Patients with gender variance have faced enormous battles of bigotry, prejudice, humiliation and have even been denied access to basic care from their GPs. Following significant concerns raised about doctors’ lack of awareness and consideration in treating transgender patients, I was delighted to see the GMC publish guidelines on managing transgender patients.
These are medications that are well known to GPs
Of course this was to be met with a variety of concerns from NHS GPs, and I have yet to see many embrace this welcome news that we can now do more to help our trans patients.
GPC chair, Dr Chaand Nagpaul, penned his concerns to the GMC, raising the emotive points that this would make GPs undertake specialist prescribing, placing them in a difficult position and forcing them to prescribe outside the limits of their competence.
Acting chief executive of the GMC, Susan Goldsmith, replied with reassurances including that they expect GPs to ‘acquire the knowledge and skills to be able to deliver a good service to their patient population’, which may mean undertaking training and that they don’t believe care for patients with gender dysphoria is a highly specialised treatment area requiring specific expertise.
She goes on to endorse a firm view of mine, that these patients actually require very simple care and well-known medication.
The medication for transgender care includes well-known oestrogen therapy used for treating female menopause (estradiol), injections that are given for women with endometriosis or men with prostate cancer (GNRH analogues), a diuretic used for heart failure (spironolactone), anti-androgens used in contraceptives (cyproterone acetate), medication for benign prostate hyperplasia (finasteride) and testosterone replacement therapy used for the management of the male menopause.
These are medications that are well known to GPs, and we are well-used to the side effects and monitoring.
The other essential aspect of transgender care is listening, hearing, caring, educating, protecting – bread and butter to GPs.
So, I have simple advice for GPs, and this may just help your patients who are transgender and may be suffering from a basic lack of medical care:
- If you don’t know then look it up, there are many training resources and literature sources on gender care.
- Listen to your patients, they are not mentally ill, they are gender incongruent.
- Their medical needs are often very simple – some hormone replacement therapy and a listening ear.
- The treatments are those that we use every day, put any prejudices aside and get your prescription pad out.
- The cost of treating these patients is far less than the loss of life and distress caused by refusing them very simple, basic care.
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