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.
Jan felt the GP she saw with her daughter was dismissive and condescending in a way she felt they would not be about other health issues.
Ali talks about the positive support that she and her daughter received from their GP.
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.
For Interview 1 being the first point of contact means GPs have a very important role to play in reassuring parents. She talks about approaches in other countries.
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.
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.
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.
Kate expected the GP to not be great’, but found the GP to be very helpful.
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.
Interview 1’s GP helped her get her daughter’s passport updated. She felt the GP would be willing to support future shared care arrangements with a private healthcare provider, if that was necessary.
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.’
Lesley speaks about her GP being exceptionally supportive’ and feeling fortunate’ having secured a shared care arrangement for her son.
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.’
Andrew emphasised that GPs need more training on transgender issues to be able to support trans children.
Oonagh spoke about her GP’s lack of knowledge of the existing process of referral to the Gender Identity Development Service.
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.’
Jan felt that certain GPs are prejudiced against trans people a problem that she felt was made worse by lack of funding and lack of more prescriptive’ guidelines for GPs.
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.
The GP refused to refer Lisa’s son to Gender Identity Development Services leading her to complain about the individual.
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.’
When Jan complained about her GPs refusal to do bridging prescriptions for her daughter, she felt that they didn’t take it seriously enough.
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’