Transgender Meds: A Call for Reports

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July 8, 2019 | 6 Comments

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  1. According to multiple news outlets in the USA, “answers” to thorny questions about youth gender transition and long-term health are on the way. The National Institutes of Health has given $5.7 million to four academic medical centers to study the question.

    But somehow, this news doesn’t reassure me. And it makes me think independent efforts to get a grip on the facts – like RxISK – are sorely needed. The reason? Well for starters, all four clinic directors (in San Francisco, LA, Chicago and Boston) are already major public advocates for medical gender transition for kids at ever younger ages. They’ve already announced that their study will “examine the impact” of drug treatments on kids’ overall well-being … but will also “document the safety” of these drugs. It sounds like they have their minds made up, and may be building their careers accordingly.

    This article on one young patient at the Chicago clinic really blew my mind:

    “Born as David, Diana is male-to-female transgender and one of about 200 patients Dr. Garofalo sees at the Lake View clinic … In Diana’s case, for much of her childhood, she didn’t even realize she was transgender. She had identified as gay. It wasn’t until she was 12 and saw an episode of Oprah about transgender women that she realized her situation was more complicated.”

    “She asked her mom to make an appointment with Garofalo. The doctor immediately put her on Lupron … ”

    Whoa. Mind you, I wouldn’t try and tell kids like this who they really are, or what they should do with their lives. And I wish them well no matter what path they take. But whatever is going on with Diana, it does not exactly sound “biologically hard-wired in the brain” to me. And whatever the doctor thinks he’s doing, it sounds very reckless and one-size-fits-all. If Diana does run into trouble on this journey, I doubt we’ll hear about it from Dr. Garofalo.

    https://www.chicagomag.com/Chicago-Magazine/June-2015/Doctor-Rob-Garofalo/

  2. Difficult territory; online transgender clinic …

    Why do GPs have to prescribe for gender dysphoria?

    29 June 2016

    GPC warns the regulator’s demands could force GPs to treat outside their competence, Jaimie Kaffash finds

    http://www.pulsetoday.co.uk/your-practice/regulation/why-do-gps-have-to-prescribe-for-gender-dysphoria/20032145.article

    GPs should initiate hormones in patients with gender dysphoria in specific circumstances, the GMC has advised.

    The regulator said GPs should be capable of initiating treatment to mitigate a risk of self-harm or suicide where a patient is already self-prescribing with black market drugs and continue to prescribe as part of shared-care arrangements. 

    Ongoing row

    It is the latest in the ongoing row over GPs’ role in treating transgender patients, which has been brought to the fore after NHS England refused to designate the treatment of people undergoing gender reassignment as non-GMS work in service specifications drawn up for commissioners in June 2015.

    The service specifications said GPs would be expected to provide ‘bridging prescriptions’ for hormone therapy and carry out safety monitoring procedures, interpreting blood test results and hormone levels – which NHS England said was the ‘non-specialised’ element of the pathway. This has now been endorsed by the GMC.

    But the GPC has raised concerns about this with the regulator, pointing out that GPs should not be initiating prescribing outside their competence, and that the shared-care arrangements stipulation ‘places a worrying expectation on any GP’ to continue prescribing specialist medication.

    In response, a letter from GMC chief executive Niall Dickson detailed the ‘exceptional circumstances’ when GPs are expected to initiate medication:

    The patient is self-prescribing with hormones from an unregulated source.
    The bridging prescriptions are intended to mitigate risk of self-harm or suicide.
    The GP has sought the advice of a gender specialist and prescribed the lowest acceptable dose.

    ‘Not specialist’

    Mr Dickson added: ‘We don’t believe providing care for patients with gender dysphoria is a highly specialist area requiring specific expertise.
    ‘Our understanding is that the same, or similar, hormone medications are commonly used in general practice for treating patients with prostate cancer or endometriosis.’
    But GPC chair Dr Chaand Nagpaul told Pulse that GPs should not be undertaking this care.

    He said: ‘We don’t believe GPs should be prescribing even in exceptional circumstances, because that is clearly outside of their competence and the guidance, which says patients should be first seen by the specialist.

    ‘It is unlikely that indemnity bodies will see “exceptional circumstances” to be a mitigating factor should a problem arise from the GP’s prescription.’
    He added that the shared-care arrangements mean GPs will be expected to prescribe hormones that ‘are not licensed in patients in this situation’.

    Dr Nagpaul said: ‘The more important thing is that the GMC is being highly reductionist in the management of patients with gender dysphoria. It isn’t about prescribing, it is about managing patients who need ongoing comprehensive care.’
    The GMC has acknowledged there are commissioning deficiencies, he added, ‘and that is what needs to be tackled’.

    How to comply with the GMC guidance

    Unfamiliar conditions can seem daunting and imposing, but meeting the new transgender guidance from NHS England and the GMC should be fairly simple for GPs – and, hopefully, rewarding. This is set to become part of routine general practice, with GPs supporting the rising numbers of people seeking help.

    Here are five tips on how GPs can manage this group of patients.

