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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.

Medical care for trans youth is a popular topic for the media and the comparison between GenderGP and the UK NHS Gender Identity Development Service (GIDS) has been of interest since 2016.

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.

Key Facts:

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.

 

We help teenagers who have nowhere else to turn

 

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.

 

Direct Questions:

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.

 

Photo by Ben den Engelsen on Unsplash

Photo by Clay Banks on Unsplash