I'm Dr Helen Webberley, gender specialist. I have been in the UK media a lot over my work with trans patients and I'm here to separate fact from fiction - AMA!

Is gender dysphoria a mental health problem ? Is the problem considering it a mental health issue or is the problem assuming that all mental health related issues are inherently bad?

Gender incongruence is not a mental health problem. When gender dysphoria is present as well (distress due to the gender incongruence) then that can cause mental health issues such as stress, depression, anxiety.

Wouldn’t it more accurate to say that you’ve been in the media a lot due to your disregard for medical guidelines rather than your work with trans patients?

These are the guidelines we use.

http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf

What about NICE guidelines? As those are what the NHS would be following: what makes the University of California (reputable and esteemed though I'm sure it is) a better guide?

I don't always agree with NICE recommendations in Mental Health but I at least respect them for what they are: what's your main issue with the way the NHS practice differs?

There are no NICE guidelines for the treatment of transgender patients.

Are there any data on the co-occurrence of poor mental health and gender dysphoria? Similarly, do these data allow us to tease out causal inferences and the success rates of gender transitions for mental health outcomes?

Yes, there is a lot of data. Mental health issues are much higher when transgender people face difficulties. These difficulties may be socially, at school or work or home. They may be medically, in not getting the healthcare they need. They may be political in not getting the rights that they deserve.

However, we definitely see that transgender people who are treated in the same way as cisgender people, and allowed to express their gender in the way they feel comfortable, have much better mental health outcomes.

Thanks for your response, its obvious that we need to treat transgender people with the dignity and respect that everyone deserves, and a horrible shame they often don’t receive that.

My question was trying to find out if we now know more about the causes of gender dysphoria, the success of transitions in relation to mental health, and the impact of mental health treatment on the prevalence of gender dysphoria. If you have any more specific information on this, I’d very much appreciate your efforts to present it.

You cannot 'cause' gender incongruence, you cannot 'treat' it, you cannot make it go away or make it happen. It is not a mental health illness, or even a medical disorder. It does however cause mental health issues of the person struggles because they have gender dysphoria.

So gender dysphoria is never caused by severe trauma or other life experiences?

I have in mind cases like Chelsea Manning, it appears (from the outside) that her dysphoria and transition occurred due to the trauma of her prosecution and treatment by the US government.

Edit: a bolt on question; if it is not a medical condition, caused or treatable. Is it more a question of self-acceptance? Of course others’ acceptance is also very important, but it seems self-acceptance can occur without a gender transition.

Edit 2: thanks all for correcting my ignorance in the Manning case. My questions were sincere with no malicious intent.

I consider it to be a normal part of human variation, but one that does, for some people, require medical intervention.

How much confusion do you come across with regards to the topics of gender/sex and the topic of sexuality.

I'm a gay man and very much feel male, masculine and 'blokey'. In the world of any gender spectrum I would place myself right firmly down on the 'man' end. However from my perspective there seems to be a strong notion that as a gay man I should somehow 'grasp' or 'get' trans issues better than straight people, which I don't.

From my point of view, who I find attractive and what gender/sex I feel I am have nothing to do with one another at all. The historicity of the tying together of trans issues and gay issues is well known and long standing, but I feel it is routed in a shared oppression and not actually in any kind of shared internal experience of ones self, but what are your thoughts?

I totally agree, sexuality and gender are very different, but they have been brought together as the LGBTQI community stand together as one in their proud fight for equality.

Trans people may not understand homosexuality, gay people may not understand gender issues, we should all just be accepting of diversity and welcome it :)

Hi Dr. Webberley, thanks for doing an AMA with us, and good luck.

I'm curious, what are some of the most common misconceptions you've seen/heard about trans and/or nonbinary people or the transitioning process? Also, how much abuse/hate do you experience normally and how do you deal with it?

Thanks!

Of course many people can't get to grips with it. Surely if you are born a 'man' then you will be a 'man'. It is not until you meet someone who doesn't identify as the gender that they were assigned at birth that you can really understand it.

As for non binary - people think it is a new thing, but we know it isn't. Everything is a spectrum - whether it is how male / female / in-between you feel on the inside, or how male / female / in-between you want to express yourself on the outside, or even how male / female / in-between the person is that you are attracted to. It cannot be binary (one or the other) nor fixed - it is a fluid spectrum. That is what makes us human.

