Following a concerted campaign over recent weeks to encourage pharmacies to proactively support trans youth, we are delighted to reveal that 85% of respondents to a recent survey have successfully had their private prescription for gender affirmative medications dispensed by a high street chemist.
Following the direct targeting of two online pharmacies dispensing to trans patients, GenderGP recently called for the General Pharmaceutical Council, which regulates pharmacies in the UK, to issue clear guidance to pharmacies to reassure trans youth that their access to medication will not be disrupted. The regulator said it was committed to supporting “pharmacies to make improvements so that all their patients, including transgender patients, receive safe and effective care.”
When asked to name the trans friendly pharmacies which had dispensed their prescriptions, many people acknowledged their local or independent pharmacies, as well as citing high street giants Boots, Lloyds and online pharmacies.
A significant two-thirds of respondents said that their mental health and wellbeing had been affected by recent regulatory and media activity. When asked about the main barriers to accessing gender affirming medication the responses were listed as follows: NHS waiting lists (29.3%) their GP (24%), NHS protocols (16.5%), media coverage (15.3%) recent action by the GPhC (11%) and The Tavistock court ruling (8%).
It is clear that access to trans healthcare is being impacted due to a lack of education and the spreading of misinformation. As such, we are actively encouraging those involved in trans healthcare to educate themselves. We have created various resources on our website including a Pharmacy Hub and a Medical Hub which provide access to research and evidence to support the care of trans individuals.
Dr Helen Webberley Update
In Autumn 2016, I was invited to be a panel speaker at an event that the Mermaids charity was hosting in London. They had a very special guest, Dr Norman Spack from Boston, USA, who is renowned as a world leader in the care of transgender youth.
My talk was to follow that of Dr Spack. He is highly respected in the field of transgender healthcare and I remember feeling very apprehensive.
I was about to stand up in front of this room of people and explain that my model starts from a place of belief. This was very different to the UK model of care that I had heard was causing deep pain and distress, especially to younger gender diverse people. I was about to explain that my model didn’t rely on psychiatrists and that I understood that to deny or withhold care can cause untold harm. I was about to present my model of care, based on my experience as a doctor and what felt like endless self study on the subject matter.
But first I listened with baited breath.
My fears were completely unfounded. I, like everyone else who was listening in awe at this great man as he spoke, was spellbound by his words. I went up on stage at the end of his talk and hugged him. He spoke my language, his approach mirrored mine, he understood trans youth in the same way that I did.
I felt a sense of empowerment knowing that Dr Spack followed the same line of thinking as I did. I felt reassured that affirmative care was the right path to follow.
A lot has happened since that day. Fast forward to 2021, I am preparing for the Medical Practitioners Tribunal Service who will examine my practice and see whether I am fit to hold a medical license in the UK.
You see, while Dr Spack is applauded for his approach and his colleagues yearn to learn from him, in the UK I am referred to the GMC by my colleagues in trans healthcare who wholly disagree with my gender-affirmative approach and feel that I am a risk to patients.
During my preparation for the hearing this year, I came across a beautiful article that Dr Spack wrote in 2009. It mirrored my thoughts and feelings and inspired me to respond, in my words, about how I learnt from the best – trans people.
Dr Spack quotes one of his mentors, ‘You learn a lot by taking care of trans-adults, because you will see the effects of decisions that doctors make when treating or not treating these kids as adolescents.’
How true this is. Denying trans youth puberty blockers when they ask for them means they will have lifelong, significant physical changes to their body which will be with them forever. As adults, they will often see, and rue, those changes they were unable to correct with surgery, or those that remind them every day of their missed opportunity to prevent them.
Dr Spack writes, ‘I, like all pediatric endocrinologists, treat precocious and delayed puberty. Transgender patients who are on the cusp of puberty are in a phase of the most precocious puberty they never wanted and, with treatment, they can have the most delayed puberty they desire.’
Children with precocious puberty are treated with puberty blockers, children with delayed puberty are treated with hormones. So why do trans youth find it so difficult to access this same treatment? All we have to do is believe them, and understand the benefits of not having a puberty you are not ready for, and to have puberty at the same time as your school friends – and we have the basics of perfect gender-affirming care.
According to Dr Spack, ‘Since adolescents are in such a constantly varying emotional state, one wonders whether anyone should make medical decisions that may have lasting effects.’
This one made me smile as I imagine teenagers ranting and raving about life, social science and politics, (and cleaning their room). But in all seriousness, under 16s in the UK are able to consent to some pretty tricky medical interventions at times. Abortion, cancer care, life-threatening blood disorders. Yet a recent ruling found that trans youth may not have the capacity to consent to puberty blockers. But of course, we all know that teenagers are so up and down how can they make any sensible decisions? Yet they can when they need to. We just need to believe them and listen to them and put our own fears aside.
In his article, Dr Spack quotes the UK directly, ‘The British claim that 25% of children and teens whom they have counseled without hormonal therapy have changed their minds by age 16.’
