Gender Dysphoria

What is your opinion about giving puberty blockers to a 12 year old? What is your view about gender neutral loos in school? Should a trans female athlete be allowed to compete in women’s events? What do you think about J K Rowling?

Ask these questions to all of your colleagues, and your students, and you will get a whole range of opinions and arguments. These are complex issues. But here’s the absolute beauty of general practice – it doesn’t matter if we don’t have the answers. Ask your colleagues if they believe in being kind and empathetic to their patients – boom! That’s the only answer that matters. We do not need to have a clear opinion on whether a trans swimmer is entitled to compete with her identified gender, or if Harry Potter is cancelled. We do need to know just how much courage it will have taken the patient sitting in front of us to talk about their gender incongruence.

Education on gender incongruence and gender dysphoria for GPs has been largely absent. And yet the prevalence of gender incongruence is at least 1% of the population. So every full-time GP will be responsible for at least 23 patients who do not identify with the gender they were assigned at birth. Perhaps you only know 1 or 2 of them though. The level of prejudice trans people experience is such, that many if not most, are not keen to talk openly about it. In a BMA survey last year, only 34% of trans and non binary doctors and medical students were open about their true gender identity, and of those who were open, half of them had experienced transphobic comments at work.

So what can you do when you have had no training? The good news is – you can do a massive amount, and you can change people’s lives, all with no training! Maybe you think I am exaggerating, but I have read and listened to so many first hand accounts of people with gender dysphoria and the medical profession, and the way we respond and react as their GP, is hands down, the only meaningful thing that stays with them - not our ability to interpret their hormone level results. Kindness and empathy is our USP. For a gender questioning teenager, experiencing the absolute agony for them that is puberty, a kind and empathic response will make the world of difference. It DOES NOT matter what we think about puberty blockers; we are not being asked that question. Our patient might not know what they want, and may be just starting to explore their feelings – this is fine, we can hold their hand while they do this, and let them know they have an ally.

Gender incongruence is not a specialist diagnosis – the patient is telling you the diagnosis, and it does not necessarily lead to dysphoria. Gender dysphoria is often a result of societal pressure to fit into the roles that are defined for us as male and female; it is the prejudice, marginalisation and abuse that entails that induces the dysphoria. As the authors of one of the BMJ What Your Patient Is Thinking  articles points out, ‘just as a disability isn’t caused by the wheelchair, but by the stairs—sometimes my dysphoria isn’t caused by my body, but by how the rest of the world regards what and who I am.’

Being trans or non binary in our society takes huge strength and courage. Being a GP to a trans patient takes kindness and support. I know which is easier.