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Transgender patients “offensively referred to by their old title”, says consultant psychiatrist

31 March 2016

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Conservatism in helping people with gender dysphoria in primary care is unacceptable said a gender specialist who called on staff to stop referring to people by their old title or legal sex.

Consultant psychiatrist Dr James Barrett who works at the Charing Cross Gender Identity Clinic in London said transgender patients are “still often, offensively referred to by their old title, or legal sex, sometimes years after hormone treatment of gender reassignment surgery.”

He said patients do not need to have a gender recognition certificate for their records to be altered to the gender and title they use.

He said although there were many examples of good practice in primary care “there does need to be some education at primary level.”

Staff can help by “not treating patients as if they are mad” or using the wrong pronoun, said Barrett, who is president of the British Association of Gender Identity Specialists.

Writing in a comment piece in the British Medical Journal (BMJ he said staff should also avoid mentioning gender realignment when referring transgender patients for treatment for other illnesses, where it is not relevant.

He added: ‘Their transgender can be viewed as a psychiatric illness, which it never was, and can feature in every medical consultation and referral even if not relevant to the ailment in question, in a manner that would be unacceptable if the issue was that they were gay or black.”

He said sometimes patients are referred to a psychiatrist when they should have been referred to a gender identity clinic instead. One patient was told by a GP that the NHS does not offer gender realignment.

Conservatism in primary care often complicates and delays access to hormone therapy, he said. He added that patients need the treatment for life and it was impractical for gender identity clinics to prescribe it. He explained that a practical solution was a joint care model with primary care giving patients hormone prescriptions, with treatment advice provided by gender specialists.

Barrett said the experience of experts working in the UK’s gender identity clinics suggested one-in-five GPs will not prescribe for people with gender dysphoria, even after getting expert advice.

Reasons cited by GPs included concerns about it being dangerous, difficult or expensive, which he rejected.

He urged GPs to refer patients to gender identity clinics and contact them for advice or information if they feel “inexperienced”.

He welcomed the General Medical Council’s guidance that ethical or “principled” objections were not acceptable in gender dysphoria.

Click here to see the comment piece

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