Dr Spack goes on to say that not one of his patients in his clinic changed their mind about their affirmed gender identity, and the same is true of my practice. Not one of my patients regretted the care I gave them, or told me that they had got their gender wrong after all. Maybe the British clinicians that Dr Spack refers to get their diagnostic criteria wrong, or maybe they count their numbers differently?
Dr Spack makes a very interesting point when he says, ‘The more youths see psychiatrists compared to seeing psychologists or social workers, the more likely they will come out of that appointment with a psychiatric diagnosis other than, or in addition to, a diagnosis of GID, and will be put on medication.’
If you see a psychiatrist because the lack of acceptance of your gender is causing emotional problems, or stress or depression or sadness, anger or frustration – then you will be more likely to come out with a psychiatric diagnosis and be prescribed psychiatric medication. Instead, if you see a doctor who understands gender, and the effects of unaffirmed gender incongruence, and you are prescribed blockers and/or hormones, then you get better!
Dr Spack talks about the tragedy of suicide and self harm in patients who are denied care. He showcases the Dutch model by saying, ‘The Dutch do not see suicide with their treated population. If a Dutch family has a child with GID [Gender Identity Disorder], they know where to receive treatment, and they have conﬁdence that the child will be treated.’
I agree with this. GenderGP patients may arrive at the depths of despair, at the end of their tether, all hope lost. But soon their mood improves, they smile, they emerge from their bedrooms, they go back to school. They no longer rely on their gaming avatar to express their true gender, because now they can do that for real.
Towards the end of his article, the UK gets a special mention, ‘In contrast to the approaches supported by the United States, Belgium, and Amsterdam, our colleagues in Britain will not initiate treatment with medication until age 16. Their view is that, as conﬁrmed by animal studies, myelination of the brain is actively occurring through puberty. They argue that interfering with pubertal development potentially interferes with brain development, including gender identity formation. This, of course, is a theoretical argument, which unfortunately informs policy throughout the British National Health System. They do not do adequate studies to test this potential risk. In the United Kingdom, there is only one center in the country authorized to treat transgendered adolescents.’
Bearing in mind that he wrote this in 2009, not much has changed in the UK. Dr Spack criticises UK rigid protocols that differ to those adopted by the world leaders in trans healthcare. He criticises them for their lack of research to back up those differences. There is still only one NHS clinic, led by Professor Butler since his move to London in 2009. Professor Butler calls himself an International expert, yet his approach could not be more different to that of Normal Spack.
I agree with Dr Spack, gender-affirming hormones are the correct course of treatment in a young person under the age of 16 who is ready for that next affirmative step. Yet, in the UK I am suspended from medical practice because I followed my International colleagues rather than my NHS colleagues.
My Tribunal hearing is listed for July 2021. I will be able to take to the stage and I will bring Dr Spack with me – if not in person then certainly in spirit. He so inspires me with his knowledge, skills and attitude. Because he acquired them from the same place that I did. By listening to those who really understand what it is to need gender-affirming medication and ask for help that is denied.
- Freedom of Information Request reveals just two patients were seen by Exeter GIC, The Laurels in 2020
- The clinic has 2,592 people on the waiting list
- The longest time someone has been on the waiting list is nearly six years
- At the current rate, it will take 1,296 years before the current list is cleared
Following a Freedom of Information request (FOI) sent to Exeter GIC, it has been revealed on Reddit that during the period 01/12/19 and 30/11/20, only two patients were assessed by the Laurels gender clinic.
The FOI was submitted by a service user and shared on social media, where it was picked up and posted in Reddit’s TransgenderUK channel, by someone who had “completely lost hope of receiving an appointment”, having been referred to the clinic last year.
The request revealed some shocking figures, including the fact that the current number of patients on the waiting list is 2,592 and the longest time someone has been on the waiting list in days is 2,092 – which is almost six years.
At a rate of 2 patients a year it will take 1,296 years before the current list is cleared and that doesn’t even account for new patents coming on board (495 new patients were referred in the same 12 month period).
The Laurels has defended its position by outlining that it is “one of only seven specialist NHS gender clinics within England, all of which have seen a very significant rise in referral rates over the past few years”. Alongside this increase in referral rates The Laurels also cites “particular challenges in recruiting to clinical posts, especially medical staffing which has further impacted on the service’s ability to increase capacity to attempt to meet demand.”
Marianne Oakes is the lead therapist at GenderGP, a private Health and Wellbeing Service supporting trans people of all ages, she explained: “We hear the suffering of these trans people on a daily basis. Suicidal thoughts and self harm are a very real consequence of being denied this essential care.”
“We have to listen to trans people. We have to help them. Right now, this section of society has been cut adrift from the NHS and abandoned. Anyone who tries to do something about it is shamed, silenced or worse.”
As a comparison, during the same 12 month period GenderGP recorded the following:
- New contacts to the service for advice on their gender – 5,109
- Number of people starting medical treatment – 2,163
- Number of patents then moved over to NHS care – 238
Oakes continued: “When it comes to trans healthcare, sadly the NHS can in no way be considered a gold standard – indeed it is a long way off being so. The lack of education and training for UK doctors, nurses and counsellors has sadly left the care of a large number of patients in the hands of a small number of clinicians. This has had repercussions in terms of outdated protocols, failing standards and long waiting lists. As can be seen by the recently published outcome of the CQC review into the standards of care delivered by the UK provider of youth services.”
