RC for GPs scraps GIRES developed course

And the test questions for that certificate

Did anyone look at the GIRES training course that was supposed to give GPs enough knowledge for them to treat and/or prescribe to gender variant children and adolescents? This course, which looks more suited to an 8/9 year old, carried points for CPD and successful completion (correctly answering 8/10 multi-choice questions) was recognised by a certificate.

Good grief, I do hope other GP training is not of this caliber!

cs1.e-learningforhealthcare.org.uk/public/GEV/GEV_01_001/story.html

There are older people who have continued to use drugs though since the 1960's!

Yes understood, and this is why the question is there. Health issues amongst the elderly are very influenced by lifestyle. But the sort of old lady who giggles when asked if she is asked about pot, may be completely convulsed when asked if she is really a man. Apparently also some people react quite agressively to the questions as they stand. But all the same problem. People having their records sealed, and perhaps not revealing in A&E that they have been on heavy doses of cross-sex hormones, are taking the same sort of risks as someone who fails to reveal they are a heavy drinker. Doctors cannot see into people's souls.

And why training needs a medical focus, ideally using current knowledge about things like possible side effects from long term hormone use (check bone density, perhaps), and how to phrase any question about natal sex to help ensure you get an accurate answer. Training should not simply be a nice little earner for those on the "trans" speaker circuit. Nor an occasion for lobbying for "acceptabnce" or changes in NHS policy.

Yes. Which is why it's annoying that it seems the NHS has the infrastructure to record sex and gender identity, but has deliberately chosen not to.

More likely the NHS was lobbied by politicians and single interest groups to do this.

see Anne Harper Wright's work:
www.mumsnet.com/Talk/womens_rights/3396859-Weve-been-lied-to-about-Single-SEX-wards-since-2010

Poppyred85
Thanks for considering an email! Glad to hear the doc is a good egg.

Including 'gender identity' but as an additional question is likely the best way forward .

Yes. Which is why it's annoying that it seems the NHS has the infrastructure to record sex and gender identity, but has deliberately chosen not to.

Already you have to ask discretely about smoking, alcohol and drug use, and you are not supposed to assume anything. This led to a sweet old lady collapsing into giggles when asked if she used recreational drugs

There are older people who have continued to use drugs though since the 1960's!

current thread about doctors' form asking about gender identity but with sex

www.mumsnet.com/Talk/womens_rights/a3498331-At-the-doctors-office-with-DD-yesterday

There needs to be two questions, one with sex which is unchanging so M/F and one for gender identity which includes an open box as there are upwards of 70 gender identities and some will write N/A.

This is especially neccessary in health as biological sex has specific health implications and ensures that data is accurate

Including 'gender identity' but as an additional question is likely the best way forward .

In some situations the gender identity of a patient may be relevent to their care by HCPs. The sex of a patient is always relevent.

Interesting.

The basic question of any training advisor would normally be whether it was relevent and cost-effective. I wonder if that is the problem.

I was talking to a medical student recently about their "trans" training. There was genuine interest, in, presumably, the same things that GPs might be interested in: diagnosis; co-morbidity (possibly even parents co-morbidity); surgery; hormones; ethics, long term risks etc. Whoever their training provider was, this is not what they got. Instead they had a transman in the morning determined to talk about their brave and stunningness, and who lost the room with the first sentence "I am one of those people you hate". Young people at woke Universities, especially those aiming to be GPs or A&E specialists, don't judge. No bottom surgery either, so less for the students to get their medical teeth into. It continued in the afternoon with a transwoman who had decided to neither have surgery or to take hormones. They ended up with a useful discussion on the problems created when you have the wrong sex on medical records, and which diseases present differently or have different rates of occurance in men and women. But all that did was have the med students rolling their eyes about why you would have your records sealed.

My best guess is that the training provider misunderstood their brief and thought they were teaching acceptance, when actually the students might have been better off with a medical professional specialising in that field.

The student is now worried. Already you have to ask discretely about smoking, alcohol and drug use, and you are not supposed to assume anything. This led to a sweet old lady collapsing into giggles when asked if she used recreational drugs. The poor student is not looking forward to having to ask similar ladies if they were born with a penis.

