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Experiences with the GP

GPs have an important role to play in supporting trans and gender diverse young people and their families. For some parents and carers, the GP was their first point of contact about their child's gender identity. In our interviews, people shared their experiences of seeing the GP with their child to talk about getting a referral to the specialist Gender Identity Development Services (GIDS) and relevant medical interventions (for example hormone blockers). A young person can also see a GP if they need bridging hormones, or to help them manage their body dysphoria or puberty. In addition, a GP can offer emotional support for the young person or the family, and/or signpost them to other organisations that might help to support them.
In our interviews, people shared positive experiences of seeing the GP that included:
  • Supportive and understanding responses to their child's gender identity and health needs;
  • The GPs taking on elements of trans healthcare.
Some of the parents and carers mentioned choosing and changing a GP, and the mixed experiences they had with GPs. There could be negative experiences with GPs when the GP:
  • Lacked knowledge and training about trans issues and the existing processes;
  • Was unsupportive, prejudiced and/or refused care.

Ali talks about the positive support that she and her daughter received from their GP.

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Well, just enabling the referral. That was good. And also if they have an accepting approach then that’s great. And it’s never questioned my daughter’s judgment. It’s, she’s never been dismissed as oh, you’re just a child don’t know what your own mind. It’s they’ve taken a role of saying that we support you. That well refer you to the specialist, because they would know more and yeah. And, they also did provide information as to accessing the mental health services, but obviously I already had that information from having gone to CAMHS initially [sighs]. I cant really—oh yes, they have also been very good about administering the injections, because that’s something that makes you feel very nervous, because youve got to get them mixed and within something like 30 seconds—administer them in 30 seconds. And Ive been worried about that if we were cut loose, I would have to administer those ourselves. And [laughs] that is so far were okay and they were quite happy to do that. So that’s been great. So from a medical point of view that’s what I’d be looking for that sort of help and support. Theyve been good and theyve done as much as I would expect. Yes, also my daughter has gone to talk to them about her panic attacks and how to deal with those. In particular at times when she hasnt got on so well with me, so it’s good that theyve respected her privacy because she wasnt over 18 at that point. Theyd been able to give that positive support which is great. A certain degree of physical care as well as mental health care.

Ross talks about positive experiences with his child’s GP and how parents need to do research to make sure the GP they choose for their child is supportive.

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Our experience there has been good on the grounds that our GP was supportive. I read through Mermaids that a lot of GP have no clue. So maybe they could do some education on gender issues. But in our personal case, weve had a very, very good GP. But again, it’s down to research and before you register with a GP. Check before you sign up. If youve got a trans child, ask the questions before you register. And if you find that it’s a transphobe running the surgery, go to a different surgery. You do have free will. You don’t have to go to that one. Okay, it might be half a mile from your house rather than three miles, but it’s your health and your child’s health. So, do a little bit of research first and you can make life easier or hard, it’s up to you.

What kind of questions would you ask a practice to—?

Immediately mine was black and white: Have you dealt with any trans, you know, patients in the past. What’s your stance on transitioning patients? Have you had any training in trans issues? Are we likely to get a good response? Certain things, ours again was particularly brilliant on pronouns. When the, when you make an appointment and it’s put up on the visual display unit. Would you like it to be Mr, Mrs or Mx and they had that option. But again, it’s only asking before you register. You could ask the receptionist, do you have that as an option and if not, why not? I find that a lot with form filling as well, it’s always male or female. It’s always Mr or Mrs. There isnt very often an Mx option, which my child has found with employment, filling in employment forms, Mr or Miss. There’s no allowance for transition. There’s no Mx possibility, which is, is only another box on the form. It’s not difficult to put into practice.

A common theme in our interviews has also been the considerable time and energy parents and carers spent researching the best healthcare options including finding or changing their GP. Many parents and carers also spoke about doing research and finding information before going to see their GP. This meant that parents and carers often arrived at GP appointments equipped in knowledge about the available trans healthcare options and legal rights.