One solution, according to GenderGP’s website, is for gender care to be brought into Primary Care. GPs have all the expertise and knowledge of hormone manipulation needed to treat straightforward cases. The challenge is that they are not supported in doing so. Additional expertise can be delivered by gender specialist teams, such as those at GenderGP.
Despite the NHS clearly stating that, ‘Gender specialists may be from many different clinical backgrounds, some specialising in mental health: psychologists, psychiatrists, counsellors or therapists, but they may also be GPs, endocrinologists, nurses etc.’ GPs do not know where they stand.
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.’
Yet doctors are still reluctant to help.
Dr Helen Webberley, Founder of GenderGP added: “It’s the public and regulatory mixed messages that are exacerbating the problem. Trans healthcare has become so politicised that doctors seem afraid to affirm their patients.”
To give GPs the confidence to help their trans patients, GenderGP has pulled together all of the available evidence to establish whether healthcare practitioners can help their patients in Primary and Secondary Care. The guide, Transgender health: Helping your trans patient to live their life more easily, is available as a free download from the organisation’s website. This guide looks at current UK advice and guidance and asks the question: Are UK GPs able and allowed to provide this care?
“The hope, concludes Webberley, is that the GenderGP guide will help to empower healthcare practitioners to do what they do best – treat the patient according to need and alleviate suffering.”
Dr Jack Turban, child and adolescent psychiatry fellow at Stanford University School of Medicine, joins the GenderGP podcast for an episode exploring the notion of detransition.
Together Jack, Helen and Marianne discuss the notion that a person’s gender expression and gender identity can change throughout their life. They acknowledge the use of detransition as an argument against affirming transgender people, and the damage that this does, as well as covering how we need to broaden our understanding of what detransition really means, what is driving it and how we can work to support someone through the process.
If you have been affected by any of the topics discussed in our podcast, and would like to get in touch, please contact us via the Help Centre. You can also contact us on social media where you will find us at @GenderGP on Twitter, Facebook and Instagram.
We are always happy to accept ideas for future shows, so if there is something in particular you would like us to discuss, or a specific guest you would love to hear from, let us know. Your feedback is really important to us. If you could take a minute or two to leave us a rating and a review for the podcast on your favourite podcast app, it will help others to discover us.
The GenderGP Podcast
Exploring Detransition with Dr Jack Turban
We are absolutely delighted to announce that, following a marathon gaming session that ran over two weekends in February, gamer Ed “SuperSweetBoy” Sweet has raised an incredible £3,050 towards the care of trans youth, via the GenderGP Fund.
Ed, SuperMario and Co, were joined by moderators @ar_crat @TenTinyKittens @ThaeInTwilight and members of the GenderGP team as well as @CaseyExplosion, @AnitaSarkeesian and several others. Together they honed their racing skills, put their music knowledge to the test and, crucially, talked about access to healthcare for trans youth.
We want to say a huge thank you to everyone who took part, watched, donated and shared. Together they helped to raise awareness of the challenges facing trans youth in the UK today as well as essential funds, which will go directly towards the treatment of young people whose care has been impacted by the recent high court ruling.
The GenderGP Fund has been designed to help young people access psychological support, puberty blockers, hormones and expert advice. Find out more by visiting the Fund section of our website.
The event resulted in almost 100 donations, with Ed himself contributing a whopping £150 to the fund to replace the admin fees deducted by PayPal.
Ed concluded his endeavour by thanking everyone who took part and hinted that he might revisit the challenge in 2022.
Thank you SuperSweetBoy – you really are awesome.
We would like to reassure our patients, following the latest attack by the Telegraph on care for trans youth, that media scrutiny and fake news will not impact our commitment to the community.
We will continue to do everything that we can to ensure that those people who need care have access to it. GenderGP is an international organisation which operates 100% legally and we are committed to improving trans-healthcare at a fundamental level throughout the world.
Trans people exist, the treatment pathways are clear. The scandal is not that GenderGP is providing care but that national healthcare providers are withholding care.
We will never give up x
This post has been written following an approach made by The Telegraph newspaper, about the care our service provides to trans youth.
As Australia’s media is being called out for the poor treatment of its key medical specialist in the care of trans youth, providers of gender-affirming healthcare in the UK continue to be targeted. Once again we are informed that the care of trans youth will be the topic for debate and discussion in the UK press, inviting concern and negativity, when this patient group simply needs acceptance and support. We will continue to provide care as long as it is needed.
GenderGP provides healthcare which is essential to trans people and in accordance with best practice in centres of excellence around the world.
We stand firmly in support of trans youth and the care they need and will not allow fear, discrimination and prejudice to affect services that are essential for them to thrive.
We are always happy to answer any questions relating to our service. We welcome an open and honest dialogue to examine any approaches to the care of trans youth as it will further the awareness and improvement of transgender healthcare around the world – which is our ultimate goal.