    1 Gender care is a recognised medical condition with clear treatment pathways recommended by the NHS. The charity GIRES has helped create an online learning resource with the RCGP that can help if you are unsure: elearning.rcgp.org.uk/gendervariance
    2 There are high rates of self-harm and suicide among these patients, so refer for specialist care. At the very least, the patient should be referred to their local gender identity clinic (check the NHS website). Waiting times can be as long as four years though.
    3 Don’t be afraid to diagnose. Many patients will tell you they have always felt they were assigned the wrong gender. They may be living in their preferred gender role publicly or in private and may be taking hormones they have acquired out of desperation.
    4 Don’t forget the drugs used are common prescriptions. The medication for transgender care includes well-known oestrogen therapy used for treating female menopause and finasteride, which is given to men with benign prostatic hyperplasia.
    5 Use the everyday skills GPs are good at. This condition causes great upset at home, at work and in public. Patients need a caring and kind approach, and a safe source of prescription medication, and blood tests to monitor hormone levels.
    Dr Helen Webberley is a GP in Monmouthshire and runs an online transgender clinic

    could force GPs to treat outside their competence – that’s nothing unusual …

  3. Interesting to find Finasteride there, in point number 4, described as a ‘common prescription’ – not a word about possible side effects!

  4. Heads up that the language used in the description above is offensive and may be very unwelcoming to the trans people you are hoping to reach. Calling trans men “women” and trans women “boys” or “men” is super non-affirming. Saying that trans men are on testosterone is much more appropriate than calling them women.

    Just hoping to educate about a potential barrier to being of service to the community that you intend 🙂

  5. BBC2 News : Health 22nd July 2019 :- Trangender Treatment : Puberty Blockers Study Under Investigation.

    Mostly concentrated on the Tavistock which is being investigated by the Health Research Authority . A snipet – ‘after a year on puberty blockers there was a significant increase in youngsters who had tried to harm or kill themselves.:
    The Tavistock had ignored warnings from a study and it seems practiced almost as a law unto themselves – old habits die hard.

  6. Update – legal challenge has been made
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    NewsBBC News
    Health
    NHS use of puberty blockers legal challenge begins
    By Alison Holt
    Social affairs correspondent, BBC News
    8 January 2020
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    Legal action is being launched against the NHS over the prescribing of drugs to delay puberty.

    Papers have been lodged at the High Court by a mother and a nurse against the Tavistock and Portman NHS Trust, which runs the UK’s only gender-identity development service (Gids).

    Lawyers will argue it is illegal to prescribe the drugs, as children cannot give informed consent to the treatment.

    The Tavistock said it had a “cautious and considered” approach to treatment.

    Papers were formally lodged on Wednesday by the lawyers for the complainants.

    The Tavistock will have three weeks to submit its response, after which a judge will consider the case and decide on the timings of any hearings.

    Referrals up
    The nurse, Sue Evans, left the Gids more than a decade ago after becoming increasingly concerned teenagers who wanted to transition to a different gender were being given the puberty blockers without adequate assessments and psychological work.

    Since then, she says, even younger children are being given the drugs, which block the hormones that lead to puberty-related changes including periods and facial hair.

    The number of young people referred to the Gids rose from 678 in 2014-15 to 2,590 in the past year.

    Of these 2,590:

    more than 1,700 wanted to transition to male
    624 wanted to transition to female
    most were in their early to mid-teens
    171 were under 10
    Ms Evans said: “I used to feel concerned it was being given to 16-year-olds.

    “But now, the age limit has been lowered – and children as young as perhaps nine or 10 are being asked to give informed consent to a completely experimental treatment for which the long-term consequences are not known.”

    ‘Too young’
    The mother, known only as Mrs A, has a 15-year-old with autism who is on the waiting list for treatment at the Gids.

    She told BBC News her child presents to the outside world as a boy but, while she is happy to allow that, she is extremely concerned about the possibility of drugs that are not fully understood being prescribed.

    “I’m worried that they will look at her age and say, ‘Well, she still says this is what she wants and therefore we will put her on to a medical pathway,'” Mrs A told BBC News.

    “And given her communication of what she feels internally is slightly different because of her autism spectrum, I worry that what she says and what she means are often two different things.”

    What are puberty blockers?

    They are drugs which can pause the development of things like breasts, periods, facial hair and voice breaking

    They can be prescribed to children with gender dysphoria who feel their sex at birth doesn’t match up with their gender.

    This is meant to give them more time to weigh up their options before they go through the physical changes of puberty.

    Although puberty blockers are described by the NHS as reversible, Gids acknowledges that their impact on brain development and psychological health is not fully known.

    Read more: What are puberty blockers?

    Mrs A said her child was too young to really assess the potential impact of puberty blockers on the rest of their life, including such things as fertility.

    “As an adolescent, what we think will make us happy is not necessarily what will make us happy,” she told BBC News.

    “It might help us in the short term – but it might not help us in the long term.”

    ‘Rated good’
    A Tavistock and Portman NHS Foundation Trust official said: “It is not appropriate for us to comment in detail in advance of any proposed legal proceedings.

    “The Gids is one of the longest-established services of its type in the world with an international reputation for being cautious and considered.

    “Our clinical interventions are laid out in nationally set service specifications.

    “NHS England monitors our service very closely.

    “The service has a high level of reported satisfaction and was rated good by the Care Quality Commission.”

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