Blimey, the RCGP actually does something sensible and helpful! I might have to reinstate my membership.

On a more serious note, this is very welcome. Many GPs were concerned when the GMC issued guidance a few years ago that suggested we should consider prescribing “bridging hormones” for patients waiting to see GID services, not least because it clashed so obviously with their usual (and correct) advice of being aware of not prescribing outside our competence area.

As it happens, I know the doctor quoted in the article. He’s a brilliant GP and all round good egg. I saw a letter from my local CAMHS service recently which had Mermaids website listed as a sources of info for gender questioning children and their families to look at. I’ve been uncertain of how best to raise this (and quite frankly worried about coming under fire for it) but I think I’ll be emailing him directly now.

In what other circumstances is a GP asked to agree with a patients self diagnosis through the threat of self-harm?
I really don't know. The "do what I say, right now, or else" aspect seems more like a personality disorder or something.

When reminded of Webberley, I was reminded of this thread, which has some very interesting points:
www.mumsnet.com/Talk/womens_rights/3385789-Helen-Webberley-found-guilty?pg=10

Poster Hamster00 provided a transsexual perspective on the issue of the role of the medical community and gatekeeping. Although anecdotal, I think the discussion is worth reading.

Quoting two of Hamster's posts in full:

Just sidetracking a little (but running parallel to the discussion)..

I don't know how many people are aware but "bridging hormones" can be readily prescribed by a "friendly GP" whilst a patient is awaiting referral to a GIC. This has been going on since GMC guidance came out in around 2016 www.gponline.com/gps-initiate-hormone-therapy-transgender-patients-says-gmc/article/1388228

As I understand it, the current wait for a 1st appt at the "big GIC in London" is approximately 12 months+

There is an implicit knowledge in the "trans" community that "to get on 'the 'mones', just go see your GP and they'll sort you out". It's not exactly difficult to convince your average family doctor - who doesn't necessarily have the specialist knowledge of trans / gd / whatever. Just thrust the guidance in front of them and pretty much walk out with boxes of pills.

GPs are more scared of patients self-medicating from backstreet internet retailers, so they tend to capitulate.

Of course I wouldn't blatantly say that anyone who claims they're trans but fancies a set of boobs because their AGP is running rampant could do this... but yeah - see the loophole?

So it's not just Webberley that's complicit in the dishing out of hormones with no background... it's MUCH, MUCH bigger.

See, when I went to my GP with my "Shania Twain Moment", I got bundled off to a psych - who diagnosed GD, then off to the GIC for TWO diagnoses of the same before I even went near an endocrinologist. I have it in triplicate, in writing lol.

Joking aside - if you know which buttons to press, you can walk in and out of your GP the same as if you wanted some painkillers for your bad back.

Food for thought...

And in a separate post:

I live in England also - but the point I am making is that obtaining hormones via a GP with no additional consultation are too easy PERIOD.

There is:

Minimal discussion with a "non specialist" care provider
No psychiatric evaluation
No official diagnosis of gender dysphoria
No physiological checks unless baseline hormone levels are taken (just kidney/liver function tests AFTER the fact)

There has to absolutely be that diagnosis of gender dysphoria from a specialist care provider plus a visit to an endocrinologist prior to prescription.

Call me a transmedicalist / truscum / whatever, I don't care - but there have to be rigorous checks and diagnosable dysphoria before hormones are prescribed.

At the moment that's NOT happening and it's too easy for any male with AGP or fetishistic transvestism (for example) to walk into a GP and obtain drugs.

The whole damn system has caved in on itself trying to "appease the feels" and it's lost the stringent criteria it once had.

And it's no wonder the private GICs are making a quick buck because it £££ in their pocket sanctioned by the GMC who have "relaxed the rules".

GPs have a responsibility to support transgender patients in the same way that they would support any other medical condition, regardless of their personal feelings.

So according to GIRES, being trans is a medical condition.

Theresa May says being trans is not an illness, and the trans lobby seemed quite happy about that.
www.independent.co.uk/news/uk/politics/theresa-may-transgender-not-illness-gender-recognition-act-lgbt-rights-sex-edution-homophobia-pink-a8008486.html

So is it or is it not a medical condition?

