Gender GP: Inside the world of private trans healthcare

I am just starting to get into podcasts and the gender GP one is the latest. I listen in my car so am only 10/15 minutes in.

Getting a massive high from being people's saviour (for ££££).
'a doctor peddling in business' - and the string of weird side hustles. (Do doctors normally have time for side hustles?) I mean, I think she probably meant 'dabbling in business', and 'peddling' was a real Freudian slip. Quite the mental image.

I picked up on that too, it explains a lot. The other point was where she talked of her first patient and them not being 'capable' of leaving Wales to go to London, but giving cross-sex hormones is all fine and dandy.

OK it seems to be a policy of some GP practices not to prescribe. I think they are mechanically applying a contraindication.

Maybe you don't want to generally treat phobia with benzos, because of the risks of long term use, or it's not seen as that effective. But to apply that to flying a couple of times a year... as contraindications go, that's on the weak side.

Personally I don't want doctors to just mechanically follow a rule from somewhere.

I think there are a number of reasons why some Drs won’t now prescribe Diazepam for flying- not just risk of addiction, which is obviously low if someone is only prescribed 2-4 tablets once a year or so to get them through a flight (though actually, the first time I was prescribed it for flying, the GP gave me 28 of them and I was only going to France and back 😂 He later got struck off for unrelated dodgy behaviour).

Some of the articles I’ve read have discussed the fact that the drug obviously causes people to be subdued and lethargic meaning they may be more difficult to manage if there is an emergency on the flight. Plus people taking it are likely to sleep or sit still for long periods, increasing the risk of DVT. And for some people, Diazepam has the opposite effect and can make them agitated/aggressive, none of which anyone wants on a flight.

The point is really that I don’t expect to just get what I want out of Drs when there may be good reasons for them not to give it to me. And because I have now flown without it (because I was given the impression there was no point asking for it as GPs won’t give it), I had to find other ways to manage and was glad to find that I could. It wasn’t a barrel of laughs but I coped.

I trust that they know what they’re talking about and that there are safer ways for me to manage my anxiety around flying.

As far as I know, it's still perfectly within guidelines to use Diazepam for that purpose. If someone were having regular panic attacks, then it's against UK guidelines I think.

Doctors in the past got a load of people addicted without proper warning. If they now don't want to use them at all, it's actually a case, imo, you can argue that patients are getting screwed over twice.

Anyway, doctors are going to have different opinions over this issue. So many may agree that we have gone a little too far against using them.

I doubt your kind of use would even be controversial with psychiatrists.

The "evidence based" guidelines aren't always going to be correct, and maybe more importantly, the level of risk that is acceptable isn't even a medical question.

Thank you for sharing this OP, I’ve only just seen the thread. Am about halfway through the podcast (and contemplating banging my head against the wall).

HW has just made the ludicrous claim that teenagers and young people don’t change their minds about their identity. Is she lying or deluded? That tiresome Knox on Twitter has changed her identity numerous times in the past few years (straight woman> lesbian > non-binary> transman) and she’s middle aged. Safe to assume that teenagers can and do change their minds about all sorts of things, including their identity.

And yes, as PPs (and Curtis) have said, Webberly clearly gets such a kick out of making her patients ’happy’. Medicine is about finding the most effective and safest treatments- these might make the patient happy and they might not. Sometimes patients won’t like what their Dr has to offer. I used to take Diazepam on flights because it helps the panic. Apparently most GPs won’t prescribe it for this purpose any more. This is because they have decided that it’s not the best way to treat the problem, and the risks may be too high. I’m not very happy about this, but my happiness is neither here nor there when it comes to clinical evidence and risk assessment. I trust that they know what they’re talking about and that there are safer ways for me to manage my anxiety around flying.

HW seems like someone with a God(dess) complex.

I have some sympathy for the freedom of patients to make their own decisions if they aren't trying to do anything insane.

I don't think the goal is always safety and minimising risks. I don't think doctors should be strictly following guidelines. And quite possibly there should be more use of off label medications.

But I'm still uncomfortable about doctors experimenting on children for profit.

Will take a listen, the last podcast serious on Tavistock was annoying because it used a lot of fluffy language the "Tavi" and went to excessive lengths to being neutral (at the expense of journalism).

There's a reason why this medication is under gatekeeping, and private businesses are more likely than not to see people who were refused treatment under the NHS.