While the UK’s NHS provision of care for trans youth is being dragged through the courts and exposed as inadequate by the UK regulator and in the context of long waiting lists, deliberately slow-paced clinical protocols and limited access to medication, many trans and non-binary people, in England have turned to private clinical care via online specialist medical services such as GenderGP (Edenfield, Colton, & Holmes, 2019). GenderGP is a world leading provider of gender-affirming care. It is a life-changing and even life-saving service to those who are left without adequate care by their public health service provider.
GenderGP provides ‘easy access’ to medicines to under-16s:
True. If a young trans person fulfils the criteria for medical intervention, then we provide appropriate blockers and hormones when clinically indicated.
GenderGP provides puberty blockers to people as young as 10:
True. When a trans adolescent starts puberty, that can be just the time to give medicines to block it. Puberty can begin as young as eight.
GenderGP offers treatment to young people who do not have the support of their parents:
True. Not all parents are supportive, and when a young patient is able to consent to their treatment in their own right, then that treatment can be appropriate and necessary.
GenderGP does not physically examine all patients:
True. If there is no reason to undress a young person to look at their bodies, then we will not do so. Unnecessary clinical examination can be intrusive and traumatic and will not influence any medical decisions.
Not all patients need to speak to a doctor:
True. Not everyone needs in-person consultations with one of our doctors. Our doctors have the ultimate authority on all treatments and over GenderGP’s highly experienced multidisciplinary team of specialists from all professions. Only those whose involvement is necessary at a given time will be involved in a consultation.
GenderGP has prescribed hormones to patients as young as 12:
True. There may occasionally be compelling reasons as to why a young trans person, who is completely aligned with their gender identity, might benefit from allowing the right puberty to continue at an age as young as 12.
Not all patients require blood tests prior to treatment:
True. There may be no need to check blood tests in patients who are medically fit and well and are starting puberty blockers. Blood tests are required for monitoring and treatment changes.
GenderGP uses staff that has no training:
False. All of our specialists are highly trained experts in the field of transgender healthcare. While there is no formal qualification in this area, there is an abundance of research, guidance and best-practice evidence.
Patients can start treatment within 4-6 weeks:
True. People who are clear about their gender identity and are eligible for treatment can start treatment when needed. We have no waiting lists and to subject patients to unnecessary delays, simply causes harm.
The medicines used are similar to those used for Hormone Replacement Therapy:
True. Gender-affirming hormones are the sex hormones that your body needs. If your own body can’t produce them (because you have gone through the menopause, or if you are transgender) then they can be given as medicines.
GenderGP circumvents UK regulation:
False. Our organisation is a global organisation which covers many countries including the UK. All of our practitioners are regulated in their country of residence.
Patients don’t have to have counselling or therapy:
True. Counselling and psychotherapy through our team of gender specialists is available as and when required, we do not force anyone to have therapy, it is not mandatory.
The following claims have been made by a Telegraph Journalist. Here we seek to answer all queries in more detail, without any need for undercover investigation. We are proud of our stringent and safe protocols and the success of our gender-affirmative approach.
For any further enquiries, please visit our HELP CENTRE. Our team is standing by to assist.
GenderGP – Health and Wellbeing Service for transgender people and those who support them.
Claim: GenderGP provides “easy access” to puberty blockers and cross-sex hormones to those under the age of 16.
GenderGP operates according to a gender-affirming model of care. Transgender patients of all ages who come to our service can be assured of receiving belief, support and compassionate access to medical care. We will do all we can to support them and to ease any dysphoria which may be causing distress.
We provide Health and Wellbeing Services to Trans people of all ages. This includes support and guidance to pre-pubertal transgender children; support, advice, guidance, puberty blockers and hormones to transgender adolescents; and gender-affirming advice and medical treatment to transgender adults. We also provide counselling and monitoring as well as life admin, including gender marker change letters and surgery referrals.
Claim: NHS guidance in England and Wales states that children should only receive cross-sex hormones from around 16, after around a year on puberty blockers, following an assessment period by a multidisciplinary team which includes mandatory counselling / psychiatric care.
There are no UK NHS published guidelines for the care of transgender people. The Gender Identity Development Service provides NHS care to UK trans youth according to Service Specifications. This is their own protocol which differs widely from those used by centres of excellence in transgender healthcare internationally.
GenderGP does not operate according to NHS policies which have been found to be lacking in many areas by the Women and Equalities Committee report on transgender equality from 2016, as well as failing in standards set by the Care Quality Commission.
When an adolescent patient, who is transgender, is ready to embark on the second stage of treatment, gender-affirming hormones are used to induce pubertal changes that match their gender identity. It is best practice to introduce these when the young person is ready rather than on an age-based criteria. This is standard in centres of excellence across the world, and allows young people to develop in line with their peers. Research shows the benefits of this approach.
Outside of the NHS protocols, the requirement for at least a year on blockers does not exist. In many patients this is a harmful and unnecessary step, delaying treatment and imposing a medical menopause.
Counselling and psychiatric care is not mandatory and should be available on a case by case basis, as needed to assist the person on their gender journey.
