British doctors are failing to help transgender people

James Barrett, the head of the British Association of Gender Identity Specialists, has penned a scathing missive in the British Medical Journal criticizing doctors for failing to help people with gender dysphoria. Gender dysphoria is defined as a condition where there is a conflict between a person's physical gender and the gender he or she identifies.

Barrett who is also a consultant psychiatrist at one of 11 gender identity clinics in the U.K., says access to hormone treatment for trans people is often delayed or prevented.

"It seems odd," he says, "that such effective treatment was ever considered a low priority, or that access to it should have been delayed."

"Currently, however, in the experience of those of us who work at gender identity clinics, as many as one in five GPs won't prescribe for people with gender dysphoria", he says, even after expert advice from a clinic.

Reasons include concerns that hormone prescriptions are "dangerous," "difficult" and "expensive." Barrett writes he's heard disturbingly frank admissions from doctors.  

"Some of them, truthfully have got, kind of ethical or religious or moral objections or find it icky, or are a bit transphobic," he told CBC News. "Or a recent one: We are not trained to change nature."  

They are backward comments that sadden and disappoint him. "Precisely the same remarks that could have been said 10 years ago about gay people, or 60 years ago, about black people. The arguments are about as invalid as those were."

'People aren't freaks'

"People with gender dysphoria aren't freaks", says Barrett.  "They are teachers and accountants, police officers and doctors, parents and taxpayers." He says trans patients deserve respect and decent healthcare as anyone else.

Greta Bauer says its a similar situation in Canada, where there's a reluctance amongst family doctors to treat their trans patients. Bauer is an associate professor in the department of epidemiology and biostatistics at Western University in London, Ont. She recently led a study that looked at transgender patients in Ontario and their access and comfort level with family doctors.

I remember being at the emergency room at one point and being questioned about why I was there, and if I was there because I was trans … I was actually asked to leave.- Luke Fox

"There are a lot of resources and a lot of training available for doctors" in prescribing hormones to trans patients, she says. "But it's something that's unfamiliar and until the family doctors start doing it you can see why they might be a little bit nervous to start."

In the Western University study, researchers found that half of transgender Ontarians didn't feel comfortable discussing transgender-related health issues with their family doctor.  Reasons included:

• Whether the patient perceived their doctor was knowledgeable about transgender-related issues.
• Negative experiences with family physicians.

"They talked about just a range of negative experiences that they'd had that were really traumatizing," Bauer said in an interview.  "They talked about being outright denied care, and sent away. They talked about being bumped from doctor to doctor to doctor and the feeling that nobody really wanted to treat them."

Luke Fox knows a bit about that.  He's a 30 year old trans person. He says he experienced discrimination during one of his visits to a Toronto hospital.

'I was asked to leave'

"I remember being at the emergency room at one point and being questioned about why I was there, and if I was there because I was trans, even though the reason I was there had nothing to do with being trans," he said in an interview with CBC News. "I was actually asked to leave."

There are more stories. "I've been called in for ultrasounds, X-rays, and I've had the wrong name called out, or the wrong gender marker has been attached to my name," he says. Fox says he's not comfortable talking about how many surgeries he's had, preferring to talk about the challenges accessing gender confirming surgeries.

"Our medical system isn't set up to service trans folks," he says.

As of March 1, the Ontario government has broadened access to referrals for medically necessary gender confirming surgery.  In a news release, it says OHIP "has changed the funding criteria for sex reassignment surgery by allowing qualified providers throughout the province to assess patients for the surgery."

Luke Fox is hopeful. "It's great that people are having the conversation. But I think it's just taking it to the next level and saying, OK, now we know this is something that's within our society and these are people who definitely need care, so what can we do to make that care more accessible, and more available."

March 31 is Trans Day of Visibility.