First contact and choosing a GP

Some people we talked to emphasised the importance of the initial interactions with the GP for both parents and trans and gender diverse children. This was important because a GP might be the first health professional to talk to them about their child's gender identity. The reason why people went to see a GP varied.

Georgina knew that she could contact Mermaids if the GP was non-compliant’ with sending the referral, but she found her son’s GP to be very helpful and willing to educate himself.

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It was with our local GP. I just trying to remember, I think I may have had a first appointment, actually, I don’t think I needed a double appointment the first time, actually. But you cant pre book for a long time. It takes a while. So, we still had to wait maybe a week, thinking about it for that appointment. And then we discussed it with him he came with us, we went together cause he wanted to do the talking. He was so excited to start the journey. I did keep expressing that these things take a lot of time. There’s a lot of waiting and all this sort of stuff. But he was very excited to tell everybody. He wanted everybody to know who he was. And we went down and had a little appointment just me and him with our the GP that we prefer at the doctors, cause there’s one that is particularly lovely. And we just sort of said, what it was, we just said, hed be, he’s preferred to be called this now and were not really sure where we go from here. However, I had, that evening, when he came out, I had gone on Facebook and just researched the hell out of the transgender support sites. So Id already joined a support page and did know that I needed a referral to [Gender Identity Development Service]. And that if the GP was non-compliant, I need to contact Mermaids. So I did know that. But he was completely fine and said, Yeah, no problem at all. I am, I havent got a great deal of experience in this, but I do have one other trans patient. I think theyre grown up. He didnt, he alluded and since a little bit with when we discussed hormones and stuff. So I don’t think he knew about the children’s services. So he said, I need to research it, but I think that’s what we need to do.

To ensure that their child's needs are met, some parents felt they needed to change their child's GP, in particular if they had a negative experience with a specific individual or practice. Ross spoke about choosing a GP who has the right experience and approach to trans people and healthcare.

Andrew emphasised that GPs need more training on transgender issues to be able to support trans children.

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What do you think is important for GPs to be aware of when working with young trans and gender diverse people? What would be useful?

Well I think to start with, I think they need to have it included in their education, so that by the time they come to be a GP they have some insights and knowledge into transgender issues for starters. And I wish, I wish that GPs would be able to offer a bit more support. When you go and speak to them about transgender, your transgender child they don’t really know what to do. They don’t really know what to say. I think they probably aren’t that many transgender kids in the population. So GPs don’t come across it maybe that often. Obviously, I think they’re gonna come across it a lot more in the future. But they just don’t see enough transgender kids to really get familiar with it.

Supportive and understanding responses from the GP

Positive experiences that parents and carers we talked to had with GPs were ones where the GP was supportive and understanding, even if they did not have previous experience with trans and gender diverse children. Georgina went to see her GP to get her son referred to the Gender Identity Development Services (GIDS). Her GP admitted that he hadn't 'got a great deal of experience in this', but was respectful and helpful and said he would do the necessary research. Josie emphasised how in a referral appointment, the GP was reassuring and said '[t]here wont be a problem.' She observed, 'He never queried anything and he just believed [her son] straight away.' Similarly, Leigh shared that her GP has 'been super helpful', and although they had no experience with under 18s, they knew to refer straight to GIDS.
Ali said her GP practice made sure her daughter felt welcome and affirmed. She said that the practice changed her daughter's name even before the name change via Deed Poll, so that 'shes always referred to by her preferred name' and that they were 'really affirming' and 'never made her feel awkward.'
Some parents, like Kate, said they anticipated the GP to be unhelpful and were positively surprised.

Oonagh spoke about her GP’s lack of knowledge of the existing process of referral to the Gender Identity Development Service.

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And the referral that we wanted to GIDS he was going to take it to a panel to decide whether that was gonna be the case. So, I pursued it by getting advice from Mermaids and wrote them a letter and asked them to refer us and, then it happened. So he obviously wasnt aware of what he should do in that situation.

Was that the first time you discussed your child’s gender identity with a health professional when you went?

Yeah, yeah.

