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Should young people be offered treatment for gender incongruence?

Writer's picture: Dr ParkerDr Parker
Dr Parker treats gender incongruence in young people

As a clinician with a particular interest in transgender, intersex and non-binary health I’m frequently exposed to debate and widely varying opinions on the best approach to care. Should young people be offered treatment for gender incongruence? The answer, of course, is of course! Anyone, regardless of age, should always be able to access timely medical support and advice.


Healthcare professionals have a duty of care - ‘primum non nocere‘ - ‘first, do no harm’. But, how can a doctor ‘do no harm’ unless they truly understand the complexities of transgender medicine? Like other professionals, doctors rely on research and training to guide the way that they work. As I write there is a paucity of research, little professional development and virtually no teaching within UK medical schools on this subject. Unlike most doctors, I have completed one of the few specialist courses on transgender healthcare created by St George's, University of London.


Unfortunately, but therefore understandably, the lack of detailed research and subsequent understanding of this subject, plus its emotive nature - and headlines! - have made it almost taboo for some doctors and they are reluctant to become involved. The fallout from the Cass review of the Tavistock and Portman clinic has perhaps further encouraged some doctors that this is an area to avoid.


Whilst specialist GICs - Gender Identity Clinics - have been established the waiting lists are unacceptably long. As a doctor, I know this is both frustrating and damaging to all those on these lists. The GMC states that all doctors have a duty to only prescribe and treat patients within their professional remit and to keep their learning up to date and relevant. But it’s difficult to see how they can do that when CPD courses are sparse, to say the least, in addition to the fear of litigation and media backlash.


A key challenge for someone with gender dysphoria is managing puberty. There is widely varying - and strong! - opinion on whether puberty should be halted to give the young person time, and others who say that a person can’t truly know who they are until they’ve gone through puberty. Some surgeons who work in this field also say that there are very practical reasons why allowing full development to complete could bring significant advantages in later life to someone in their changed gender. Regardless of opinions, what is inarguable is that there is simply not enough comprehensive evidence today to support any argument or viewpoint one way or the other in its absolute entirety.


So, if debate will continue on the right course of treatment what do parents and caregivers do today? Our solution at ENL is a treatment model that isn’t just hormones. A broader, holistic approach is used which ensures that, if hormones are right for that person, then that person is right for the hormones at that given time.


And, to help answer the questions that are still unclear, our clients are offered the opportunity to participate in research by sharing their personal story. Consolidated and fully anonymised, this data will enable us to drive research and so improve future care worldwide. Dr Parker


Questions? You can always contact me via help@edennew.life.


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