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Gender identity and the management of the transgender patient: a guide for non-specialists

A recent article published in the Journal of the Royal Society of Medicine discusses the management of transgender patient. Transgender people, whose gender identities, expressions or behaviours differ from those predicted by their sex assigned at birth, are receiving increased attention both in the general media and in the medical press. Recent guidelines in the UK have proposed placing much of the responsibility of care for transgender patients on primary care physicians and their teams. With waiting lists for most gender identity clinics extending beyond 12 months and increasing numbers of patients coming forward for treatment, hospital doctors are also likely to encounter transgender patients in their clinical practice.

General Medical Council guidance published in 2016 recommended that general practitioners play a key role in the care of transgender patients. This includes counselling or appropriate referral (which can be done directly by general practitioners, without an interim referral to general psychiatry) but also, in some cases, the initiation and maintenance prescription of hormone therapy. If a patient is self-medicating from non-verified sources or is suicidal due to gender dysphoria, the General Medical Council and Royal College of General Practitioners argue that a primary care physician should start cross-sex hormonal therapy as a bridge treatment until the patient is seen in the specialist gender identity clinic,1 with or without additional referral to general psychiatry. The guidance recommends general practitioners should initiate therapy if advised to do so by a specialist, provide maintenance prescriptions and ensure any screening and monitoring blood tests are carried out.

The British Medical Association’s General Practitioner Committee has raised concerns that the General Medical Council guidelines may force some general practitioners to prescribe beyond their level of competence, In the article, we conclude that it is unreasonable to require general practitioners to prescribe medications that they feel are outside their area of competence. At the same time, it is clear that gender identity clinics are currently too overstretched to adequately address the needs of transgender people in a timely fashion. Hence, NHS commissioners at both local and national level must invest in an expansion of capacity in specialist clinics so that access is improved, waiting times to see specialists reduced and specialist services have much greater ability to provide support to both non-specialist clinicians and patients.



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