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GPs should initiate gender dysphoria hormones in ‘exceptional circumstances’

The GMC has said that GPs should initialise hormones to patients with gender dysphoria only in ‘exceptional circumstances’, after its original guidance was questioned by the GPC.

A letter from GMC chief executive Niall Dickson to GPC chair Dr Chaand Nagpaul said these ‘bridging’ prescriptions, while a patient was awaiting a specialist appointment, should only be considered when three criteria were met. 

He defined these as:

  • The patient is already self-prescribing with hormones obtained from an unregulated source (over the internet or otherwise on black market);
  • The bridging prescription is intended to mitigate a risk of self-harm or suicide;
  • The doctor has sought the advice of a gender specialist, and prescribes the lowest acceptable dose in the circumstances.

Mr Dickson said the GMC will now ‘review the wording’ of its new guidance ‘to make sure it’s clear to doctors that it’s only in these exceptional circumstances that bridging prescriptions should be considered’.

The GPC had also raised concern regarding continued prescriptions under shared care arrangements, which it said went against GMC Good Medical Practice by ‘forcing’ GPs to prescribe ‘outwith the limit of their competence’.

But Dr Dickson said that ‘this principle’ cannot ‘be a bar to doctors taking on new responsibilities or treating unfamiliar conditions’.

He said: ‘We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population… Having said that, we don’t believe that providing care for patients with gender dysphoria is a highly specialist treatment area requiring specific expertise.’

He added that he ‘sympathetic’ with the ‘difficult position’ GPs were placed in with regards to long referral waits, offering to be ‘part of conversations’ with NHS England on how to ‘help make sure that trans patients are able to access the specialist services they need’.


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