Claim: Any decision to prescribe cross sex hormones or puberty blockers to a patient before their 16th birthday should be taken jointly by at least two doctors involved in their treatment including a consultant endocrinologist and a senior psychosocial clinician. There should also be a court order in place sanctioning the treatment.
Gender specialists can come from any medical specialty. In the NHS Document clinical models operated by England’s gender identity clinics it is stated 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.’
In the WPATH Standards of Care Version 7: it states that: ‘With appropriate training, feminizing/masculinizing hormone therapy can be managed by a variety of providers, including nurse practitioners, physician assistants, and primary care physicians (Dahl et al., 2006).’
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.’
There is no requirement for a minimum number of doctors needed in order to manage or care for a young person having gender-affirming hormones.
The advice from the General Medical Council is clear on the need for court involvement in patients’ care: ‘If a child lacks the capacity to consent, you should ask for their parent’s consent. It is usually sufficient to have consent from one parent. If parents cannot agree and disputes cannot be resolved informally, you should seek legal advice about whether you should apply to the court.’
Claim: A publication by Gender GP staff in the International Journal of Transgender Health in December 2020 included data sets which indicate it has treated patients as young as 10.
In accordance with current NHS practice, transgender youth are eligible for treatment at the start of puberty (Tanner stage 2), at which stage puberty blockers can be given to prevent the development of secondary sex characteristics such as a broken voice or facial hair and masculine skeletal development in trans girls; and breast develoment and periods in trans boys. Tanner stage two can begin as early as eight years of age.
Claim: The clinic issued a prescription for a four-month supply of Testogel without seeking any parental consent or conducting any physical examination of the patient.
There are many trans people of all ages who sadly do not have the support of their parents or loved ones. In the UK, the ability to consent can be presumed at age 16, and can be assessed prior to this. All of our young patients have their capacity to understand and consent assessed in a number of ways, including by email messaging, questionnaires, information gathering sessions and consultations. Parental consent is desirable, of course, but sadly not always available.
Intimate clinical examination can be a very traumatic experience for any young person, and many find the process intrusive and even abusive – imagine going to your doctor to ask for the pill and being forced to have a genital examination without clinical reasoning? It simply would not happen with a cis child and should not happen with a trans child. Current guidance suggests that examination is not carried out unless there is a definite indication to do so that would affect management.
Cisgender people can indeed pose as trans people, they may be able to convincingly relay a story of trans identity, and even get as far as being prescribed medication. However, in reality, transitioning goes further than simply answering the right questions, or telling the right story. Medical transition is a long and slow process of seeking gender affirmation. Cisgender people can’t do that nor would they want to.
Claim: GenderGP told our reporters that the child could potentially access puberty blockers without speaking to a doctor of any kind, and that taking cross-sex hormones was “no different” than a post-menopausal woman taking hormone replacement therapy. In both cases no psychological support was offered.
GenderGP has an experienced and compassionate multidisciplinary team of gender specialists from all professions. Not everyone needs in-person consultations with one of our doctors. Only those whose involvement is necessary at a given time will be involved in a consultation.
Our doctors have the ultimate authority on all treatments but recommendations can be made jointly with any of our specialists in conjunction with the patient. The criteria for treatment are found on Table 2 of the Endocrine Society Guidelines.
It is true that the medicines that are used are the same as those used in hormone replacement therapy in adults. The sex hormones as medication, oestrogen and testosterone, are used in any situation where a person is unable to produce that hormone naturally.
Claim: In the case of the 15 year old, no blood tests were required before starting hormone treatment despite Gender GP stating on its website that they are an ‘essential’ part of treatment.
Blood tests may be essential for anyone with any pre-existing medical conditions or to monitor the effects of gender-affirming medication. However, some people find that there are geographical and sociological barriers to accessing investigations. Tests should only ever be carried out according to medical need rather than to satisfy management decisions.
Claim: Gender GP did not ask to speak to an appropriate adult nor did it seek proof that any adult knew about the treatment.
We offer a number of ways for parents to access advice, support and medical care for their adolescent children. This includes counselling, psychotherapy, puberty blockers and gender-affirming hormones and we welcome parental support and involvement at all stages. However, there are many trans people of all ages who sadly do not have the support of their parents or loved ones. For these individuals we take the same stance on consent as the NHS. More information can be found in our article on treating young people.
Claim: The reporter received a generic request for patients under the age of 18 that had support to have an adult with them at the start of their Skype calls, but GenderGP did not require this of her.
It is not an absolute requirement that patients have someone present with them at their consultations. Obviously the younger someone is, the more we would encourage someone to support them, but not having someone present should not be a barrier to having a consultation with one of our specialist counsellors or doctors to discuss their gender identity and the options available to them.
Claim: Contrary to NHS guidelines GenderGP staff said GenderGP could potentially allow the 12-year-old to progress to cross-sex hormones within as little as six months of going on puberty blockers – at which point that child would be just 13 years old.
There are no NHS or NICE guidelines in the UK, and there is no formal medical education in medical schools or in postgraduate deaneries. Core competencies for doctors working in this field do not exist in the Royal College Curricula.