"I am self-taught in trans healthcare. I treated an 11 year old with blockers and a 12 year old with testosterone. This was fully scrutinised by a Medical Practitioners Tribunal and they determined this was good and necessary care."

I don't see how anyone could be "self taught" here, when the quality of evidence for the treatments is in question.

People have mentioned she is very likely misrepresenting the decision of the tribunal, but even ignoring that it's just meaningless anyway.

Even if this tribunal had an opinion on the underlying research, if they even looked at that question in any detail, their opinion on this isn't going to outweigh other assessments of the evidence.

There is a YouTuber called Ezra butler who has used Gender GP. Ezra is F2M.
Ezra was prescribed T after one consultation in February and last week after only 6 months underwent top surgery!!

I listened to the first of Polly Curtis’s podcasts about the Tavistock and found them so woolly and hand-wringing that I decided not to bother with the rest. However, I felt the Gender GP one might worth a go so heard it yesterday.

As pps say, even Polly Curtis had to come off the fence with this one, didn’t she? She was clearly gobsmacked by HW. It was very striking that HW readily admitted she’d been scouting around for ways to make money for some time with her various schemes that didn’t pay off. How lucky for her that a stray algorithm led to her initial attempts at what became the Gender GP website receiving hundreds or thousands of hits and sparking the realisation that this was the one to pursue.

Curtis’s rough calculation that just the registration fees alone might be capable of pulling in 300k a month was the point at which my eyebrows shot up into my hairline.

This is big, big business if so. Affirmation all the way? Well. Yes.

HW shows very clearly how far immense confidence can take you, even when you're making confident statements about entirely hypothetical things (such as this child definitely 'wouldn't have made it' ie would have killed themselves) or things which are clearly, provably untrue (such as 'noone has ever complained or regretted their treatment'), then jumping to the assertion that this treatment is lifesaving, necessary and has no downsides. People, understandably, prefer to hear clearly asserted, confident statements, not nuance and caveats about lack of evidence or inconvenient downsides. It's how hucksters have always thrived. I'm still surprised that the GMC Tribunal seem to have been vulnerable to this bias though.

Health watchdog probes private gender clinic https://www.dailymail.co.uk/news/article-12254933/Now-health-watchdog-probes-private-gender-clinic-set-staff-scandal-hit-Tavistock-unit.html?ito=native_share_article-nativemenubutton

Just badly written - they mean
prevents [the need for Top Surgery, Facial Feminisation Surgery, Breast Augmentation] and Suicide.

She appears to make decisions by making up fantasy futures for her patients.

4/4 And let’s not forget - early access to blockers and hormones prevents the need for: Top Surgery, Facial Feminisation Surgery, Breast Augmentation and Suicide.

The need for suicide? A doctor saying that suicide is necessary?

The tribunal definitely appear to have been fully convinced of HW’s expertise in this case. I still think to say the tribunal said the treatment was “good and necessary” is a push. What they’ve basically said is that they have accepted that she was competent to make the decision about treatment.

I've read some of the section about her treatment of Patient A (paragraphs 237-403), and I find it quite worrying that the MPTS were convinced that what she was doing was the right thing.

For example:
275. Essentially, both Dr Y and Dr P are saying the same thing. Dr Webberley’s case is that she did take into account synchronising pubertal development with Patient A’s peers. Had she not, the prospect of Patient A having to wait for four years before being prescribed gender-affirming hormones, while living alongside XXX and his peers whose puberty would continue to develop, could have had a detrimental impact on Patient A’s emotional and mental wellbeing. Indeed, the Tribunal finds that Dr Webberley’s treatment plan for Patient A was developed precisely to ameliorate the distress that would result from being held back developmentally while Patient A’s peers progressed through adolescence.

276. Based on the evidence, the Tribunal is satisfied that Dr Webberley assessed Patient A’s pubertal development to ensure synchronised pubertal development with his peers. It therefore finds paragraph 1(b)(i)(5) of the Allegation not proved.

I'd assumed that the tribunal members were medically trained, but it seems that only one of the three appointed to this tribunal was a medical doctor. But surely even a non-medically trained adult of reasonable intelligence knows that a girl cannot go through a male puberty. How could a girl have 'synchronised pubertal development' with her male peers? Do these people think that giving a girl testosterone actually changes her into a boy?

The way to prevent this girl from being 'held back developmentally' is to not give her puberty blockers and let her go through puberty naturally with all the other girls.

