICE Document “clinical models operated by England’s gender identity clinics” it states that “Gender specialists may be from many different clinical backgrounds, some specialising in mental health: psychologists, psychiatrists, counselors or therapists, but they may also be GPs, endocrinologists, nurses etc https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/gender-ident-clncs-rep-nov15.pdf

As a GP I am very used to managing hormonal manipulation, stress and depression – common issues amongst transgender patients.

It is important that all medical conditions are properly monitored and I am very happy to help with all aspects of monitoring.

I use a variety of methods to communicate with my patients. Email, telephone, video and face to face. Everyone is different and has different needs, so with modern technology, we can really open up access between patients and healthcare workers to provide good care. Not all cases are appropriate for ‘remote healthcare’ but it is surprising what can be achieved.

The GMC have clear guidelines on this issue: http://www.gmc-uk.org/guidance/30549.asp

I have had numerous complaints to the GMC about my transgender service.

1. A complaint from Alec Rook questioning whether I was qualified to provide gender care. This was fully investigated and no concerns were found on my fitness to practice in this area.
2. A letter from Stuart Lorimer, consultant psychiatrist at Charing Cross and GenderCare private clinic regarding my practice with numerous comments and concerns. The GMC decided that the complaint did not need investigating.
3. Another letter from Stuart Lorimer with further concerns. The GMC did not feel this warranted an investigation.
4. I raised concerns about James Barrett, consultant psychiatrist at Charing Cross and the GMC did not investigate but instead opened an investigation about me. This was closed with no fault found.
5. Professor Hindmarsh, via Dr Butler, consultant paediatric endocrinologist has made a complaint about my treatment of a transgender child. This investigation is currently ongoing.
6. A ‘senior doctor’ from Charing Cross has made an anonymous statement to the CQC which has now ben passed to the GMC. He outlines various concerns he has, none of which he can substantiate.

There are currently no NHSE guidelines on the management of gender variant children.

WPATH (vers 7)

‘Adolescents may be eligible to begin feminizing/masculinizing hormone therapy, preferably with parental consent. In many countries, 16-year-olds are legal adults for medical decision-making and do not require parental consent. Ideally, treatment decisions should be made among the adolescent, the family, and the treatment team. Regimens for hormone therapy in gender dysphoric adolescents differ substantially from those used in adults (Hembree et al., 2009). The hormone regimens for youth are adapted to account for the somatic, emotional, and mental development that occurs throughout adolescence (Hembree et al., 2009)’. Also;

Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence, withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents’

NHS options (http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx)

Clinical guidelines

In addition to the legislation above, there are also clinical guidelines for health professionals that outline what high-quality care for transsexual people should involve.

Such guidelines include:

the WPATH Standards of Care – produced by the World Professional Association for Transgender Health (WPATH)

the Good Practice Guidelines for the assessment of adults with Gender Dysphoria (PDF, 611kb) – produced by the Royal College of Psychiatrists

Neither the Royal College of Psychiatrists or WPATH guidelines offer specific advice on treating children with cross sex hormones.

Recently they have told me that I should no longer provide services and that they are mindful to not approve my application.

As there are a large number of patients relying on my care who can’t get the help they need from anywhere else, and because there is a high incidence of self harm and suicide in this patient group, I am going to transfer the hub of my service to my other residence in Malaga, Spain so that I can continue providing care while the regulatory processes are being sorted out.

As part of the NHS ‘Five Year Plan’ there are great development plans for using technology to enhance the provision of safer, more accessible healthcare. In the future, this will be mainstream.

https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/harnessing-technology-and-innovation/