Who has advised NHS England and the GMC? Was it transactivists?

threads:
www.mumsnet.com/Talk/womens_rights/3396859-Weve-been-lied-to-about-Single-SEX-wards-since-2010

www.mumsnet.com/Talk/am_i_being_unreasonable/3397257-to-think-the-public-have-a-right-to-know-that-same-sex-wards-are-a-lie

www.mumsnet.com/Talk/womens_rights/3326933-NHS-told-give-trans-patients-equal-access-to-fertility-service

www.mumsnet.com/Talk/womens_rights/3333708-NHS-faces-lawsuit-for-not-funding-fertility-services-for-transgenders-who-want-kids

www.mumsnet.com/Talk/womens_rights/3454191-women-risk-health-over-trans-nhs-worker-fear-article-in-tomorrow-s-times-scotland-edition

www.mumsnet.com/Talk/womens_rights/3475792-Telegraph-article-NHS-trans-row-as-men-get-access-to-womens-wards-if-they-identify-as-female

www.mumsnet.com/Talk/womens_rights/a3385533-Prominant-campaigning-role-of-Tara-Hewitt-NHS-TELI-Social-work-universities

GP's are quite rightly concerned when someone comes into their surgery and asks for cross sex hormones. GIRES et al say that this will prevent suicide and also prevent people obtaining hormones off the internet, so think GP's should prescribe as an interim measure until a gender clinic gets involved.

In what other circumstances is a GP asked to agree with a patients self diagnosis through the threat of self-harm?

The GIRES response is interesting.

There have been no changes in the policies relating to this matter published by NHS England and the General Medical Council, who are clear that GPs have a responsibility to support transgender patients in the same way that they would support any other medical condition, regardless of their personal feelings.

Who has advised NHS England and the GMC? Was it transactivists?
Also, wasn't one of Dr Webberley's proud certificates on the GenderGP website this very same "Gender Variance" course run by the RC of GPs? Her archived site seems to suggest so.
Why are the words "pyramid" and "scheme" springing to mind?

I really hope what we are witnessing is the beginning of the queer-theory promoting policies meeting the real world where healthcare professionals say "hey, hang on a second, this is not correct."

GIRES, I feel, have misunderstood the situation completely. IMO, Doctors have NOT been approaching transgender issues like any medical condition. GIRES are probably going against their own advice if they are even hinting at transgenderism as being a medical condition, no? If there was anything equivalent that was as poorly understood as this nebulous "gender identity," which may be psychological/behavioural in origin, has complex interactions with mental health issues/neurodiversity/sexual orientation/history of abuse, one would expect doctors to proceed with extreme caution. I actually would expect that gender dysphoria would be considered a diagnosis of exclusion, when everything else has been looked at and ruled out. Like a how someone might have a particularly rare syndrome, but you can't say for sure until you've had the tests for multiple other things that can cause the symptoms first. The reason to be so careful is that the treatment currently on offer for gender dysphoria is actually very radical at its endpoint, involving permanent physical interventions that can result in sterility, lifelong reliance on off-label medication, and in children the treatment is so new as to be seen as experimental.

And yet, transactivists want to remove gatekeeping?

What other condition in children has 84% resolution rate if you do nothing, but if you take action children are more likely to be locked into a pathway in which their natural development is blocked by drugs, they go on to take a lifetime of cross-sex hormones, they don't gain mature sexual function, they go on to permanently alter their bodies with significant surgical procedures, and they deal with the risks and side-effects of all of these including infertility? All before the child is even able to give consent or really understand what's happening? With no long-term evidence of safety. Being trans is not necessarily a negative outcome, but if you're weighing up risks vs benefits, it does seem that supporting children in their personal and psychological development, whilst avoiding permanent interventions is better. Especially if the evidence says the majority of children won't need these "treatments." Or am I just not understanding something?

The whole problem, as I see it, is that doctors AREN'T treating this issue like they would any other, because it's become a political/ideological project instead of a scientific one. In what other condition is part of the treatment that a healthcare professional pretends an entire organ system of a patient is irrelevant or can be ignored? When else are doctors supposed to unquestioningly bow to lobby groups, without independently examining whether the advice is sound? In public health education do doctors normally allow activists to completely obscure the clarity of language around the human body and how it works in the general discourse, especially for something as fundamental as sexual dimorphism and human reproduction?

text from embedded link above:

'GIRES response to Sunday Times re: Royal College of General Practitioners website'
2019-02-02
The Gender Variance eLearning course was previously hosted on the Royal College of GPs website.

