ASD son & GenderGP - Help needed

[SisterSupport]

My DS (19, ASD & ADHD) has made an appointment with GenderGP because he wants HRT.

What can we say to help him change his mind please or at least help him to question and properly think about whether this is really for him? What do we and he need to be aware of please, either with the organisation or with the medical side of things? Does HRT affect fertility or stop orgasms? How long would he need to be taking HRT before it wouldn't be possible to reverse some of the changes? Would the medication be from a UK based pharmacy (regulated) or from overseas (unregulated). Would his GP have any input into this? Would he need to freeze his sperm?

We're so out of our depth and scared that he'll be pushed along so fast once he has this appointment. He lives away at uni and will be home for Easter shortly (but after his appointment).

Also, although he decided 2+ years ago that he's trans and has since unofficially changed his name, he's done nothing to particularly feminise his appearance. He doesn't even shave regularly and still has hairy legs!! It seems such a giant leap to go from that to HRT (although he is stressed about uni work currently so I can understand him deep-diving into one of his special interests instead).

What a mess.

Such an interesting discussion. Different approaches work with different children obviously. What matters is that parents enable children to access all aspects of this. Not just the cheerleading euphoria or terrifying suicidal threats from transactivists but the detailed evidenced about the massive risks and irrevocable life changing decisions they're being gaslit into making.

I think the first, most pressing thing might be to get him to see that Gender GP are not the people to help him with this.

Might the one-star reviews here help? GenderGP Transgender Services Reviews | Read Customer Service Reviews of gendergp.com (trustpilot.com)

After that, then the advice from Bayswater Support Group linked above will be invaluable.

How old is he? Are you in England?

They've now banned all hormone therapy for under 18s so he wouldn't be able to go down that route now.

@RingRingDoor He's 19 and puberty blockers have only been halted by NHS England, OP's son is going privately to Gender GP who are still allowed to prescribe.

If we want to shut down Gender GP's access to children then Liz Truss' bill needs support

URGENT: Ask your MP to support the bill! - Sex Matters (sex-matters.org)

I was talking to a different lady than the OP...

@SisterSupport started the thread but I was talking to @SisterMidnight77 who didn't say how old her son was.

If he's under 18 he probably wouldn't be able to fund private prescriptions himself without parental support.

Ah, sorry @RingRingDoor my mistake.

I was just reading the thread about NHS puberty blockers and this excerpt from a post from @Brainworm might provide the OP and others insight :

^The key issue is that of formulation. Patients with trans identities often arrive with fixed ideas about their symptoms and the cause- my body is wrong, I need treatment to change my body, regardless of any contraindications arising. They believe that no other outcomes to that of changing their bodies (halting puberty and/or changing hormone levels) are significant.

A healthcare professional's formulation should include exploring a range of potential underlying causes for the presenting symptoms (dysphoria) and should aim to treat the causes rather than the symptoms.

'Power and oppression' and post modern narratives can be like kryptonite to well educated/professional healthcare practitioner's critical thinking skill. We see the negative impacts of inequality and discrimination on health outcomes for marginalised groups and are frustrated by being limited to treating the symptoms of this.

There is validity to claims that patient's healthcare experiences are often that of experiencing further marginalisation. However, related research often flags up issue to do with marginalised groups not being fully informed about the full range of possible treatments, or not being considered for the full rage, and too little research being undertaken relating to outcomes (or symptoms) pertaining to the specific group. There is a widespread movement relating to 'doing with' rather than 'doing to' when it comes to research and development.

TRAs stand out here. They reject the 'doing with' and consider anything other than 'do as we say' oppressive. I think this may come from a similar place as a functioning alcoholic not wanting treatment as they fear having to give up alcohol, and self harmers fearing losing the relief that comes from cutting. I expect many with gender dysphoria fear losing the relief that comes from their gender identity.

However, those working in addiction services (and, interestingly, many effective treatments for anorexia and self harm are based on these being conceptualised as an addiction) have been more successful in navigating (tolerating?) patient anger and resentment. They do adopt approaches that seek to empower patients and 'do-with' but are clear that the outcomes they are working towards are based on improving functioning.

In short, I don't think there is any place for treating 'identity' in medicine. Identity in itself should not require medical intervention, the exception being when it negatively impacts on functioning. When this happens, the goal of treatment should be to return to full functioning.

Further discussion on page 18 of that thread (Page 18 | No more puberty blockers for children from the NHS - reported in the Times! | Mumsnet)

I'm really sorry you're going through this.

Baywswater Support are a good shout. Their website is good and I've used them for support though my own DC is a bit older, mid twenties and had already left home, DC also decided to get hormones from GenderGP. I tried to raise some questions but DC mainly dismissed them and was very willing to accept risks in future for sake of the here and now.

I have not really been able to find clear objective studies of risks, on humans, that a patient or a parent could make sense of - and I'm well educated in a tech subject and understand enough statistics to know what a confidence interval is. To be honest I'm not sure how much difference it would make, many (not all) detransitioners say that nothing a parent can say would have made any difference to them. My main concern was to keep contact with DC and avoid alienation because DC also has an ASC diagnosis and needs me.

Fertility preservation is not a requirement. I nearly talked DC into fertility preservation which DC could have had free on the NHS (not possible everywhere) but DC changed DC's mind because after only a few months DC's sperm count was already too low and DC would not pause the hormones for it. So, if the effects do become permanent (which they do for some people, I don't know the exact risks though they rise over time) well, too bad for DC and for anyone who cares about DC.

DC's experience with GenderGP has also been along the lines of @Pinkmagics "try this, then this" rather than setting goals and assessing risks and benefits.

Your DC might look into GenderCare instead of GenderGP. One of DC's friends uses them, I think they're still in practice and they are at least UK based and do look slightly less casual than GenderGP. Although it's not totally reassuring to learn that "Dr Lorimer practises according to guidelines from the World Professional Association for Trans Health (WPATH)"

Sorry if that all sounds a bit brutal. This just is brutal.

I don't have any answers and I am sorry you (and your son) are going through this.

GenderGP are a disaster - totally cavalier. Local practice here is not to do any shared care with them which means all appointments, blood monitoring, prescriptions carry costs. And that continues until an NHS clinic takes over (assuming patient is on a waiting list) which can be 2-7 years. That is quite a bit of cash. However, your DC is at uni and it is possible that they will find a GP to take over care. If you could express concern (as PP) about the provider and persuade your DC to go with a better outfit, there may be a bit more in the way of assessment and preparation.

I don't know all the risks etc but I don't think anorgasmia is an issue if puberty is complete. However libido shrinks a lot on oestrogen, for many. Fertility seems very hit and miss - there is a real risk it will be irreversibly impaired (and I am not confident that GenderGP counsel for this as their letters are cut-and-paste) but it isn't guaranteed.

The 17-25 autistic kids are really vulnerable. I don't have a solution but many people say Bayswater is very helpful. My sympathies.

Yes, Dr Bell raised that point on the BBC interview yesterday - that 17-25 years olds.in this cohort are vulnerable, but they were outwith Cass' remit.

Thank you so much to everyone who's taken the time to read and reply and for all the advice and information on this thread. I'm so grateful and also so sorry for those who are going through similar. I have a lot of reading and digesting to do now.
@Leafstamp thank you also for the link to the Sex Matters Bill. I've signed.