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Advice on the management of the transgender patient in primary care

A recent article in the journal BJGP Open provides advice on the management of transgender patients in primary care. With referrals to gender identity clinics rising rapidly, general practitioners (GPs) and primary care physicians are more likely to meet patients who are transgender (whose gender identity, or internal sense of gender, does not match their gender assigned at birth) or diagnosed with gender dysphoria (the severe psychological distress that is experienced by an individual as a result of the conflict between their gender identity and gender assigned at birth).1 Teaching on transgender medicine is lacking in both undergraduate and postgraduate curricula, leading to a perceived lack of expertise in this area. Furthermore, General Medical Council (GMC) guidelines on the GP’s role in prescribing are vague, resulting in some controversy. As waiting times for appointments at specialist clinics are often at least 18 months, GPs and primary care physicians will increasingly be involved in the initiation of the transition process: this is the process by which an individual changes their phenotypic appearance of gender to match their gender identity through medications and/or surgery.

Some of the actions advised:
  • Ensure the patient’s electronic record is updated with the correct pronoun and patient’s desired name.

  • Outline potential treatment options to include psychological therapy, speech and language therapy, hormones, and surgery.

  • Discuss with the patient a direct referral to a specialist gender identity clinic, advising that wait times are often lengthy.

  • Explain that initiating medications is usually done by the specialist gender identity team or under their advice, then discuss medication side-effects and risks.

  • If the individual is distressed or experiencing mental ill health, discuss a referral to the community mental health team.

  • If the patient is self-medicating, consider specialist advice from an endocrinologist.

  • Discuss smoking cessation if the patient is a smoker, or weight loss if they are overweight.

  • Provide the individual with advice on websites or support groups for transgender people.
The full article can be read in BJGP Open.

DOI: https://doi.org/10.3399/bjgpopen17X101001

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