As outlined above, GenderGP does not adhere to NHS protocols which are outdated and result in delays which can be harmful to trans youth. We operate according to best practice Guidelines which favour a stage not age approach. There may indeed be compelling reasons as to why a young person who is completely aligned with their gender identity might benefit from having puberty induced at an age as young as 12. You can read the account from the mother of a 12 year old we treated here.
Claim: The counsellor involved in the consultation said that the child could potentially start on the puberty blockers four to six weeks after signing up with the clinic, and advised them not to use the NHS Tavistock clinic(s) because it would take far longer.
GenderGP has no waiting lists and does not operate a gatekeeping model of care. Patients can start treatment when they are eligible, and certainly within the 18 week timeframe expected of the NHS.
A lack of education and training for UK doctors and counsellors has sadly left the care of a large number of adolescents in the hands of a small number of clinicians. This has had repercussions in terms of failing standards and long waiting lists. As can be seen by the recently published outcome of the CQC review into the standards of care delivered by the UK provider. As such the NHS can in no way be considered a gold standard when it comes to trans healthcare – indeed it is a long way off being so.
Claim: GenderGP representatives said treatment on puberty blockers could potentially commence without talking to a doctor. The doctor who was involved in the consultation said that regular counselling sessions or any consultation with a doctor were not required unless there was a specific issue. The counsellor involved in the consultation said it was not mandatory for children undergoing sex changes to have regular counselling, in case they find it ‘traumatic’ and it puts the patient off therapy later in life.
Our model of informed consent ensures that before any irreversible or life-altering medication is taken, all patients know what the effects would be, both psychologically and medically. We have a very experienced team of doctors, counsellors and psychologists on hand for consultations at every stage of the process. Current best practice is to make counselling, psychotherapy and support available at any stage of a trans person’s journey, and while this is certainly not mandatory for all it is available to all of our patients on a case by case basis. Forcing people into therapy is counter-productive against the true potential benefits of good counselling. You can find out more about our approach to assessments here.
Claim: GenderGP uses doctors based abroad who have no apparent training or specialism in the field of endocrinology or clinical psychology in order to circumvent NHS guidelines and the law in England and Wales.
Our organisation is a global organisation which covers many countries outside the UK and all of our practitioners are fully regulated in their country of residence. There are no formal qualifications in this field but all of our practitioners who work with GenderGP are very experienced and fully educated in Transgender Healthcare. There is no requirement for practitioners to only be endocrinologists or clinical psychologists, gender specialists can come from a number of disciplines.
There are no UK NHS published guidelines for the care of transgender people, no NICE guidelines and no formal medical education in medical schools or in postgraduate deaneries and standards do not exist in the Royal College Curriculae.
In the absence of UK guidelines, our specialists follow the Guidelines of the Centre of Excellence in Transgender Healthcare at the University of California and San Fransisco, and the Standards of Care set by the World Professional Association of Transgender Health, and the Guidelines set by The Endocrine Society for the Care of the Gender-Incongruent Person. In addition to these, the Australian Guidelines for the care of transgender youth are an invaluable, evidence-based representation of what excellence in transgender care can achieve for young people.
As highlighted above, gender specialists can come from many different clinical backgrounds including psychologists, psychiatrists, counsellors or therapists, but they may also be GPs, endocrinologists, nurses etc.
Claim: Gender GP downplayed the effects of medications. The GenderGP counsellor involved in the consultation, said that going on cross-sex hormones was ‘no different’ than a post-menopausal woman going on HRT, and the doctor involved said that the question over whether puberty blockers would damage fertility on a permanent basis was “the very tiny part” of taking them that was “sensitive”.
Of course the benefits of any treatment must be weighed up with the risks, as well as the risks of not having the treatment.
The benefits of gender-affirming care are well-attested, as are the consequences of withholding that care which may ‘prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization’. When considering gender affirmative care – as is the case with ANY treatment – the patient must be given ALL of the facts so that they can come to an informed decision.
While it is understood that loss of fertility is a risk, it is one that is discussed at length with any patient undergoing any kind of treatment that may impact their fertility. It is important to note that there is plenty of evidence to suggest that this is not the inevitable outcome of gender affirming hormone treatment.
In its 2016 statement, the WPATH clearly states that ‘These medical procedures and treatment protocols are not experimental: Decades of both clinical experience and medical research show they are essential to achieving well-being for the transsexual patient.’
Claim: In operating outside NHS guidelines and assisting children under the age of 16 to circumvent both the guidelines and the law in England and Wales in order to access life altering prescription medication, GenderGP’s practices are at best unethical and at worst, potentially dangerous to the mental and physical health of children.
GenderGP operates in line with international best practice. In their joint statement, issued in response to the Bell v Tavistock ruling, world leading experts in transgender healthcare WPATH et al explain that: ‘although treatment for young transgender adolescents involves uncertainties, as is the case in many fields involving young people, several studies demonstrate the clear mental health benefit of gender-affirming medical treatment (including puberty blockers). Withholding such treatment is harmful and carries potential life-long social, psychological, and medical consequences’.
What IS dangerous to the mental and physical health of children is withholding treatment which is endorsed by leading experts worldwide on the basis of social or political grounds.