GIRES Statement: response to Sunday Times re: Royal College of General Practitioners website

Nicholas Hellen, Assistant Editor (Social Affairs), The Sunday Times contacted the Gender Identity Research and Education Society (GIRES) on 30 January 2019 regarding the removal of the Gender Variance elearning course from the Royal College of GPs website.

GIRES responses to the questions posed by the journalist are:

1 – What led to that decision?
The RCGP had without prior warning made unauthorised changes to the content of the course for which GIRES owned the copyright. Some of those changes undermined the responsibility of GPs, as stated by NHS England and the General Medical Council, to prescribe and monitor the medication recommended by the specialist clinicians in the gender identity clinics. The RCGP was unwilling to reverse those changes. Both parties decided that the course should be removed from the RCGP website.

2 – Had there been pressure from GPs to remove the material?
GIRES understands that the RCGP had received representations from some of its members about their willingness and competence to prescribe and monitor the medication. However, many GPs have for decades been undertaking those functions, alongside prescribing and supporting an array of other conditions that they do not have specialist knowledge of. The course itself provided the information that GPs need, who could also, if in doubt, consult with the specialists in the gender identity clinics.

3 – Was there any change in medical policy?
There have been no changes in the policies relating to this matter published by NHS England and the General Medical Council, who are clear that GPs have a responsibility to support transgender patients in the same way that they would support any other medical condition, regardless of their personal feelings.

4 – What would be the consequences of the removal?
GPs who have patients for whom the specialist clinicians in the gender identity clinics have recommended treatment will no longer have easy access to the accurate and helpful information that GIRES originally provided.

5 – What is the anticipated effect of the removal on GIRES?
GIRES will be seen as remaining true to its aim of improving the lives of gender diverse people. The removal of the elearning course was implemented as GIRES could not agree to the amendments made, as this would associate the charity with misleading information for GPs that would have been harmful to the people it serves and to its good reputation.

GIRES understands that knowledge of gender dysphoria is limited, however the aim of the charity is to support people to fulfil their potential and live happy lives. Access to timely and appropriate medical interventions is a key part of promoting wellbeing for transgender people. Refusal of primary care support is a major detriment and GIRES could not agree to changes in a resource that was meant to help GPs to support transgender people with confidence, when the changes made are in direct contravention of NHS and GMC guidelines, and give GPs excuses to deny access to healthcare for transgender people.

Link to NHS England policy: shsc.nhs.uk/wp-content/uploads/2016/04/SSC1620_GD-Prescribing.pdf

Link to GMC guidelines: www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare—advice-based-on-gmc-guidance#prescribing

A more detailed account is available under Comments regarding the Gender Variance eLearning Course."

www.gires.org.uk/gires-response-to-sunday-times-re-royal-college-of-general-practitioners-website/

twitter.com/GIRESUK/status/1091734882865369095?s=19

Here is Gires statement regarding the GPS decision

I tried posting this already but it seems to have vanished into the ether...

Here is the link to the anecdotal 'evidence' of transition as a type of 'cure' for autism and a screenshot of the relevant part. <a class="break-all" href="https://www.google.com/url?sa=t&source=web&rct=j&url=www.gires.org.uk/wp-content/uploads/2016/04/GIRES-Young-People-Response-to-Service-Spec-1.pdf&ved=2ahUKEwiDyMPb4p_gAhVmSxUIHSN_AhgQFjAAegQIBhAB&usg=AOvVaw3E-Mb3qShyjBli1VgRFre2" rel="nofollow" target="_blank">www.google.com/url?sa=t&source=web&rct=j&url=www.gires.org.uk/wp-content/uploads/2016/04/GIRES-Young-People-Response-to-Service-Spec-1.pdf&ved=2ahUKEwiDyMPb4p_gAhVmSxUIHSN_AhgQFjAAegQIBhAB&usg=AOvVaw3E-Mb3qShyjBli1VgRFre2

The problem is that Mermaids and the TRAs generally have managed to convince large numbers of people that failure to affirm a person's 'gender identity' is 'conversion therapy'. So this would be fine for a girl who said 'I'm a girl and I want to build robots', but not for a boy who said 'I like dancing and I'm a girl'.

