Information for medical professionals

Royal College of Psychiatrists Good Practice Guidelines

New Treatment Guidelines for Gender Dysphoria have been published by the British Medical Colleges. The provision of care for patients experiencing gender dysphoria is an excellent example of an area where multidisciplinary and interdisciplinary care is not only good practice but ensures that a wide choice of treatment pathways are offered, tailored to the needs of the individual patient. This intercollegiate document provides guidelines which we hope will optimise the clinical care pathways for patients who may need to access several medical and allied health professionals.

Good practice guidelines for the assessment and treatment of adults with gender dysphoria (PDF, 632KB)

RCPsych UK Good Practice Guidelines – Useful Extracts

A guide to useful aspects of the Royal College of Psychiatrists Good Practice Guidelines produced by GIRES.

UK Good Practice Guidelines for the assessment and treatment of gender dysphoria in adults (2013) (PDF, 369KB)

E Learning Resource for GPs

The Trans Mental Health Study 2012 demonstrated that GPs need better information to meet the needs of trans service users. GIRES has therefore initiated a project to develop a readily accessible online e-learning resource, for use by GPs as well as those they care for. GIRES will engage with the broad range of people, including trans individuals, clinicians and policy makers, who may have an interest in this project. The initial phase of the project is to prepare a Training Needs Analysis.

The scope of that work and the way it is to be carried out are summarised in GP-E-learning (PDF, 92KB)

General Medical Council Guidance for doctors treating transgender patients

The General Medical Council has just published “Guidance for doctors treating transgender patients”. The Guidance fully respects the entitlements of non-binary people. It provides guidance for GPs on prescribing and monitoring, which includes the provision of bridging prescriptions for patients who are already self-medicating. It explains that the appropriate medicines include some that are not licensed for use in treating gender dysphoria.

The guidance may be viewed at: Advice for doctors treating transgender patients.

Trans Mental Health Study 2012

The Trans Mental Health Study 2012 (PDF, 2.9MB) is based on an online survey that generated responses from 889 people who had personal experience of transgender healthcare in the UK.

The authors of that Study received the GIRES Research Award in 2012.

Preventing suicide among trans young people: A toolkit for nurses

This toolkit is a collaboration between the Royal College of Nursing (RCN) and Public Health England to support and develop the role of nurses in the prevention of transgender suicide.

Preventing suicide among trans young people (PDF, 391KB)

World Professional Association for Transgender Health (WPATH) – Standards of Care

Now in its seventh edition, Standards of Care V7 Full Book (PDF, 8.7MB), the standards of care are based on the best available science and expert professional consensus. The new edition reflects the current attitude that transgender people are not inherently disordered.

One of the British gender identity clinics has stated in response to a Freedom of Information request:

“Specifically, our Care Pathway follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun.”

The clinic is using an out of date document to justify its questionable practice. WPATH has therefore made it clear in a recent letter, WPATH-SOC (PDF, 115KB), that the new Standards of Care take precedence over all earlier versions.

The committee for the standards of care are the recipients of the GIRES Research Award for 2011.

In September 2011 GIRES donated $20,000 to the WPATH Translation Fund, which is being used to cover the cost of translating Version 7 of the Standards of Care into other languages. This will reinforce world-wide the validity of this more enlightened approach to treating gender dysphoria. Already, the Chinese, French and Russian translations are available.

GIRES plenary presentation at the LGBT Health Summit – September 2012

The slides from the GIRES presentation at the plenary session of the 2012 LGBT Health Summit can be found in LGBT Summit 2012 (PDF, 470KB).

GIRES presentations at the 2011 LGBT Health Summit

Bernard Reed & Terry Reed’s presentations at the 2011 LGBT Health Summit in Cardiff are available to watch online.

Watch Bernard Reed’s presentation (MP4, 32.46MB)

Watch Terry Reed’s presentation (MP4, 241.42MB)

NHS Survey of Patient Satisfaction with Transgender Services 2008

Report of the 2008 study, AIAU Satisfaction Audit June 2008 (PDF, 493KB), to capture the patient experience of NHS transgender services, to assess the positive and negative aspects and to inform future development of the service.

WPATH Clarification on Medical Necessity for Sex Reassignment Surgery

The World Professional Association for Transgender Health has issued a ”Clarification on Medical Necessity for Sex Reassignment Surgery“. This is in response to questions about the medical necessity of transgender treatments and sex reassignment surgery, particularly in the U.S.A.,where insurance exclusions often prevent access to health care for transgender people. The WPATH Board of Directors has issued a clarification statement which is now available on the Resources page of the WPATH web site. Questions about this statement may be directed to the WPATH office, or to Mr. Jamison Green, Chair of the Public Policy, Advocacy & Liaison Committee of the Board. A parallel statement for international use (without the U.S. insurance focus, and reflecting ICD-10, to which the U.S.A. is not a signatory) is also under development.

The clarification may be viewed in Medical Necessity of Treatment for Sex Reassignment 2008 (PDF, 82KB).

Record Keeping

Medical record-keeping for trans people can be a challenge for clinicians and staff. Names and titles must be changed to reflect current gender status; this should always be done as a matter of courtesy and is not dependent on having a Gender Recognition Certificate. However, most doctors prefer to have evidence of the permanency of the name change, by way of Deed Poll or Statutory Declaration before making official changes to the patient notes. Treatment must not be withheld on the basis that a patient has not provided either of these documents.

According to the GP notebook site: “Trans patients have a legal right to change their name and gender on their NHS records and would be able to bring a civil claim against any GP or practice which refused to accede to their request”.

The process is as follows:

  • the patient informs the GP, or directly informs the Clinical Commissioning Group (CCG), that they are transitioning and that in future they would be known by their new name and gender. They can write a “Statutory Declaration”, they may have a deed poll document, or they may simply make a request. This request should be in writing, signed by the patient;
  • the GP writes to the Registration Office at the CCG. The GP may write a letter of support confirming the gender role change and that this change is intended to be permanent, but this is not a requirement;
  • the Registration Office then writes to the Personal Demographics’ Service National Back Office. The National Back Office will create a new identity with a new NHS number and requests the records held by the patient’s GP. These records are then transferred to the new identity and forwarded to the GP;
  • on receipt, the GP surgery changes any remaining patient information including the gender marker, pronouns and names.