I want to explain why I don’t prescribe hormones for people who identify as trans. I also want to explain my serious concerns about the way people who present with gender dysphoria are being treated. I also want to empower other GPs to think about what they are prescribing and why.
There appears to be a basic misunderstanding of the Equality Act 2010, which leads GPs to fear being accused of discrimination if they do not give these patients what they want. The Equality Act does not state this. Instead, it mandates that transexuals must not face discrimination and should not be treated differently due to their protected characteristic—gender reassignment."
A female patient in her twenties on testosterone presented at my surgery with urinary incontinence and vaginal atrophy. Vaginal atrophy occurs when the tissue in the wall of the vagina becomes thin and fragile, which can lead to pain and bleeding. The incontinence was caused by the effects of testosterone on the bladder and urethra – it was unable to function properly. The patient was in distress. Together these symptoms are known as urogenital atrophy.
A male patient in his twenties taking oestrogen and decapeptyl (also used to block puberty) had chronic widespread pain. As it was poorly controlled with medication he had been referred to the chronic pain clinic by a colleague. The pain was thought to be multifactorial. He was under psychiatry for depression and anxiety, as well as known autism and was a vulnerable patient. Having no guidelines or protocols to follow in general practice I turned to Google and found that patients who had medically transitioned were at higher risk of chronic pain. However, no mention of chronic pain had been noted in his most recent Gender Identity Clinic letter despite the BNF (medicines guidance) noting that a common or very common side effect of decapeptyl in men and women is joint disorders.
Testimony of a GP Who Will Not Affirm by Graham Linehan
A Message to You, GPs
Read on Substack