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GPs go forth

Working Life: Working in trans health

Dr Sophie Quinney shares a typical day in the life of a GPSI in trans health

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Profile - Dr Sophie Quinney

Roles - GP with a special interest in trans health at Meddygfa Canna Surgery, Cardiff, and former associate medical director for the Welsh Commissioner

Hours worked per week - 40

8.00am

The kettle is on and I’m checking the new GP referrals. I support prescribing for gender-diverse people across Cardiff and the Vale, but also further afield in Wales, where endocrine support is unavailable. We are shortly launching a DES to incentivise GPs to prescribe long-term maintenance HRT.

A fellow GP arrives, along with a sexual health consultant, both from neighbouring health boards. They are here to shadow me for the session and will soon join the local gender team, initiating HRT on behalf of mainstream GPs as part of the new Welsh service model. Also with us is Eve, a fourth-year medical student inspired by a workshop on gender diversity that I delivered for the RCGP Discover General Practice day.

9.00am

It’s time for clinic. Patients each have a 30-minute slot. The guys are keen to show off their new facial hair, but for my trans-feminine patients this is often a source of significant distress. In Wales, unlike in England, facial hair electrolysis isn’t funded by the NHS, and it’s not cheap. Carly asks me if £585 sounds like a good price for nine sessions.

Gamete storage, however, is funded, and Andrew recounts his experience of egg retrieval being positive, although the forms assumed that he was cis-gender.

I administer injections, review bloods and advise on sexual health and screening.

Every one of these patients tells a difficult story of battling to be their authentic selves and at times feeling let down by their GP.

It’s part of my job to explain that we also face barriers, particularly with feeling adequately skilled in this area.

12.30pm

It’s lunch time, and I’m off to visit a practice that isn’t currently prescribing HRT. We sit around the table and mop up food left over from an earlier drug rep visit. The younger salaried GPs are keen to prescribe, but want more training. Older partners are concerned about workload and inadequate shared-care support. I offer reassurance that the DES will address these concerns. We discuss other ways to have a positive impact, such as changing the name and gender marker on a record, the correct use of pronouns and setting up screening alerts.

Bringing everyone together is an important part of my work, as is championing policies that support GPs.

2pm

There’s a web page on GP One calling for my attention. GPs and other non-specialists want to access information in one place, so I’m creating a trans health section.

I also add the final touches to my presentation for the upcoming series of national GP CPD events.

3pm

I dial into a conference call with gender leads from the seven Welsh health boards. They are responsible for setting up the local gender teams, ensuring all patients have guaranteed prescribing support close to home. I talk through the new treatment flowcharts that I have devised as a way of demystifying the hormone initiation schedule.

4.30pm

The kettle is back on and the Welsh cakes are warmed. Nick, from the charity Umbrella Cymru, is helping with a proposal for peer support – people with lived experience to provide a community presence at the new Cardiff gender identity clinic and support patients on the waiting list.

Gareth, the manager at Leeds gender identity service, joins the meeting via conference call. His outreach team provided the inspiration for this project.

6pm

It’s the last Thursday of the month, and time for the Trans Social Meet-Up, a get-together in Cardiff for the community, and a vital place to build bridges and to become an advocate.

9pm

Bedtime reading is Transgender Health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care by Dr Ben Vincent, which I recommend to all GPs.

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Readers' comments (14)

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  • Is funding for gender dysphoria more important than for, say, dementia simply because of the highly advocative nature of those affected? Or autism? Or learning difficulty? Is it an actual illness? If someone’s saggy boobs is making them sad do we pay for cosmetic surgery? Or their big nose?

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  • A great summary of valuable work, Dr Quinney. I am really proud of what you have achieved in Wales, especially for the system of wide support (and funding) for GPs in this area. Trans people are here to stay. They are not mentally ill (as demonstrated by the removal of transexualism from the mental health chapters of the ICD11 and the DSMV) and the deserve the same access to treatments as people with DSD or other hormonal problems do.

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  • Does removal from a book prove anything? Especially the DSM? If it’s not a mental illness, what type of illness is it? I have exactly the same hormones as men wishing to change gender to women.

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  • Cobblers

    Dr Simon Braybrook Chair SE Wales RCGP Faculty.

    Heavy weight establishment piles into support a, no doubt, well meaning doctor.

    Are you going to be around, either of you, when the chickens come home to roost as DecorumEst has suggested?

    In 10-20 years time those who have had their genitalia refashioned regret their actions and decide to unload legally?

    "Well m'lud it was the zeitgeist. It seemed like a good thing to do".

    Good luck with that.

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  • doctordog.

    With funding limitations , I’m not sure how this should be prioritised,

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  • @Cobblers (by name and nature).

    Ex-chair. Ex-member actually. Definitely not establishment

    I'm sure 30 years ago you would have been fighting against the "zeitgeist" removing the definition of homosexuality as mental illness.

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  • Cobblers

    SB 4:13pm

    Unlikely. I counted homosexuals as friends then and still do now.

    Are you not in the least troubled by what are irreversible actions in a very vulnerable population?

    Primum nil nocere is our dictum is it not? This is harm. Even if a vocal group are baying for treatment do we give it if it is harm?

    Let alone balance the funding needs of the whole population?

    I don't have an answer but what we do need is a grown up discussion generally how we afford any treatment on the NHS.

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  • The question is "Should people who believe their gender does not match their birth sex be eligible for taxpayer funded treatment to match their sex to their chosen gender?"

    Hw far does this go? What stage do we need get people to where they are happy? Just a new penis/vagina? Or a fake Adams apple? Do we insist they get their fair amount of back hair?And if not, is this to be free for those men who don't want it as they want to feel a bit more womanly by having it removed?

    And please don't use the insult that those who are making reasonable debate about a very contentious issue of being homophobic. The two issues are chalk and cheese.

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  • "freely removed on the NHS"

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  • Wow. Comment removals? Can I ask - is it self harming to have a penis, or breast tissue surgically removed, for a condition which is essentially mental in nature? First do no harm?

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  • There is no money for heart operations on the NHS or cancer treatment as well as a host of other potentially life threatening conditions such as cystic fibrosis, yet there is money for sex change operations? How come I wonder?

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  • The UK has the worst cancer detection and survival rates amongst Developed Countries.

    Mic drop.

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