Thread by @Transgendertrd

We welcome this excellent position statement from @rcgp on the care of transgender patients, which acknowledges the difficulties for GPs and the conflicting advice from @gmcuk, the lack of a national training programme and lack of robust evidence. rcgp.org.uk/policy/rcgp-po…

"There is an urgent need to [...] expand the understanding of gender variance issues including more definitive knowledge about the causes of rapidly increasing referrals and the outcomes of
interventions or ‘wait and see’ policies."

"The significant lack of evidence for treatments and interventions which may be offered to people with dysphoria is a major issue facing this area of healthcare."

"Gonadorelin (GnRH) analogues are one of the main types of treatment for young people with gender dysphoria. These have long been used to treat young
children who start puberty too early, however less is known about their long-term safety in transgender adolescents."

"Children who have been on GnRH for a certain period of time and are roughly 16 years of age can be offered cross-sex hormones by the NHS, the effects of
which can be irreversible."

"There is a significant lack of robust, comprehensive evidence around the outcomes, side effects and unintended consequences of such treatments [..] particularly children and young people, which prevents GPs from helping patients and their families in making an informed decision"

This is a particularly vulnerable group: "Informal feedback is that some new university students may not register with a new GP practice near to their campus due to fear of dropping off the waiting list for a GIC appointment."

"GPs often feel it its outside their area of competence to advise patients with gender dysphoria. However, GPs can contextualise a person’s presentation of gender dysphoria with other conditions, particularly autism, and within their broader environment."

"GPs may also be able to contextualise the distress felt by the individual against that person’s medical history and possibly relate it to the distress and discomfort often experienced by many young people
during puberty and adolescence."

Goes without saying, but good to see it stated: "GPs and their teams are required to show the same level of support, dignity, respect, sensitivity and understanding, to patients with gender dysphoria or trans patients, as they would with any other patient."

"Patients [...] should receive prompt and timely access to the skills of relevant healthcare professionals across the healthcare system (GPs, gender identity specialists, mental health professionals, counsellors and so forth) and appropriate treatment when they
need it."

"These patients should have access to high quality, joined-up, person-centred healthcare based on robust evidence. GPs should be trained and prepared to provide high-quality, holistic care to patients
who identify as suffering from or are diagnosed as has having gender dysphoria"

"When responsibility for ongoing medical monitoring and prescribing is assumed by a GP, the limitations of this need to be recognised and mitigated. This is especially important for children and young people, where there is concern regarding the outcomes of some interventions."

So good to see acknowledgment of this: "Recognise that the family members of a patient experiencing gender dysphoria also face significant challenges and refer these family members to further support services where appropriate."

"Provide appropriate treatment or signposting to patients presenting with gender dysphoria alongside other social or medical issues. This may include referring the patient to mental health services or engaging with social care, safeguarding or sexual
health colleagues."

Of key importance: "NHS systems should record codes for biological sex as well as gender identity, while ensuring all patients are afforded the right to express their preferences for how they wish to be named and referred to by their GP and other healthcare professionals."

This is a comprehensive and compassionate position statement which - relief! - uses language based on reality, eg. this definition of gender dysphoria: "discrepancy between a person’s gender identity and their biological sex observed at birth."

And this is the part we welcome the most: