Trans Health Care by GP’s


I’ve recently learned that it’s not uncommon for a trans person, who has had a diagnosis of Gender Dysphoria and requested their GP to enter into a shared care plan with the GIC or specialist treating the person to be declined hormones or shared care by the GP.

It would appear that this could be an offence worthy of reporting to the General Medical Council as it goes against advice from the Royal College of General Practitioners and the GMC.  UPDATE 15/3/2016: The GMC have recently issued this guidance to GP’s

UPDATE: 6/4/2016: Dr James Barrett from Charing Cross GIC has written to the British Medical Journal “Doctors are failing to help people with gender dysphoria.”

I appreciate that some GP’s may feel unqualified to treat trans patients and so decline hormones.  I doubt this lack of confidence gets applied to patients presenting with depression that the GP feels they must refer to a psychiatrist rather than prescribe anti-depressants!  There is a very helpful online e-Learning programme made by GIRES which can bring a GP up to date on how to treat a trans or gender diverse person.

I have it on good authority that NHS England knows about this problem but has so far been ineffectual in addressing it.  This is remarkable given that NHS England commissions each General Practice in England!  They have contract non-compliance powers and they often fail to instigate them equality matters.  If these GP’s are failing their trans patients they are probably also discriminating in other areas (failing to provide teenage girls with contraception or treating their LGB patients with sensitivity).

Some years ago the Lesbian and Gay Foundation (now the LGBT Foundation) produced quality standard for practices ‘Pride in Practice’.

In addition to the links above, I’ve put together a list of useful documents to help trans and gender variant people inform their GP and negotiate for better health care:
Royal College of Psychiatrists guidelines for the assessment and treatment of adults with gender dysphoria

Guidance for GP’s and other clinicians on the care of gender variant people

A guide to hormone therapy for trans people

Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guidelines (US Document)

GMC Good practice in prescribing and managing medicines and devices (2013)

There is also this excellent health guide for Trans men, trans masculine and non binary people

Finally, since most people can’t afford to consult private therapists, there is this excellent guide written for trans and gender variant abuse survivors on accessing therapy

Dominic Davies
CEO Pink Therapy

Bad Language and Psychoanalysis


I’m increasingly becoming concerned when I see language used like this: by colleagues in the psychoanalytic world.

What I am talking about here is the misappropriation by some sectors of the psychoanalytic community of the terms ‘sadism’ and ‘masochism’ to largely mean acting in a way which punishes others or themselves, (usually with words or thoughts rather than physical activities).

I believe it’s now pretty widely understood that in the real world, sadism and masochism refer to consensual sensation based ‘play’ (giving or receiving pain in sexualised contexts).  I think that in mainstream society this is fairly well understood and  I suspect more people understand sadism and masochism in this context than the obscure psychoanalytic one.

Language is constantly evolving and dynamic and words that for one generation were acceptable are no longer acceptable.  This continued usage is akin to us using the word ‘Coloured’ to mean Black, or ‘cripple’ to mean disabled. It’s outdated and no longer acceptable practice.

In 2012 the British Psychoanalytic Council held its first conference, Homosexuality: Moving On, reviewed here by my former supervisor and friend, the late Dr Bernard Ratigan who was sat next to me.  It really felt there was a genuine desire to apologise for the harms done to the lesbian and gay communities by psychoanalysis.  The conference had an air of the Truth and Reconciliation Commission of the post-apartheid era South Africa..  I know the BPC as an organisation are keen to no longer pathologise homosexuality, although how much progress has been made in their desire for moving on has been reflected in the curriculum of their member organisations psychoanalytic trainings or in their being openly lesbian or gay psychoanalysts as members is another question (there are several out gay psychoanalytic psychotherapists but to my knowledge not a single openly gay or lesbian psychoanalyst within BPC membership.

But what of other diverse sexualities, identities and lifestyles?  Is it acceptable to continue to pathologise members of the BDSM/Kink communities by using outdated and frankly offensive and misleading terms like sadism, masochism and perversion?

If the world of psychoanalysis wants to show it has something to offer those with diverse genders, sexualities and lifestyles and step aside from its history of pathologisation of sexual difference, and heteronormativity, then I think it would be wise to consider the impact of pathologising language on those disenfranchised members of society they might hope to help.

Dominic Davies
CEO Pink Therapy

P.S. In 2004 Pink Therapy’s held it’s first ever conference on the  subject of Queers, Queer Theory and the contribution of Psychoanalysis and Psychoanalytic thinking.  You can listen the audio recordings of the keynotes on our YouTube channel playlist