When I was working in full-time general practice I would occasionally see young women whose periods had stopped who came for another opinion after an initial visit to a gynaecologist. The gynaecologist had prescribed female hormones but this hadn’t worked. The reason was obvious. The gynaecologist had failed to look above the patient’s waist: she was suffering from anorexia nervosa, a psychological condition.
I was reminded of this unfortunate situation by a news item in The British Medical Journal (BMJ) of 2 December 2022 headed, ‘Transgender care: Patients and campaigners challenge NHS England over delays in access to treatment’. As a result, two adults and two children are bringing a case against NHS England. They claim:
NHS England was in breach of its statutory duty by failing to ensure that 92 per cent of patients started treatment within eighteen weeks of referral [and] had also unlawfully discriminated against the four patients.
According to the BMJ:
One patient, aged 12, was referred to the Tavistock in May 2020 but has not yet received an appointment. She has started to show signs of male [sic] puberty which were highly distressing.
(A discussion about the Tavistock Clinic’s approach to gender dysphoria can be found here.)
If an adolescent girl were to show signs of male puberty one would suspect a masculinizing tumour or a chromosomal abnormality; it’s understandable the patient would find it highly distressing. But what the BMJ is referring to is a boy who doesn’t want to become a man.
This situation illustrates the whole problem of what is called transgenderism and the related notion of transgender care. The above-mentioned child’s problem is psychological and if he were my patient I would endeavour to help him understand the origins of his distress and to accept or at least come to terms with his reality. In a physically healthy child what I would not do is offer, or agree to a request for, a prescription for hormonal treatment, nor would I refer him to a so-called specialist for this purpose – it would amount to child abuse.
The BMJ continues:
Two of the claimants…are children who were identified as male at birth but now identify as female and are seeking puberty delaying treatment.
It seems that the BMJ editorial policy is firmly aligned with transgender ideology. To say these children were identified as male at birth implies they may have been misidentified – highly unlikely – but now they ‘identify as female’. These are cases where the doctor, at least in the first instance, does not need to look above the waist: the two children were born with male genitalia. But if they now identify as being of the opposite sex then the doctor does indeed need to take a wider view, since it is in the brain where our mind and sense of identity reside. There is, however, no recognisable state of the brain that corresponds to the diagnosis of gender dysphoria.
In its defence, although NHS England accepted that it had not met the 92 per cent rule, it argued that it is only a target duty and that a breach does not give rise to enforceable individual legal rights. Yet these children are seeking the authority of the High Court to enforce their perceived right to receive life changing and lifelong treatment based on a fantasy.
The confusion over this matter is echoed in another news item in the BMJ (25 November 2022) headed: ‘GPs call for better gender dysphoria services’. The first sentence reads:
Current care pathways for gender dysphoria are putting patients at risk by forcing GPs to prescribe outside their competency.
It sounds as if a new disease has been discovered and the treatment is a prescription of some sort – yet this disease exists only in the mind of patients deemed to have it.
At the conference giving rise to the above motion, one GP is quoted as saying:
I’m here to tell you about my wonderful transgender boy, Theo. When he was 16 he came out as transgender, and his GP referred him really promptly. The wait was thought to be 24 months, but that increased with Covid and he was seen at 37 months for an initial (virtual) appointment…this week he is 22…at the threshold of definitive treatment that he would like.
And if Theo, who was born as a girl, had been seen promptly by the specialist, what would have happened? It’s likely she would have been given a puberty blocker, followed by the administration of testosterone, and have had her breasts removed – to prevent her developing into a woman!
I don’t blame GPs for not wishing to get involved in this sort of prescribing. But should even so-called gender dysphoria specialists be doing it? Should there even be gender dysphoria specialists?
As I have argued before, gender dysphoria is no more a diagnosis than rhino dysphoria – unhappiness over the shape or size of one’s nose. Thus, for someone suffering psychological distress, unless it’s due to an identifiable physical disorder, if the GP can’t deal with it, referral can be made to a psychotherapist or psychiatrist.
Text © Gabriel Symonds
Photo credit: Alexander Grey on Unsplash