The Royal College of General Practitioners has issued an unprecedented warning over NHS treatments for children which pave the way for a sex change.
In a powerfully worded ‘position statement’, the highly influential RCGP says there is a lack of ‘robust evidence’ about the long-term effects of ‘puberty blockers’ that stop the body maturing, and cross-sex hormones.
And it says there needs to be far more research into the pros and cons of treatment, including medical intervention being compared with a ‘wait and see’ approach.
Research call: More research needs to be carried out into puberty blockers which could pave the way for child sex changes
In plain language that could upset transgender rights activists, the RCGP also urges the NHS to record what it calls every patient’s ‘biological sex’ – in addition to their chosen gender identity – to avoid potentially calamitous medical mistakes.
It says family doctors are being pressured into providing transgender services that ‘lie outside the remit of a GP’s generalist expertise’, and sometimes face pressure to prescribe cross-sex hormones themselves.
Last night, doctors said it was the first time a major UK medical institution had called into serious question how transgender patients are treated on the NHS.
Professor Richard Byng, a practising GP and professor of primary care at Plymouth University, said: ‘I hope it will provide GPs with the confidence to talk openly and compassionately with patients about the differences between gender identity and biological sex, the limited evidence for the treatments available, and the fact that transitioning can be an irreversible process with lifelong implications.’
The 12-page policy document, ‘The role of the GP in caring for gender-questioning and transgender patients’, is in part a response to the huge rise in young people claiming to be transgender.
The number of 13-year-olds seeking treatment at England’s only child gender identity clinic has risen by 30 per cent in just one year, while referrals for 14-year-olds are up 25 per cent, recently released figures show.
Children learn about treatments online – but never the risks
As a practising family doctor, I warmly welcome the Royal College of General Practitioners more cautious approach to the treatment of patients questioning their gender.
None of the other Royal colleges has spelt out the pitfalls of caring for these individuals with such clarity and plain-speaking.
Like most GPs, my ultimate concern is to see patients receive the highest possible quality of NHS care.
That means there must be solid evidence that the treatments offered to them are appropriate – and do more good than harm.
Yet when it comes to the treatment of young patients presenting as transgender, I can’t say this is the case.
First, there is the essential question of whether we should be providing puberty blockers.
We are seeing an unprecedented rise in demand for referrals to gender identity clinics, particularly from teenage girls. Many describe a sudden desire to change gender rather than a long-held conviction. GPs recognise the distress they feel is very real. But is anything else behind their unhappiness?
In these circumstances, a ‘wait and see’ approach should be an option.
Second, there is what the RCGP calls the ‘significant lack of evidence’ for treatments.
Youngsters can pressure us to provide puberty blockers when they have little idea of the long-term implications. But then most of their information appears to come from social media, which perpetuates the notion that these medicines are safe.
Regrettably, specialists advocating slowing the process of transition have often been vilified by activists.
The RCGP has given medics who urge restraint institutional ballast. It should be applauded.
The GP has asked to be anonymous to maintain patient confidentiality.
For the first time, most patients are under 15.
Equally significantly, girls wanting to transition to being male dominate, making up 74 per cent of patients at the Tavistock Clinic in London.
The rapid increase has swamped the Tavistock, leaving GPs with often limited experience having to cope.
But the RCGP says guidance on how to care for patients has been contradictory and ethically dubious.
While the General Medical Council (GMC) advises doctors to ‘promptly refer patients requesting treatment’ to gender identity clinics, the RCGP warns there is ‘a significant lack of robust, comprehensive evidence around the outcomes, side effects and unintended consequences of such treatments for people with gender dysphoria, particularly children and young people’.
There are question marks over ‘long-term safety [of puberty blockers] in transgender adolescents’, while the effects of cross-sex hormones ‘can be irreversible’.
The RCGP also highlights ‘difficulties with current IT systems which do not accommodate for transgender and non [gender] binary patients in relation to referrals and screening’.
‘For example, a trans male’ – born a girl – ‘cannot be referred for a cervical smear… if they are recorded as male in the database, despite still having female reproductive organs’.
That problem was identified by The Mail on Sunday 18 months ago, when we also revealed how ‘trans women’ – born boys – are routinely invited for smear tests and mammograms.
The transgender charity Mermaids said: ‘This document from the RCGP is warmly welcomed.’
A GMC spokesman said that the advice ‘should reassure doctors who wish to prescribe for their trans patients that it wouldn’t be against GMC guidance to do so, without forcing those doctors who did not feel that prescribing would be in their patient’s best interests down a treatment route’.