The abuse / hate that I experience on social media is easy. I try and educate and if that is not shifting then I block! The negative effects that I face from those who have power over me and is harder to bear. But I maintain honesty, professionalism and calmness and do what I have been taught to do as a human and as a doctor and treat people in accordance with my skills and knowledge and compassion. I hope that one day this will be recognised.

Hi, I have a question that will probably sound insensitive, but it really is not intended for it to come across that way, which is:

What's the difference between a man feeling like they are a woman and a man who has feelings and thoughts that are normally attributed to the female archetype?

Also, how much of this needing to change genders has to do with the dislike or dysphoria of one's genitalia?

Thank you for doing this AMA

Gender identity is much more than just about the genitals. It is about the whole feeling of how you feel on the inside and whether that is male or female or somewhere in between.

When you are transgender woman you are not a man who feels like a woman. You are a woman.

When you are a transgender man, you are not a woman who feels like a man. You are a man.

That is a very simple explanation, but I hope it helps?

Hi Helen

​

To be honest, transexuality is something I never understood. The big thing I always wanted to know is, when a male by birth person says they identify as a woman, what does the word 'woman' in that sentence mean?

The problem with that sentence is that they weren't male at birth in the first place. Everyone thought they were going to be male because that is what their body looked most likely to fit with, but actually as they grew up it became obvious that everyone had got it wrong and actually there were going to grow up into a woman.

Hi Helen,

So many questions that I could ask here but I think there's one that's more important than any other:

The UK trans community has seen three private gender clinics having to fight GMC cases in the last decade or so - first Dr. Reid, then Dr. Curtis, then you.

At this point the most obvious explanation is that someone is deliberately trying to shut down private gender services in the UK using GMC complaints.

Why do you think this is happening? And what can we do about it?

Hi, ask me as many as you like, I have time and a cup of tea!

The complaints that have gone to the GMC about me have all either come from the gender specialists working in the NHS, or have been encouraged by them. From what I have read in the newspapers, the same is true for the other two private clinics you mention.

I don't know why. None of the doctors have come to me personally to ask what I do, they simply go behind my back and complain to the GMC. The GMC then have to investigate.

Deeper though, the GMC seem to investigate those doctors who DO treat transgender patients and not those who refuse to treat them or treat them badly.

I think the transphobia that we see in the public eye extends deep into institutions that provide and regulate healthcare.

What can you do? - well most importantly you can write to the GMC every time you see examples of good care and every time you see examples of bad care. We need to hear the voices of those affected by decisions and care provided by doctors.

Do you have any evidence that the GMC doesn’t investigate doctors who treat trans patients badly? That seems quite a serious accusation to make

It is a sweeping generalisation, but from my own personal experience and knowledge the balance is swayed against those who are willing to help.

Hi Helen,

Do you approve of the actions of Dr Adrian Harrop on Twitter? I believe he is a friend of yours. I'm speaking in particular about the way he doxxes vulnerable women. He comes across as a misogynist who hates women and doesn't appear to be very stable. He also appears to enjoy wasting police time. Are these things you support him in doing?

What are your thoughts on this man?

Dr Harrop is a friend and colleague of mine. He is a passionate doctor who feels strongly for the rights of LBGTQI patients.

Using a throwaway ... thanks for taking the time to answer questions.

I'm a middle-aged parent, in the U.S., in a very liberal community. When one of my kids was 13, her close friend decided that he wasn't the girl he had been born, parents and doctor delayed puberty and he fully transitioned at age 15. That same year, my 16 year old had a close friend who transitioned in the other direction, mtf. In both cases, it was new to me, but I loved the kids and thought their families were great and just tried to be as supportive as possible. I know there have always been trans people around throughout history and I read the reports that kids who transitioned before puberty had much better mental health outcomes. In the three years since then, we know 3 other teenagers who have come out as trans. I am not kidding when I tell you that we have received TWO different Christmas letters this season from friends letting us know that their kids are transitioning, so 7 kids just within our immediate social circle. Again, all great kids, great loving families. But ... but ... I don't know, I can't help but wonder if we aren't serving these kids well. The reason I'm using a throw away is because in our community it is totally taboo to raise any kind of question about whether delaying puberty and then transitioning is the right course of action. And I know the families who have gone through this, it's been gut wrenching for the parents to decide on this course of action, and so then to have others question it, has been very hurtful for them. My own kids think I'm woefully old-fashioned even questioning whether this is the best way to handle the pain these kids are feeling, and so I have just kept my big mouth shut.