There's also a push by some with considerable influence to enable the earlier use in UK of cross-sex hormones alongside unquestioning medical affirmation.
There have been concerted efforts by some TRAs to adopt medical approaches as used in other countries particularly USA.
see WPATH 2018:
www.mumsnet.com/Talk/womens_rights/3414279-Can-we-talk-about-WPATH

TedTalk December 2016
84,726 views
'A Trans Man at the Doctor's' | Toby Walker

"In this disarmingly courageous and hilarious talk, Toby Walker exposes the obstacles facing the transgender community when it comes to accessing complete and competent medical care- in the hope of ‘making being trans less fatal and more fun’.

Toby Walker is a trans journalist and LGBTI+ Liberation Officer for Westminster University, where he is in his final year of study. "

see also discussion of Toby Walker's call for protest September 2018 when elective mastectomies for female transpeople were delayed due to demand ffrom treating women with breast cancer :

www.mumsnet.com/Talk/am_i_being_unreasonable/3368777-To-think-that-in-the-current-dire-state-of-the-NHS-finances-its-a-no-brainer-that-first-priority-for-mastectomies-goes-to-cancer-patients

Yet here we have GIRES conflating gender nonconforming and trans by saying that gender nonconforming people might need medical treatment for their condition

I think it's like anything tbh

People get greedy. Nothing is ever enough

They got this far. Instead of being grateful and concentrating on "helping" who they have . They wanted more. They want all the kids

Why would someone need treatment for being gender nonconforming?

Why indeed.

If the option for a boy who loves pink and his worried parents is between Mermaids who say the child is the wrong sex and advocate transition, or a group where families can be reassured the child is normal (with work on deconstructing gendered expectations and perhaps meet other kids who are similar if the child is very isolated) then I'd like option B, please, while we work on society to drop gendered expectations.

The problem is that Mermaids and the TRAs generally have managed to convince large numbers of people that failure to affirm a person's 'gender identity' is 'conversion therapy'. So this would be fine for a girl who said 'I'm a girl and I want to build robots', but not for a boy who said 'I like dancing and I'm a girl'.

In order to augment capacity and provide the required equity of access to services for gender nonconforming individuals who need treatment...

The language used around this issue really needs to be pinned down. Why would someone need treatment for being gender nonconforming? When women say that they were tomboys as children or wanted to be boys, but are now happy with their sex, they get pounced on by TRAs who say that they weren't trans, they were just gender nonconforming, and that's different.

Yet here we have GIRES conflating gender nonconforming and trans by saying that gender nonconforming people might need medical treatment for their condition.

I understand the objections to the notion of support groups for gender-non-conforming children. I wasn't envisioning them necessarily as being to "other" any kids who aren't performing gender as society expects, and on the whole I am for the abolition of gender roles. The thing I am trying to remember is that some people DO pathologize their kids for not living up to gender. So, if there is some kind of need for support groups for these kids and their families, then I'd prefer ones where everyone is reassured and not medicalised. If the option for a boy who loves pink and his worried parents is between Mermaids who say the child is the wrong sex and advocate transition, or a group where families can be reassured the child is normal (with work on deconstructing gendered expectations and perhaps meet other kids who are similar if the child is very isolated) then I'd like option B, please, while we work on society to drop gendered expectations.

GIres posts above from July 2018 thread:
Up to 150 youngsters treated with puberty-blocking jabs 'might not even be transgender'
OP hungryhippie wrote:
www.dailymail.co.uk/health/article-5978515/Up-150-youngsters-treated-puberty-blocking-jabs-not-transgender.html

Tory MP David Davies said it could be a scandal and 'the NHS needs to fully investigate'

Lets hope so! Its scandalous
Im an autistic woman myself and my eldest son is also."

www.mumsnet.com/Talk/womens_rights/3313760-Up-to-150-youngsters-treated-with-puberty-blocking-jabs-might-not-even-be-transgender