Do you remember how that meeting was?

He seemed open to it. He seemed open. He was professional. He didnt display any prejudice or anything. But he, you could tell that he didnt really know what the process was or what would happen with a child and how the referral, what would happen with a referral to GIDS, yeah. So I don’t think he, I don’t think he’s quite high up GP sort of on the [name of the area] level I think. At his level, I think he should have known a bit more about the process.

Not all parents we spoke to felt that they needed support from their GP, as they could get a referral through other avenues, for example through their child's school.

Taking on elements of trans healthcare

An important aspect of positive experiences with the GPs that parents and carers talked about was the GPs willingness to take on shared care and deliver elements of trans specific healthcare such as administering hormone blockers. For example, one parent said: 'the GPs surgery were fantastic about administering blockers. And I know a lot of GPs wont do it, They sent the practice nurse to have some special training, because, you have to mix the injection... And theyve always been fabulous about doing that, I was really surprised when I learned from other parents that some doctors wont do it, because they were so brilliant about it.'
One parent emphasised that her GP was 'super helpful' and 'super supportive' about administering hormone blocker injections for her foster son in the future. She said: 'the GP, if I'm getting the blockers, he has said, you know, 'Thats fine. Our nurse will do the injection. If the nurse isnt available, Ill do it, you know. If I need to come out to your house if you want me to do that, Ill do that.'

Lack of knowledge, training and referrals.

Although people gave us positive examples of good GP care, some also talked about disappointing appointments when things didn't go so well. Lack of knowledge and training in trans issues and health on the part of GPs was a concern that many parents brought up. For example, Andrew said that GPs 'have very little understanding of gender dysphoria and trans kids'. She didn't think they covered it as part of their training and their GP 'didn't quite know where to refer.' Elijah also emphasised that GPs 'don't have any specific knowledge. They're always keen to be helpful and do what they can. But there's no particular knowledge there specifically around this issue.'
Some parents felt that GPs might have experience of supporting trans adults but lacked specific knowledge on supporting trans children. The GP Oonagh and her trans daughter saw, was not initially familiar with the referral process.
Adele saw the lack of knowledge as resulting from the lack of training on trans issues and health. She said: 'GPs, you know, there isn't kind of any training for them at the moment. And there's definitely no mandatory training. So I see, time and time again, you know, retrospectively parents have sort of literally going, 'What do I need to say to my GP cause they know nothing about this.'
For some parents the lack of knowledge and experience was part of wider issues of how trans healthcare was delivered through GPs. Oonagh said, 'Theres been cases where GPs have been outspoken or healthcare factions have been outspoken against trans people and policies in their workplace, havent they? So, its always a worry that we are gonna encounter it.'

Unsupportive experiences, prejudice and refusal of care

Some parents and carers spoke about some GPs being directly unhelpful and not taking parents' views and concerns seriously. This included GPs outright refusing a parent or carer's request to refer a child directly to the GIDS, and parents or carers feeling GPs were dismissive or condescending.
Some parents we spoke to also shared experiences of GPs refusing to take on parts of trans specific healthcare such as blood tests, or bridging hormones. Bridging hormones refers to initiating hormone therapy before the patient is assessed by a specialist. The General Medical Council (GMC) consider this to be a part of a harm reduction approach.*
At times, parents and carers who paid for their child to access trans healthcare privately, found that it was difficult to incorporate this into the local GP care. Andrew spoke about his daughter's GP 'not being very helpful.' He said his daughter was 'having bloods every three months to keep an eye on her testosterone and oestrogen levels. ... But then we received a letter one day saying that [they] could no longer do it, because the Trust, weren't happy, to have bloods done, because we were paying privately for the medications. They didn't see why they would have to pick up the tab if these blood results were abnormal. They never have been abnormal. So we now have to pay privately to have blood tests every three months. That was disappointing.'
Based on their experiences, parents and carers we spoke to had some important messages to health professionals working with young trans and gender diverse people.
*General Medical Council, 2020. 'Trans healthcare: Bridging prescriptions'