Thread by @JackRaoul

One of the most common problems I see as a trans healthcare advocate in the UK is GPs refusing to prescribe or abruptly stopping hormones. Here are some things you can do when that happens. [THREAD]

First, get informed. Stopping hormones abruptly for any reason other than a health emergency/impending surgery is dangerous and unethical, and it's within a GP's duty of care to prescribe.

These are the documents I use to show evidence of just that:

WPATH Standards of Care, pgs. 33-34: On the medical necessity of hormone therapy and 'rare' circumstances in which they are stopped.

These are the leading international standards of care, used as guidance (in name) by NHS and private gender services.
wpath.org/media/cms/Docu…

NHS 2019 England Schedule 2 for Gender Identity Services for Adults, pg. 32: On GPs' obligation to prescribe hormones once a patient has been discharged from an NHS gender clinic.

If you went private to start hormones, read on!

england.nhs.uk/wp-content/upl…

NHS GPs aren't obliged to uphold what's called a 'shared care agreement' with private clinics – basically, to prescribe you hormones after a private clinic greenlights. It's a good idea to get lots of paperwork from your private clinic, but also:

NHS Gender Dysphoria Services Guide for General Practitioners, pg. 11: Explicitly discouraging NHS GPs from stopping a patient's hormones if they've started via private clinic or self-medding.

And pg 8: On GPs' 'life-long' role in prescribing & monitoring
gendergp.com/wp-content/upl…

(There's a good bit on pg. 11 of the above which explicitly says it's not acceptable to stop/deny hormones based on a doctor's religious or political beliefs – just, you know, in case!)

The above tells GPs pretty much everything they need to know about the NHS gender services at present, including their own role in the process and how to contact a GIC for information! There's also a dedicated email for GPs to contact w hormone queries: it's [e-mail]

GPs often stop prescribing bc they say they've had a change of heart, or they're not sure how to do this long term, or maybe your old GP handled it. You can remind them that they're ethically bound to explicitly prioritise their patients' well-being over their own convenience:

"Decisions about who should take responsibility for continuing care...should be based on the patient’s best interests, rather than on your convenience or the cost of the medicine and associated monitoring or follow-up." (GMC shared care guidance, pp 35).

gmc-uk.org/ethical-guidan…

What if you're self-medding or wanting to get/on a bridging prescription? Trans Leeds has got a nice cited list of all the relevant guidelines in their excellent guide for GPs treating trans patients (pgs. 11-17):

transleeds.lgbt/wp-content/upl…

Next, start a paper trail. You can ask your GP surgery for your medical records; ask them to include the details of why they've stopped your hormones (often, it won't be for a valid medical reason!).

Here's a template of a generic email you can send to your GP. Make sure you cc in the practice manager for accountability and records, especially if you choose to do a Patient Advice and Liaison Service (PALS) complaint.

docs.google.com/document/d/1xh…

Straight-up changing GPs is often just the simplest solution. Your local trans group usually has the goods on who's a decent doctor. Lots of people don't do this bc they think it'll be a hassle – it actually just means filling out a form at the new surgery, no break-up required.

If you're still having trouble, escalate. There are a few ways to do this, from pestering to direct action. Contacting local LGBTQ services/networks/Pride orgs/uni LGBTQ socs for support is often more effective than a PALS complaint (that's the formal way to complain abt a doc).

Public reviews on Twitter/FB can be a useful thorn in a practice's side. Escalating to local mutual aid/national LGBTQ groups/patients' charities are options; coordinated complaints and direct action campaigns can work if you bring in ppl who know what they're doing.

As always, having an advocate for this stuff is crucial. @queercarenet and @GalopUK have trans advocacy services (chuck them some ££ if you can!) – but even a friend can make a huge difference.

Here's a detailed guide to doing trans advocacy:
instagram.com/p/CBgjtJplJWj/

Why does this happen? NHS GPs don't have trans-related training – I've literally not met one who was already sufficiently clued up about their role and their patient's rights in transition-focused care. Some are happy to be taught, most are cautious, a few hostile.

Anecdotally too, the uptick in media transphobia has really freaked out GPs – they're worried about getting sued/harassed, offering basic (and legal) informed consent workarounds like bridging scrips, etc. It's not brave but it's to be expected.

It's very easy for doctors to break rules when they don't know them. Here are a few common scenarios where trans people get into trouble bc they don't know their rights and GPs don't know what they're doing and/or aren't willing to learn:

Scenario 1: GP stops prescribing because they don't know how to monitor a patient's bloods.

Relevant info is in the guides for GPs above, but a local endocrinology referral can also be made (pg. 18, NHS Guidance for GPs):
gendergp.com/wp-content/upl…

Scenario 2: GP stops prescribing because they want information/follow-up from a specialist.

Get them to email [e-mail] or contact your private clinic (get confirmation too). Refer to GMC shared care guidance – their convenience/wait doesn't come before your care.

Scenario 3: GP claims you need to be seen by a community mental health team or the gender clinic before they continue prescribing.

Required mental health team assessment hasn't been the case for about a decade. Emphasise mental/physical health risks from stopping for 2yr+ wait.

Scenario 4: GP refuses to prescribe because of unspecified concerns abt mental health.

This is a bring out the big guns one rather than clearing up a misunderstanding – either GTFO to another practice or go straight to a national org. Slippery enough to be often ill-intentioned.

Plenty else to say about the sheer scale of just how often this happens and how terrifying it can be, but threading for resource brevity. [/END]

Don't have much capacity to support/talk about individual cases rn, but happy to answer general qs about this stuff (for doctors too)!