The Guardian published a story on September 7th about a study which found that US doctors and therapists are struggling to give transgender patients the best medical care.
The author, Stef Shuster, makes the [very valid] point which is just as pertinent here in the UK: there is very little scientific evidence and clinical experience on which to base medical decisions relating to the best treatment for transgender patients and it is "this particular feature of trans medicine [that] introduces the potential for providers to bring bias or limited knowledge into their work with trans people."
The NHS has approved care for transgender people in the form of counselling, hormone therapy, voice therapy, laser hair removal and surgery but why are so many patients struggling to gain access to these services?
The majority of trans people do not want to have full reassignment surgery, and would be very relieved to just receive timely, compassionate support and simple hormone treatment.
So why are healthcare workers struggling to give the best care? The US study cites reasons such as personal bias and limited knowledge.
Here in the UK, the GMC is very clear that no doctor should allow their personal beliefs to hinder the care that they offer to someone with gender variance. This means that your doctor is not allowed to:
a) not believe you
b) refuse to offer help and support with your condition on the NHS
c) refuse treatment based on any religious or ethical grounds
The key issue, here in the UK at least, appears to be a perceived lack of knowledge on the part of the GP which is further exacerbated by the lack of evidence-based research which GPs can refer to in order to help with any decision making on the best care pathways for a patient with gender variance.
The medications we use are often unlicensed for the use in this situation. We are short of large and comprehensive research studies to examine the best medication and the best age to start it. Of course there is information out there and resources are available to support any GP who wants to learn more about how to treat patients in this very specific area of gender health but, for many, the lack of precedents leads to a fear of making a mistake and ultimately the withdrawal of care from a vulnerable patient.
There may be a lack of evidence on the best treatment pathways for these patients, but does that mean they should have no care at all or, at best, care filled with prejudice and bias? Why is it that so many of my patients tell me that they were the one telling their GP what to do next?
As for lack of available care, if we start offering more care then we will have more case studies on which to report successful and unsuccessful outcomes. Doing nothing is not a neutral option, it causes terrible detriment to the future mental and physical health of these patients.