Tag Archives: transsexual

Trans Health Care by GP’s

Posted on by

s300_nhs_gp_laycock_st_gp_consult_32-10777_960x640

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

Reparative therapy in Rutter’s Child and Adolescent Psychiatry

Posted on by

The new (6th) edition of Rutter’s Child and Adolescent Psychiatry features a chapter on a gender nonconforming young people for the first time, entitled “Gender dysphoria and paraphilic sexual disorders”. This chapter draws upon flawed and outdated research to effectively promote ‘reparative’ therapy, with the intention of changing children’s gender identities. It can be read here.

Authors Kenneth Zucker and Michael Seto suggest that therapists work with parents to “set limits with regard to cross-gender behaviour, and encourage same-sex peer relations and gender-typical activities”. In doing so, they promote the idea that issues faced by gender nonconforming children are due to an innate problem with the child, rather than with the child’s relation to normative societal gender roles.

Reparative therapy for gender identity issues can harm children by leading them to internalise the idea that nonconforming gendered expression is shameful or wrong (Ansara & Hegarty, 2012). It runs counter to explicit guidance on the treatment of children and young people from the World Professional Association for Transgender Health Standards of Care (WPATH, 2012). In contrast, approaches that enable and support children in exploring gender identity and expression have been shown to have beneficial outcomes (De Vries et al, 2013; Ehrensaft, 2012).

The chapter also exhibits poor scholarship. The first author prominently cites his own work no less than 17 times. Strong inferences are drawn from statistically insignificant quantitative findings. Blanchard’s (2010) deeply reductive typology of male-to-female transsexualism is reported on prominently, but the controversy of this theory (Serano, 2010) is not acknowledged.

Zucker’s own Gender Identity Service at the Toronto-based Centre for Addiction and Mental Health was recently recently suspended pending investigation following complaints from a number of parents. It is unclear whether or not the service will re-open, particularly as Zucker’s approach to therapy is now arguable illegal in the state of Ontario following a recent change in the law. Zucker has also been criticised for building his academic profile through an ‘invisible college’ of mutual citation and peer review (Ansara & Hegarty, 2012).

In light of these issues, it is deeply concerning that Zucker was invited to co-author this chapter.

For these reasons it might be best if the 6th edition of Rutter’s Child and Adolescent Psychiatry is not bought for libraries or used within training.

Guest Contributor:
Ruth Pearce
August 2015

Works referenced

Ansara, G and Hegarty, P (2012) Cisgenderism in psychology: pathologising and misgendering children from 1999 to 2008. Psychology & Sexuality 3:2, 137- 160

Blanchard, R (2010) The DSM diagnostic criteria for transvestic fetishism. Archives of Sexual Behavior 39, 363–372

Ehrensaft, D (2012) Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children. The Experiment Publishing: New York

Serano, J (2010) The Case Against Autogynephilia. International Journal of Transgenderism 12:3, 176-87

De Vries et al (2013) Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics: 2013-2958

WPATH (2012) Standards of care for the health of transsexual, transgender, and gender non-conforming people. WPATH http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf