Over the last six months, there have been reports of a significant increase in cases of trans people being refused access to hormones (HRT). TransActual has heard from 215 trans adults across the UK who have been refused prescriptions of HRT by GPs. This is effectively an attempt to force a medical detransition upon them.
This is not new. It merely continues a pattern of some GP’s attempting to refuse support to trans people, despite the NHS’s duty to ensure provision of trans healthcare.
Updated guidance from the RCGP in April 2024 on GP responsibilities towards transgender patients has clearly contributed to this spike. We welcome clarification of this guidance by RCGP in the last few weeks. However, we demand accountability from them for the harm they have caused. It is also clear that they need to go much further to ensure that rogue GPs stop tinkering with the critical medicines of trans people by explaining their responsibility to comply with the prescription of HRT by gender clinics.
Not one of these was for reasons of medical safety. Many
GPs admitted it was due to their personal beliefs. Transphobic GPs, especially in England, are feeling empowered to deprive their patients of critical
medicines for reasons of their own bigotry, and every part of the medical system must take some responsibility for this.
Eight respondents were refused HRT despite having had surgeries which mean they rely on HRT for normal hormonal function. This puts them at significant medical risk of harm. Again, this amounts to GPs unilaterally deciding to attempt to force medical detransition on a patient without any scrutiny, oversight, or guidance telling them that they should. Those GPs should be held accountable to the harm they have caused and the discriminatory coercion that they practice.
The most common reason GPs gave for this reckless and dangerous behaviour was that they did not feel competent to prescribe or had not been trained to. This further highlights the role of the updated RCGP guidance. This is an unacceptable reason to actively harm your patients. It is laughable considering the relative simplicity of the role of GPs in monitoring the bloodwork of trans people on HRT.
All GPs should be trained to provide this service as a matter of urgency. There should be a clear responsibility on them to do so and to ensure continuity of provision of care. Right now, nobody in the NHS is taking responsibility for preventing forced medical detransition of trans people.
Receiving these letters, and the discussion that follows, sends shockwaves through the UK trans community. People fear to talk to their doctors, to share information with them, or to attend check-ups. The mental health impact on a group who already experience huge amounts of discrimination from, and distrust in, the medical system (as found in our Trans Lives Survey) cannot be overstated.
Fight back!
The RCGP guidance may have introduced doubt into the minds of GP’s. However, the advice of the General Medical Council (GMC) is clear: “you must not refuse to provide a patient with medical services because the patient is proposing to undergo, is undergoing, or has undergone gender reassignment.”
If your GP is starting to play fast and loose with your HRT, make them aware that as well as complaining to their practice and any relevant funding bodies, you will be complaining about their conduct to the GMC.
If you do decide to complain, please let us know the outcome.