Charities and medical professionals have warned of a “staggering increase” in GPs denying gender affirming care, even when it is requested by a specialist clinic.
Campaigners have told The Independent that increasing numbers of trans people are being denied hormone replacement therapy by GPs, with doctors claiming they are either not competent to provide the service or they are not contractually obliged.
This has caused people like Matthew Lyon, a trans man from southwest Scotland, to lose their trust in medical practitioners, even self-injecting hormone replacement treatments and avoiding doctors.
The 27-year-old said that his mental health went “down the drain” after his GP halted his hormone treatment.
He said the GP refused to prescribe or administer hormone treatment recommended by a specialist sexual health service because it was “unlicensed for the condition that has been recommended for, and long-term safety data is lacking.”
Mr Lyon’s previous GP had prescribed Nebido, an injection licensed in the UK as a testosterone replacement therapy for male hypogonadism. It is widely used off-label as a treatment option for gender dysphoria.
Without a doctor to administer his Nebido, Mr Lyon experienced a “mini menopause” as he was left five weeks overdue from his testosterone, which was meant to be administered every 11 weeks.
“I don’t have the best mental health generally, obviously having stable hormone balances helps all of that,” he said. “But it kind of just throws me into a bit of a hormonal tornado.
“I’m hesitant to get my blood work done in case a doctor sees something they don’t like and then everything stops,” he said, adding that he felt unable to register for a new practice for months.
TransActual director Chay Brown said the charity had seen a “staggering increase” in GPs refusing to prescribe trans people HRT since spring last year.
The Independent previously revealed that a key factor impacting transgender people having hormone treatment withdrawn was the Cass Review, an independent review of gender identity services for children and young people in the NHS, which led to the banning of puberty blockers as treatment for gender dysphoria.
Mr Brown said the situation has been exacerbated by the Supreme Court’s ruling in April that the terms “woman” and “sex” in the Equality Act refer to a biological woman and biological sex.
“It continues to be a problem,” he said. “Trans people being denied the very same medication that cis people are given without question. Many of the refusals are for people that are already on HRT.
“There are many reasons for this, ranging from GPs claiming they are ‘not competent,’ GPs claiming they are not contracted to provide this service, and, of course, in an unknowable number of cases, out of good old-fashioned bigotry. It is rarely the case that there is a medical reason for refusal.”
Mr Brown says the charity hears reports of GPs denying trans people care every week, while in previous years they would only hear of occasional cases.
“Those are just the ones we are hearing about,” the charity boss said. “Trans people often wait years to be seen by an NHS Gender Clinic. For their GP then to refuse to prescribe officially recommended medication to them is an extra slap in the face.”
Dr Kamila Kamaruddin, a GP and lead clinician at the East of England gender service, agreed there had been an increased incidence of GPs not prescribing hormone treatment, citing a lack of expertise or saying that it is not funded under a shared care agreement.
“We have had instances where GPs have been prescribing for many years and then decided not to prescribe anymore for various reasons,” she said, adding that the reason many hormone treatments were unlicensed for trans people was because medical companies couldn’t do random trials on cisgender people.
“We, in general practice, have been prescribing unlicensed medication for many years,” Dr Kamaruddin added. “The issue of unlicensed medication should not be a barrier to provide a prescription for hormone therapy.
“I’ve heard a lot of GPs saying that we don’t have the expertise. So if you don’t have the expertise, we provide a lot of training to local GPs,” she added, citing that the GMC and RCGP offer guidance about prescribing trans medical care.
Dr Kamaruddin warned that the abrupt stop of hormone treatment can “have a huge impact on mental health, and patients can become suicidal because of this.”
An NHS spokesperson said: “To support GPs in prescribing for patients with gender dysphoria, NHS England has established a number of specialist gender services in primary care, staffed by specialist GPs who are available to provide timely support to colleagues. We are currently carrying out a review of adult gender services which will look at how to overcome the challenges that some individuals face in accessing a timely prescription.
“We have also more than doubled investment in gender dysphoria services, increasing the number of adult Gender Dysphoria Clinics in England from seven to 12 since July 2020 with the rollout of five new adult gender pilot clinics.”
A Scottish government spokesperson said: “Cross hormone therapy for adult transgender patients is a specialised area provided by a combination of healthcare professionals. Appropriate procedures are in place at gender identity services to ensure each patient receives the appropriate level of care, with GPs able to refer patients directly to one of NHS Scotland’s four adult gender identity clinics, or the Young People’s Gender Service.
“Any concerns with respect to delivery or provision of care under GP contractual arrangements would be a matter for patients to raise with their respective GP practice, via the practice manager, or for other matters via the NHS Board.”
