Information for GPs

GPs should not feel compelled by Gender Identity Clinics (GICs) to prescribe cross sex hormones.

If you, as a GP, receive a letter from a Gender Identity Clinic (GIC) asking you to take over the long-term monitoring and prescribing of cross sex hormones for their patient, what should you do?

· GPs are not obliged to prescribe cross sex hormones. It is our right to refuse to take part in shared care agreements, which are optional.

· GPs are not contracted under GMS to prescribe.

· You can refuse, as these medicines are used off-licence. GMC prescribing standards state that if proposing, prescribing or providing an unlicensed medication you must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate safety and efficacy. This is not the case

· If you are already prescribing and have concerns about patient harms and no longer wish to do so, you can hand long term monitoring back to GICs.

Furthermore, our opinion is that GPs are not required even to refer to GICs as we discuss in this blog:

We hope you will feel empowered after reading this to act in the best interest of your patients.

• Our factsheet on why GPs are not obliged to prescribe cross sex hormones

• Letter template letter from GP to GIC, opting out of prescribing and long term monitoring

• Template letter from GP to patient explaining why the GP practice is no longer partaking in prescribing and long term monitoring

We have witnessed the irreversible harms caused by cross sex hormones to our patients and the distress caused. Our patients are not being fully informed of these irreversible harms by Gender Identity Clinics.

Effects of oestrogen in males

· Weight gain

· Infertility

· Ischaemic Heart Disease

· Pulmonary embolism

· Ischaemic stroke

· Early mortality

· Increased risk of Breast Cancer

· Reduced libido

· Erectile dysfunction

· Mood changes e.g. anxiety, depression.

· Reduced bone density

Effects of testosterone in females

· Virilising (development of male characteristics which are irreversible)

· Weight gain

· Endometrial hyperplasia, which is a a risk factor for endometrial cancer

· Urogenital atrophy, which can occur within 6 months of treatment. This is thinning, drying, and inflammation of the tissues in the vagina and urethra which can cause symptoms such as vaginal dryness, itching, burning, and pain during intercourse

· Stress incontinence (pelvic floor dysfunction) – leakage of urine from activities like coughing, sneezing, laughing, or exercising

· Sexual dysfunction (prevents you from wanting or enjoying sexual activity)

· Infertility, and poor pregnancy outcomes

· Mood changes: irritability, aggression, depression or psychosis

· Unexplained persistent pelvic pain

· Ischaemic heart disease (raised blood pressure, polycythaemia and atherogenic changes in lipid profile)

· Strokes

· Possibly breast cancer and ovarian cancer

· Increased mortality

If you need further advice please email us on biologyinmed@outlook.com