Skip to main content

The child transgender patient in primary care: practical advice for a 10-minute consultation

Children and adults with gender identity concerns are increasingly presenting for treatment, with referrals to specialist clinics rapidly rising. The percentage of children with gender identity disorder that self-harm or attempt suicide is estimated at 50%, so it is essential that it is recognised early and managed appropriately.

Gender identity disorder of childhood usually manifests before puberty. The child typically experiences distress resulting from an incongruence between their current gender identity (sense of themselves as ‘male’, ‘female’, or otherwise), and their gender assigned at birth. Behaviour and activities of the child may stereotypically be associated with that of the opposite gender and the child may be preoccupied with wanting to change their name and gender pronoun (‘she’, ‘he’). Depending on the age, they may also have a strong desire to acquire secondary sexual characteristics of the opposite gender. This may cause significant distress and can impact their performance and experiences at school or at home. Six months of persistent gender non-conforming behaviour has been proposed as an indicator that this is more than ‘a phase’, which is common and not necessarily pathological for many individuals in childhood.

Example case
Tom is 13 years old and has come with his mother to see you. She tells you he becomes distressed when people address him as Tom, and asks to be called Kelly. He hates wearing boys’ clothes, and most of his friends at school are girls, leading to teasing about him being ‘gay’. Recently, his mother found a skirt in his room, which he eventually admitted to having stolen from a friend’s house. He has asked his mother if he can ‘become a girl’, and seems so preoccupied with this idea that he is struggling to complete his school homework. Today Tom’s mother wants to know what to do.

The full article can be read in the journal BJGP Open.

DOI: https://doi.org/10.3399/bjgpopen17X101169

Comments

Popular posts from this blog

Protecting Against the "Quad-demic": Influenza, Covid-19, Norovirus and RSV

As the NHS braces for a challenging winter season, it is grappling with a "quad-demic" of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups. The Four Viruses: What Are They? Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions. Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SA...

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...

How can we work successfully across the health and care system to make a success of Pharmacy First?

Pharmacies in England to begin treating patients for seven common conditions. How can we work successfully across the health and care system to make a success of Pharmacy First? 1. The Pharmacy First scheme aims to provide convenient access to healthcare through community pharmacies. Patients with minor ailments or common conditions can seek advice and treatment directly from their local pharmacy instead of visiting a general practice, urgent care centre or emergency department. The conditions covered by the scheme may vary depending on local funding arrangements and participation of pharmacies.  2, A potential problem with Pharmacy First is pharmacists misdiagnosing a patient's condition. It may also lead to delays in patients seeing doctors when medical assessment is needed. To mitigate these risks, appropriate safeguards and referral pathways should be established, ensuring timely medical assessment when necessary. The scheme will also increase the workload of pharmacies, thereb...