But as you say, the tribunal ruled on her competence to make these medical decisions, not the suitability of the actual decisions she made since two of the tribunal members are not medically trained themselves and the other one may have no expertise in this particular area. So they haven't commented on whether the treatment was 'good and necessary', since that was not the purpose of the tribunal.

I think you are right, they aren’t the same. What Webberley did cannot be said to be misconduct because it was in line with a respectable body of medical opinion. That is not the same as saying that this treatment approach is “good and necessary”, as webberley claims.
the sands are shifting here of course, which is why webberly is bleating. I am not sure that this sort of hearing will play out in the same way in say 5 years time.

The MPTS decision is here:
https://www.mpts-uk.org/-/media/mpts-rod-files/dr-helen-webberley-30-june-22_following-appeal.pdf

It's long (over 300 pages) so I've skimmed and I think this might be the relevant paragraph about prescribing testosterone to a 12-year-old girl:

284. The Tribunal relies on its analysis of Dr Webberley’s competencies as set out in the relevant preceding paragraphs of this determination. It rejects the allegation that Dr Webberley failed to provide good clinical care to Patient A by prescribing a hormone, testosterone, which was not appropriate for use in children of his age.

It doesn't exactly say this was 'good and necessary care', but the MPTS seem to have accepted that Webberley was competent and this treatment was appropriate.

237. Dr Webberley was at the material time a GP with a special interest in gender dysphoria and she was competent in the roles of mental health professional and hormone prescriber. Dr Webberley adopted a hub-and-spoke approach to her care for Patients A, B and C, referring them to specialists if and when required. She was competent to determine when such referrals were necessary. Dr Webberley was not bound to follow precisely the WPATHSOC7 or Endocrine Society Guidelines 2009 guidelines, although she did avail herself of the guidance therein. She was at liberty as an autonomous medical practitioner to look to alternative guidance and did so. Her reliance on the UCSF Guidelines was in accordance with a responsible body of expert medical opinion.

281. The Tribunal relies on its analysis of Dr Webberley’s competencies as set out in the relevant preceding paragraphs of this determination. The Tribunal finds that Dr Webberley, who had a special interest in gender dysphoria, was competent to recognise that the anxiety and depression which Patient A was evincing was a reaction to his profound and lifelong gender dysphoria coupled with the bleak prospect of being suspended by GIDS in a peripubertal state for some four and a half years while XXX and peers progressed through puberty. In consequence, Dr Webberley prescribed testosterone.

Helen Webberley tweeted the following this morning on the new NHS service specification for children's gender care

I am self-taught in trans healthcare. I treated an 11 year old with blockers and a 12 year old with testosterone. This was fully scrutinised by a Medical Practitioners Tribunal and they determined this was good and necessary care.

So why is the NHS saying that we should not let kids socially transition, prevent them from accessing blockers at the start of puberty, certainly no hormones until they are adults?

Denying trans youth the healthcare that they need causes immense harm and the people responsible for this must be called out. Trans youth deserve the best healthcare possible. And yes, that includes blockers, hormones and surgery.

And let’s not forget - early access to blockers and hormones prevents the need for: Top Surgery, Facial Feminisation Surgery, Breast Augmentation and Suicide.

https://twitter.com/HelenWebberley

Just listened to this. I hesitated because by the end of the Tortoise Tavistock podcast series I was so annoyed by Polly Curtis and her endless handwringing about how very nuanced it all was and failure to ask some very very obvious questions. Like 'Stef, isn't it a bit of a coincidence that you and your online gaming friend discovered you were trans at exactly the same time?' And 'How do you reconcile your belief at the time that you needed puberty blockers and hormones immediately, and you couldn't cope with having to wait, with your subsequent realisation that you are non-binary and not a trans girl after all"

(And then the whole thing just looked completely stupid reading Hannah Barnes book afterwards, because they'd missed the real story. )

But this was gobsmacking. Even Polly comes down off her 'it's all very nuanced' cloud somewhat. And almost everything Dr Webberley says is unbelievably shocking.
A masculine presenting girl is 'the most boy thing I'd ever seen' and therefore needed drugs to avert suicide, which was otherwise inevitable.
Flat denial that any patient has ever changed their mind, or that hormone treatment has ever not turned out well.
Getting a massive high from being people's saviour (for ££££).
'a doctor peddling in business' - and the string of weird side hustles. (Do doctors normally have time for side hustles?) I mean, I think she probably meant 'dabbling in business', and 'peddling' was a real Freudian slip. Quite the mental image.