There were some jaw dropping things (again) today:
Dr B: Yes, those guidelines are not laws written in stone, we are Drs to help relieve distress. Dr Klink made a joke about me, but I see people who are in severe distress every day, who self harm & want to kill themselves, lets not forget that, hormone treatment does relieve that
Dr B: & in some Pts self harm does stop with hormone treatment. I don't agree with Dr Kierans saying well to do a bit of relaxation to relieve your distress, that's not going to help a Pt with GD at all, I found that shocking.
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Dr B: There is some discussion as to if that should've based on the gender someone identifies with or the gender assigned at birth, there is some disagreement amongst peadds endos. They want to know the nitty gritty of every physical parameter,
Dr B: but what is more important: that the Pt who is suffering from severe GD V the Pt is a cm or 2 less tall, I know what I think is most important. We don't do these things in our service, some endos do, some do not. There is no absolute necessity to do this
Dr B: there is no evidence anywhere that doing so is better for the Pt. we all know the longer the Pt is on blockers, if this Pt was kept on the blockers for 5 yrs I would've had concerns for their bone health.
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SJ: I've not put to you issue of bones scan, but issue of examination, BP & psychological exam as being necessary
Dr B: I would say height, weight, medical problems yes, psychological issues absolutely not. Any Dr working in this field can determine if someone is trans,
Dr B: and if they need homrmones. I want to explain to you and tribunal there is significant overlap between 12 year old and 16 year old and the assessment and treatment is the same
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Dr B: I really do not agree every single thing needs to be looked at, there's no evidence in literature that putting Pt through, not hoops, but other assessment for ASD of ADHD that that will influence outcome. I have many Pts 16+ with ADHD, some on medication and some not,
Dr B: I have many patients on autistic spectrum. I do not think seriously that this impacts on treatment, its is very straightforward and not nearly as complex as someone people believe it may be
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Dr B: we work with models & diagnoses. Diagnosis of pubertal 12, 13, 14 year old are exactly same as 16+, we heard from Dr K that in Belgium they're moving toward pubertal adolescents, we know that pre-pubertal adolescents do wonder & ask questions,
Dr B: but once puberty sets in and it becomes really strong, it will be very cruel to not treat those young adolescents
IS: I want to be clear, so one aspect is diagnosis is no different for +16 and -16?
Dr B: That's right
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IS: When you see 16yo's do you discuss history prior to 16?
Dr B: We always have ask, "how did your gender develop?" And they can say 'when I was a girl, only had male friends, only played with male toys', then there's always - which is crucial, you have to have parental history
IS: When you see 16yo's do you discuss history prior to 16?
Dr B: We always have ask, "how did your gender develop?" And they can say 'when I was a girl, only had male friends, only played with male toys', then there's always - which is crucial, you have to have parental history
Dr B: Lets not forget we've all been young & when you see Pt who is 16+ or 83 I see all of those, their narratives are remarkably similar. Having seen so many 'blueprints' it's literally as straightforward as that.
dr B: We are experienced enough as clinicians to tell when a Pt is telling you porkies, you can tell in millisecond.
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TM: As an adult therapist/Dr do you see issues in adults that could have been circumvented by earlier inventions?
Dr B: yes there are a lot of problems, I'm sure the tribunal has heard some, the simplest is if your body grows in the gender you don't identify with, you will need surgery for that, early intervention means no need for surgery.
Dr B: It also a big expense to the health service to fix that. Once you block a trans girl very early, the skin of the penis doesn't grow much more, sometimes it's not possible to turn it into a vagina, you may need to use part of the bowel,
Dr B: nothing is straightforward in this case, but it is straightforward that young ppl, where the GD becomes so enormous & all-consuming it happens with adults too where either they kill themselves or transition.
Dr B: The distress doesn't go away after doing a bit of relaxation or CBT of course not!
TM: You say its not complicated, when a Dr has a young trans individual & they are weighing up risks or benefits or early intervention, its important to take all aspects into account?
Dr B: I think that's an impossible task, I don't think anybody would be able to do that, ultimately goes down what Dr Brian Ferguson said when I took over centre, he said at end of day you could talk for hours, look at every aspect, but at the end of the day
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