What is the clinical basis for treating children as young as 10?
Leading experts agree that: ‘(puberty suppression and subsequent gender affirming hormones) is the most widely accepted and preferred clinical approach in health services for transgender people around the world. The aim of puberty suppression is to prevent the psychological suffering which stems from undesired physical changes that occur during puberty, and to allow the adolescent time to carefully consider whether or not to pursue further transition when they are eligible.’ This is also the approach taken by the NHS. Tanner stage two of puberty can begin as early as eight years of age.
It is a standard part of the WPATH’s Standards of Care as well as the Endocrine Society’s Clinical Practice Guidelines. To be fully effective, puberty blockers should commence early in the puberty process, not at the age of 16.
Please give us details of the qualifications of the Gender GP workers named in this letter, as well as who regulates them.
We are very proud of our team and full details of our MDT and our specialists are available on our website. All of our practitioners are fully qualified and regulated to carry out their roles and of course any patient seeking care or treatment would be at liberty to ask any questions they wanted about their professional qualifications and credentials. We request that you respect their personal privacy and that any names and contact details that you have gained while posing as a patient to access their services, are kept confidential and treated with the same respect as any doctor-patient confidentiality.
Dr Helen Webberley is currently suspended by the GMC, what is her involvement?
Dr Helen Webberley is the Founder of GenderGP and her license to practice medicine is indeed under an order of temporary suspension by the Medical Practitioners Tribunal Service. No finding of fact has been made against her medical practice to date. Her substantive GMC hearing will be in July this year and we publish regular updates in regard to this. She has remained in association with GenderGP as a proud advocate for improvements in access to transgender healthcare, but does not currently provide medical care. Read more about the history of GenderGP on our website.
UK trans people deserve better than this!
Our petition campaigning for better trans healthcare has amassed more than 25,000 signatures and counting. We cannot let personal opinion, bigotry or ignorance prevent this incredibly resilient group of people from accessing the care they need.
Youth Worker Alex Thomas offers the low-down on LGBTQI youth groups and why – if you’re a teenager – you might want to consider joining one.
I found out about my first youth space through Facebook. It was a group for transgender young people to meet and explore their gender. I had never been to a youth group before and was anxious about meeting other transgender people, who I wanted to connect with but wasn’t sure how to.
I found myself in a room with the greatest number of transgender people I had ever met in my life … three, and it felt incredibly overwhelming. That seems funny now, considering that these days most of my friends are transgender. I enjoyed it so much that when one of the attendees told me about an LGBT youth group that was happening later that evening I went along. It felt so exciting to be around other LGBT people that I kept going back. I was soon asking the youth workers “How do I do what you do as a job”?
I wouldn’t be where I am today without them. Simply having a space where I could talk and people would listen and understand gave me confidence that the problems I faced – like being misgendered or feeling isolated – weren’t just me, and they weren’t due to anything being wrong with me. They were common experiences that lots of LGBTQ people faced, and as a group, we talked about our lives and I was supported to face tough times with kind words and humor.
That youth group is still running (they are Bristol based and still going strong) and I’m passionate that other people get the chance I had, to experience such kind and empowering spaces. I have worked in transgender youth spaces, youth groups open to anyone and LGBTQ youth spaces. Through my work, I often receive questions about what youth spaces are like, and lots of people say they are nervous about attending. So I wanted to share my experiences of LGBTQ youth groups to encourage more young trans people to access them.
You can expect most LGBTQ youth groups to have time for socialising and time for activities. Different services offer different things including mental health support, counselling, STI prevention, and referrals to internal and external services.
The most common reason young people give for coming to LGBTQ youth groups is to meet other LGBTQ people. Some are confident and chatty, others are shy but, regardless, they want to be around people like themselves. From my professional experience as a youth worker, and from personally attending transgender social groups, I have seen the value of trans people making connections with others like themselves. It’s much easier to make friends with people if you have things in common and you don’t have to worry about being accepted. Other reasons people come along are to get involved in the local LGBTQ community, make friends outside of school and have somewhere to relax away from home.
Here are some answers to questions and concerns that young people or their families may have about LGBTQ youth spaces:
Do LGBTQ youth spaces encourage young people to transition?
If someone has questions about being transgender or transitioning we will answer them, however, we don’t encourage anyone to transition. We support the young people who come to our groups to express who they are and support their choices. Youth groups can be a great place to try out a new name, pronouns or gender presentation.
Do they tell parents what their children have talked about?
In most LGBTQ youth spaces and 121 support everything that is said is confidential. Youth workers uphold safeguarding. This means if we think you are in danger, or someone else could be in danger based on what you have said we would need to tell someone. This could be parents, carers or other services. In these cases confidentiality would be broken. We try to communicate with the person involved about this first. Safeguarding is implemented in every youth service. If we think parents should know about something but it’s not a safeguarding concern we would encourage a young person to tell their parents themselves, but we would not do this without permission from the person involved.
I don’t have any problems or mental health concerns, can I still attend an LGBTQ group?
Of course! While we can help with problems people might be going through, most LGBTQ youth spaces are open to any LGBTQ young people, with some restrictions on age or area. There are some spaces that are reserved for people who would like mental health support as well.
