GPs could initiate hormone therapy for transgender patients, says GMC

GPs should consider prescribing 'bridging' hormone treatment to transgender patients attempting to self-medicate while they await specialised gender identity treatment, GMC guidance recommends.

GPs may choose to initiate hormone therapy to transgender patients before they are assessed by a specialist if they are turning to unregulated drugs bought online to self-medicate their condition, guidance released by the GMC says.

It follows a report on transgender equality released by the House of Commons women and equalities committee in January, which found that health professionals often lacked an understanding of where to refer trans patients and what their own roles were in prescribing treatment.

The guidance says GPs should refer patients requesting treatment for gender dysphoria to a Gender Identity Clinic (GIC) or gender specialist ‘without delay’ to help best meet their needs.

All GPs in England, Northern Ireland and Scotland may refer patients to a GIC directly, and do not need to refer patients to a mental health assessment beforehand.

But patients may face long waits before their first appointment with a gender specialist, and GPs are advised that this can be very distressing and their mental health may suffer as a result.

Patients deemed to be at risk from self-harm and distress should be referred to local mental health services if appropriate, it says.

Transgender care

Other patients may seek to self-medicate with products bought online from an unregulated source, it warns.

In these cases, it recommends that GPs should consider ‘bridging prescriptions’ of hormone therapy.

The guidance says: 'Some trans people – after many years of suppression, and facing continued deterioration in their mental health while waiting for a specialist appointment – become desperate for medical intervention and may turn to self-medication with products bought on-line from an unregulated source, without prior medical assessment or supervision.

‘It may well be that the risk to your patient of continuing to self-medicate with hormones is greater than the risk to them if you initiate hormone therapy before they’re assessed by a specialist.’

It adds: ‘The GP or other medical practitioner involved in the patient’s care may prescribe "bridging" endocrine treatments as part of a holding and harm reduction strategy while the patient awaits specialised endocrinology or other gender identity treatment and/or confirmation of hormone prescription elsewhere or from patient records.’

Patients should be made aware that hormone therapy could have an irreversible effect on their reproductive capacity.

GPs should cooperate with GICs and gender specialists as they would with other specialists and prescribe the treatment they recommend.

GPs are also advised that patients do not require an updated birth certificate or gender recognition certificate to have their gender changed on their GP record, and any requests from a patient for their sex, name and title to be changed should be honoured by the practice.

Professor Terence Stephenson, GMC chairman, said: ‘Transgender patients have the right to be treated with the same respect, sensitivity and understanding as all patients.  We hope our guidance will help doctors understand their roles and responsibilities in this area, and we will work with others to consider whether there is any further support we can give.’

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