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GPs urged to co-ordinate care for people with gender dysphoria

GPs should take the lead in co-ordinating care for people with gender dysphoria, says new guidance from the Royal College of Psychiatrists, endorsed by the RCGP.

The RCP says up to 40% of people with gender dysphoria are not getting appropriate care and that the support of GPs is ‘essential’ to help improve access to treatment for gender identity problems.

The new guidance – endorsed by 13 organisations, including the RCGP – calls for GPs to take the lead in co-ordinating care for gender dysphoria from a range of specialists.

According to the report, gender dysphoria is ‘not uncommon’– a recent survey demonstrated around 1% of people are gender variant to some extent – but people can find it difficult to confide their feelings about to their GP because they fear ridicule or feel ashamed.

As a result, the guidance says people are increasingly self-medicating with hormones and hormone blockers available on the internet, and up to 40% may not be receiving appropriate treatment.

Gender treatment involves multidisciplinary teams including psychiatry, speech and language therapy, endocrinology and surgery specialists; GPs will usually refer patients to a specialist gender identity clinic in the first instance.

The guidance states: ‘The support of a GP who is prepared to be proactive in supporting referrals for treatment and to enter into collaborative care arrangements is essential.’

It goes on: ‘Primary care continues to be central to the delivery of medical and psychological care to the majority of patients. It is desirable for a single practitioner to adopt the lead role to facilitate coordinated care. General practitioners are likely to undertake this role.

‘Under new commissioning arrangements it is particularly important that treatments provided locally are coordinated with those provided by tertiary services. All information should be shared with the GP, and patients should be copied in to all letters between clinicians.’

Professor Gabriel Ivbijaro, a GP in north east London and member of the guideline working group, said: ‘I’m very pleased that this [guideline], a collaboration between a range of royal colleges and stakeholders, has finally been published.

‘As the Royal College of General Practitioners representative, I believe that this guideline will help to improve access to treatment for adults with gender dysphoria and will promote inclusion in the primary care setting.’

Professor Kevan Wylie, chair of the guideline working group, said: ‘These guidelines have been ten years in the making, and we are delighted to have endorsement from so many different organisations.

‘The document provides guidelines which we hope will optimise the clinical care pathways for those individuals whose phenotype is inconsistent with their gender identity.

‘We hope our guidance will ensure best practice across all NHS organisations which either commission or provide treatment and health services for trans people. Some people with gender dysphoria avoid seeking professional medical assistance. We hope that by adopting our patient-centred recommendations, patients will be less likely to do this.’

Royal College of Psychiatrists - CR81: Good practice guidelines for the assessment and treatment of adults with gender dysphoria