I want to come but I’m not sure if I’m ready to tell other people I’m trans
When you join an LGBTQ youth space you will probably have a chat with one of the workers to find out a bit about you and it’s likely you will be asked your gender and sexuality. If you explain you want these kept confidential your wishes should be respected. At most groups people introduce themselves with their name and pronouns, but you should not have to disclose your gender or sexuality if you don’t want to.
I’m not good at meeting new people and I’m worried about joining a group
If you can, explain this to the youth workers before you join. They will help you settle in and introduce you to people. Youth groups aren’t like school, you won’t be expected to talk or give answers to questions if you don’t want to. Lots of people who join youth groups need a bit of time to feel comfortable.
If you would like to find an LGBTQ youth group near you follow these links to the Stonewall website, Consortium and LGBT Ireland. If you’re reading this and feeling alone, remember there are people just like you out in the world and LGBTQ youth groups are a great way to meet them.
Alex (They/He) is a queer, non-binary youth worker for METRO Charity’s LGBTQ+ youth group Snap based in Bromley and transgender youth group Transcend based in London. Their favourite things are being queer, sushi and dogs.
The event kicks off at 2pm UK time (9am Eastern Standard Time) on Twitch for Mario Kart for Hope: twitch.tv/supersweetboy
The fundraiser has been organised in response to the challenges facing trans youth in the UK today. This situation was recently made worse following a high profile court ruling that has made it harder than ever to access the essential medication which has been proven to be a lifeline for these young people.
Ed, who recently featured on an episode of The GenderGP podcast, sets out his reasons for supporting trans youth in this short trailer:
He will be playing through almost every Mario Kart game in the series, from Super Mario Kart on the Super Nintendo, all the way through to Mario Kart 8 Deluxe on the Switch.
There will be:
- guests on the show
- fun donation incentives
- prize draws and other surprises!
Ed has pledged to continue driving as long as people are there to support him – so if gaming’s your thing, why not join in! And if it’s not, but you know someone who would be interested, send them Ed’s way.
We’ll be there to support and we hope you’ll join us at twitch.tv/supersweetboy.
General Pharmaceutical Council
25 Canada Square
Sent by email 17.02.21
Dear Mr Rudkin,
We call on you to provide reassurance to trans youth that their access to medication will not be disrupted.
Thank you for your prompt response and for explaining your regulatory processes in such detail.
While we hear your message that you are not trying to prevent pharmacies from supplying medicines to trans youth, the fact remains that your actions have blocked access to essential medication for this group of patients.
Following patient experiences in October, when your actions led to access to care being impacted through our other pharmacy, it is easy to see how those affected might have been left with the perception that preventing access is indeed your intention.
This perception is further exacerbated when individuals contact you and receive the same generic letter that was written to us in response to our recent communication, rather than a personalised response to their concerns.
These are young patients whose options for timely care in the UK are non-existent. Not only are waiting times for NHS care illegal, but the care that is available via specialised NHS services, was recently rated by the CQC to be inadequate.
The only timely care available to them is via GenderGP and any disruption to their medication prescribed via our service is a serious risk to their safety.
You mention various steps you have taken to secure continuity of care. This information will be of great interest to our service users.
As such, please provide us with:
- A list of the signposting solutions you mention in your letter so that we can reassure, and more importantly direct, our service users to alternative providers.
- Any information our patients can print off and take with them that will satisfy pharmacists that they can indeed honour prescriptions for transgender individuals of all ages.
- The outcome of any discussions, engagements or projects, to which you refer in your letter, that relate specifically to the provision of safe and effective pharmacy solutions for trans people.
You state that the inspections of the two services working with GenderGP were not ‘targeted’ as we described, but ‘intelligence-led’. We ask that you share the intelligence relating to our service which led to these inspections. If you would feel more comfortable releasing this information following a Freedom of Information request, then please let me know. It would help us very much if we could reassure our service users that your intelligence-led inspections were based on properly founded concerns rather than transphobic motives.
If you would like to educate and reassure the trans community that your intentions are in the interests of their health, then you might like to consider the following:
- An interview with our clinical team.
- Join us on our podcast to discuss pharmacy safety.
- Write a blog for our website.
- Publish a statement on your website highlighting your commitment to securing care to this cohort.
We have published a Pharmacy Hub on our website to support our pharmacy colleagues. The following pages may be of particular interest to you, and if you would like to make any contributions, please let us know:
- Our prescribing protocols can be found here.
- Our approach to assessments can be viewed here.
- The Clinical Guidelines we follow can be viewed here.
- Our monitoring protocols can be found here.
GenderGP is a global organisation which provides excellent care to trans individuals when their own public health service fails them. We have one objective in the UK and worldwide and that is to bridge the gap that trans individuals of all ages currently face due to inadequate support from their national healthcare provider, or indeed where no national healthcare provider exists. We invite you to collaborate with us on delivering a solution which will ensure the same safe, regulated care is available to all trans individuals, as it would be to anyone else.
I look forward to hearing from you.
Katie Tiplady Startin
Chief Operating Officer