Abstract
With referrals to gender identity clinics rising rapidly, GPs 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 wait times for appointments at specialist clinics are often at least 18 months, 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. A 36-year-old patient, who was male at birth, has been living as a woman for the last 9 months. Her birth name still appears on GP records. She would like legal recognition as a woman and a referral to specialist gender services. ### What needs to be ascertained? #### Preferred pronoun and name The patient's preferred name and pronoun should be updated on the electronic patient record system; …
Highlights
GPs should determine whether there are any absolute contraindications to hormonal preparations; such as, past history of thrombosis, breast cancer, or current pregnancy
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, discuss medication side-effects and risks (Boxes 1 and 2)
Summary
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