BBC Article about why Transgender People are Ignored in Medicine

Shouldn't the teams who provide the sex reassignment hormones have the same duty here?

You would think so, but trans patients only stay under the care of the GIC while they are completing the trans pathway - once they’ve gotten to a certain point they are discharged and their GP just issues repeat prescriptions. Many GPs don’t even feel qualified to alter a dose strength, so they certainly aren’t going to take on responsibility for decision making in complex cases.

Add in the confusion of the GICs being funded by NHS England/Wales/Scotland and you end up with weird situations such as a person in Devon attending the Sheffield GIC (because the waiting list was shorter) and the GIC endocrinologist has no relationship with Devon renal consultant and no one knows who is funding what.

Whereas in normal NHS situations the endocrinologist and renal specialist work for the same trust, often in the same hospital, and likely have numerous common patients and are used to consulting each other.

For arguments sake how would a patient with a sex hormone endocrine disorder and unusual hormone levels be treated? I would have thought their endocrinology consultant would communicate with their renal consultant and work out the best way to implement the treatment protocols if it wasn't obvious. Shouldn't the teams who provide the sex reassignment hormones have the same duty here?

The threat of prosecution for 'outing' someone as transgender puts the doctors treating such a person in an impossible position.

This article is unhelpfully written, as it's not explicit about what doctors knew and didn't know. My interpretation is not that the medics didn't know the patient was trans, but rather that the treatment protocols they apply are either 'male' or 'female', and the guesswork was actually about how to treat people who are trans, and they plumped for 'treat as male'. I looked at another couple of pieces about this case published in journals, but they are co-authored by the patient themselves, so can't exactly be considered reliable. But I'm pretty certain that the patient being trans was not concealed.

It’s Schrödinger’s transperson all over again: simultaneously insisting they identify as male (or female) not trans thank you very much AND demanding special treatment on account of the trans status they otherwise refuse to identify as.

That was a key demand of trans rights organisations.

So trans rights organisations campaigned for the right of trans people to hide their sex from doctors who are treating them, and trans people are now complaining of inadequate healthcare which is a direct result of doctors not being aware of their sex.

And whose fault do they think this is?

I absolutely do not believe it is possible, at least in the UK for someone to be on the brink of receiving a transplanted kidney without a Dr spotting evidence of their medical history.

Of course a doctor will eventually - on close examination of the patient - find out the sex of their patient. However, it seems to be a common occurrence for these patients to change doctors if their sex is flagged up as important. And as you can see from the BBC article, the first ultrasound did indeed allow the HCPs to establish the actual sex of their patient. Who then immediately changed doctors.

It is true however, that there will be no record of a patient's complete medical history available to an NHS doctor in the UK if said patient re-registered as the opposite sex. Records do not carry over. That was a key demand of trans rights organisations.

This has nothing to do with the GRA by the way. It is not part of the law. It was just a demand made at the time of the GRA process and the NHS then implemented it.

Even though, given how we register patient details on NHS databanks, adding a field showing that the patient identifies as trans would de dead easy. Problem solved.

Sorry I'm going to repeat my earlier point. Even if someone foolishly chose not to disclose that they were trans and had undergone treatment, I absolutely do not believe it is possible, at least in the UK for someone to be on the brink of receiving a transplanted kidney without a Dr spotting evidence of their medical history. It is just inconceivable.

There is a long, long list of examinations, investigations & assessments and evidence of transition is not hard to identify.

There are many reasons to reform or repeal the GRA but this issue is a sideline, if not a complete derailment. Let us not be distracted by fictional bollocks.

asking me if I wanted references to my sex censored from the notes so they wouldn't be outing me to my new practise.

Wow, that really is crazy. A recipe for disaster really.

In the UK following transition a patient can choose to have a new nhs identity with no previous history and their new sex. It is there own decision and they take the risk themselves.

However it is very dangerous for the patient. There is no data carries across, so no previous medical history.

Other patients choose to keep to keep history and have their sex changed on the same record. At least this preserves historic details but it's still very unsafe

every trans patient is likely to have something in their medical record that gives away their bio sex.

I don't understand the word "likely" here, how can a person transition medically without this being on their medical record?

It’s not the first time a female bodied person who identifies as trans, has suffered because they have tried to hide the sex they were born as.

thefederalist.com/2019/05/23/baby-died-doctors-told-mother-man/

This case may have occurred in the USA, but it's a perfect example of why the GRA is bad law.

I would actually like to see how a court case would work out. Regarding a trans person taking hormones/testosterone and not declaring it, I’ve had similar treatment, which has left me with osteoarthritis, due to endometriosis and my insurance would definitely be invalid, if I didn’t declare it. I’d be bloody furious if there was special exemptions if you identified as trans. Actually, what would stop any woman declaring herself trans, in order to take advantage of the exemptions, if they have their tubes tied, a hysterectomy, breast implants removed, hormone treatment, etc? Now that would be interesting.

I agree that the GRA's provisions on this unworkable for healthcare and were clearly not drafted by anyone with a brain an understanding of operational realities.

@LillianBland
A court case would be very interesting. It was discussed above how even without any disclosure of biological sex, any related treatment in medical notes would still give it away. I don’t see how it could be argued in any sensible way that cross sex hormones or anything like that could be ruled exempt from disclosure for the purposes of insurance without it unleashing a torrent of knock-on effects. Underwriters employ doctors, who will assess the risk posed by medications and medical history when calculating a premium. As the health risks posed by things like puberty blockers have recently shifted from ‘Its all totally FINE’ to ‘Well, actually we don’t know, this could be iffy’, then insurers will seriously resist such an imposition that might cost them money. The dropping of sex as part of a premium calculation would have been fine with them, as it would mean they could just bump up women’s premiums, but this... this would be different. There could be various end results- 1. Trans people get some special dispensation that means they don’t have to declare any medical info regarding their transition, so everybody else’s premiums get bumped up a bit to cover it as a result, which could potentially lead to more legal wrangling due to its inherent unfairness, or 2. Trans people who have had any treatment become virtually uninsurable, or 3. Reality bites, courtesy of a slick legal team from someone like Axa or Lloyds. You have to be truthful, no ifs or buts, crying or whining.
Ideally the latter, as something has got to give and anything else certainly isn’t equality, it’s unjustified special rights for a tiny minority.

[quote Vermeil]@LillianBland
Good question. I didn’t deal with payment protection, but as it’s just another form of insurance then yes, I would say that any failure to declare long-term prescribed medication, of any sort, would potentially invalidate the policy even if what you were claiming for was unrelated. The underwriters have to rely on you telling the truth so they can calculate your premium, therefore they take a dim view of withholding, lying, or even ‘Oh, whoopsie I forgot’.
I suspect that the insurance angle is one that has yet to really cause issues, but it’s time will shortly come, mark my words.[/quote]
Thanks for answering, Vermeil. I dare say the next complaint will be that an insurance company hasn’t paid out because transphobia.

Actually, all GPs are probably at risk of inadvertent disclosure anyway, because every trans patient is likely to have something in their medical record that gives away their bio sex. But we would be foolish to compound the risk by explicitly documenting the sex.

@LillianBland
Good question. I didn’t deal with payment protection, but as it’s just another form of insurance then yes, I would say that any failure to declare long-term prescribed medication, of any sort, would potentially invalidate the policy even if what you were claiming for was unrelated. The underwriters have to rely on you telling the truth so they can calculate your premium, therefore they take a dim view of withholding, lying, or even ‘Oh, whoopsie I forgot’.
I suspect that the insurance angle is one that has yet to really cause issues, but it’s time will shortly come, mark my words.