Can GPs provide safe care?

A competency issue for GPs treating patients who deny their biological sex and claim to be 'trans'

The answer to the question of safe care depends on whether a GP has an objective understanding of the research evidence or not. Let's be clear, the term 'transgender' has been defined by activists in nebulous and circular terms. The term 'trans' is meaningless in itself and many in our society have been duped into thinking it is a real condition. Those who claim to be 'trans' exist, but it is clear that other issues: emotional, psychological, and neurological also need to be addressed in the first instance. GPs are faced with an impossible task in the face of much societal confusion. The following important points were given to ScotPAG by a practising GP in Scotland.

"The aim of doctors is to do no harm. But are GPs competent as per the General Medical Council (GMC) guidance? Is it good medical practice, for instance, to prescribe puberty blockers and cross-sex hormones if the GP partakes in long term monitoring of patients who think they can change sex due to a belief in a prevailing ideology? An ideology that disregards medical evidence?

It is clear that there will never be robust evidence because this is a patient’s belief which is based on an ideology, not ICD-10 or DSM-5 criteria which of course is also deeply flawed. Hormone therapy is not only used off-licence and is known to cause long term irreversible harm, but it also lacks robust medical evidence. Good medical practice and professional GMC standards state that to retain competency, doctors must keep up to date with guidelines. But the Cass Review found there is not enough robust medical evidence to create robust guidelines for transgender ‘care’.

On 'Providing good clinical care', the standards state that GPs must prescribe effective treatment based on the best available evidence. Again, there is a lack of robust medical evidence. The question remains: can GPs be competent and provide good clinical care for these patients? The recent article Towards Best-Practice Healthcare for Transgender Patients: Quality Improvement in United Kingdom General Practice repeats the message that there is a paucity of robust evidence regarding the long term effects of hormone therapy for those stating they are 'transgender'. Freedom of Information requests (FOIs) have revealed the only Gender Identity Clinic (GIC) in Scotland to have a shared care protocol is the Chalmers GIC in Lothian. This leaves all other areas in Scotland without a GP specific protocol to follow. In turn, this not only exposes patients to clinical harms but also exposes GPs to liability. It is unsafe and surely goes against the Hippocratic Oath which requires that GPs to do no harm. The study found:

1. Inconsistencies between guidelines in long-term monitoring, which would include SCAs, such as frequency of recording of blood pressure and body mass index, lipids etc.

   
   

2. Patients were more likely to increased mental health and neurodevelopment difficulties, with the need for a high degree of secondary care and psychiatric support.

   
   

3. A substantial proportion of patients did not have the most basic monitoring of oestrogen (27%) and testosterone (11%). Annual BMI and BP, which it notes is recommended by most UK clinics, was absent in 50% of patients.

   
   

The majority of adults who attend their GP stating that they are transgender are likely to have other pre-existing conditions such as autism, anxiety, post traumatic stress disorder etc. The Cass Review reached a similar conclusion regarding co-morbidities and other mental health difficulties.. It found that many children (at least 43%) who 'socially transition' had experienced childhood trauma and/or other adverse childhood experiences (eg bullying, sexual abuse, and domestic violence). These patients are vulnerable and more susceptible to peer pressure. GPs who collude with transgender ideology are putting vulnerable patients at risk of medical and psychological harm.

The study states that it is the role of specialists to develop evidenced based guidelines and mandated shared care agreements for safe patient care. The fact that there is a lack of consistency within the guidelines is proof that there is no robust medical evidence. The question remains: 'Should GPs involve themselves in treating patients who state they are transgender? Should GPs be involved in monitoring these individuals longterm?

The sensible answer is 'No'. Any long-term monitoring (including prescribing) should be provided by GICs, if they are brave enough that is, to commit themselves to treating these particular patients in the first place."