But I do wonder if maybe there aren't other things going on sometimes that wouldn't require such drastic physical action. Couldn't these kids be figuring out their sexuality and gender in ways that when they came out the other side might not mean that required surgery and hormones? Puberty is such a crazy time! And homophobia and societal gender roles can really restrictive and harmful, but are they really all trans kids who require transitioning? I remember seeing the pictures from one kid I had seen grow up and who I thought was so quirky and fantastic, and he had posted pictures from the hospital after having his breasts removed. He was very happy but I felt so, so sad.

So I guess the question is, how can doctors really be sure that transitioning is the answer?

Hi, it is so difficult to understand, and I have asked myself all of these questions. Of course we should ask questions and try and figure out what is real and what is fiction, that is what humans do. And if a young person really feels that their gender doesn't feel right then there is no harm in asking why, how, who, what. You are right to question, challenge and ponder - but if the answers are clear that this is how someone truly feels then that is when acceptance plays a massive part.

Hi Dr Webberley,

What's the biggest single change the NHS could make to improve this situation?

EDUCATION!! It is not acceptable that doctors and nurses are 'allowed' to not know how to provide simple gender-affirmative care. Many patients just want access to very simple support, medication and blood tests and that can easily be provided by a GP or practice nurse within your local GP surgery. The specialist clinics should be saved for the trickier cases where people are unsure of their gender, or have other medical conditions that may interfere. Most people are very sure of their gender, and just want the simple medical help that is available. Doctors are currently too scared to provide help, and that is putting patients at risk.

Do you feel that those working within NHS gender clinics do enough to try and change the system? The wait times, limited funding and treatments for physical transition etc.

This is something I cannot really comment on in this arena.

I feel that the care of gender patients needs to be spread out into secondary care (local hospitals) and primary care (GP surgeries), leaving the specialist clinics to deal with the very difficult scenarios.

Changing NHS protocols is a very lengthy process. There are many good pieces of work underway to make improvements, but it all takes time.

Thank you for your reply. I attend a gender clinic. It's hell. If I had the money when I began transition I would have gone to you. I think you do amazing work

Thank you so much, I hope all goes well for you :)

Any patients regretted having their surgery?

There are many reasons why people might regret having any operation. Maybe the results didn't turn out the way they hoped, maybe the social reaction and support was not what they hoped.

How many genders are there and could you name a sampling of them please? I am tired of 4chan style made up genders that are intended as strawmen and would like to become a bit more educated in this area.

I have always identified as the gender that I was born into and am sadly lacking in my knowledge of this area. I assume if I learn more I can avoid being an ass, which I fear I may have been in the past without meaning to be.

Maybe it is better to consider gender as a spectrum in the same way that sexuality is. Some people are fiercely heterosexual and some fiercely homosexual, some are in between. Some may be bisexual which maybe implies they like women and men equally. Some may be mostly homosexual but like the opposite gender a little bit.

The same applies to gender.

Imagine gender is a spectrum that runs from 1 to 10. Some are 1, some are 3, some are 10 etc.

You previously worked for more general online drugstores - references online suggest 'The Great British Drugstore' and the 'Oxford Pharmacy', some of which crossed international borders.

What made you switch from general to specifically transgender drugs online? And in terms of oversight/patient care do you see the online model as suffering in comparison to more traditional relationships?

Finally now you have been convicted in Wales, will this change the way you practice, or do you plan on changing jurisdictions periodically in order to sidestep regulation?

Hi, I have worked with and for many online providers of healthcare, I think the Internet opens up many avenues for providing care remotely.

When I started a page for transgender patients, I had no idea there was such a need. I am a doctor who hates any kind of injustice and the stories I heard from transgender people through my own websites, were full of massive injustice and I wanted to focus on that and help as much as I can.

The online model is fantastic for those transgender patients who find it difficult to leave the home and travel very far, we have done some amazing work by email, telephone and video.

As for the conviction, we are working really really hard with the regulators to resolve the issues. I do not wish to side step anything, and that is not possible, but I need to work with them to protect our patients and not abruptly withdraw their care, while resolving the registration issues.

what does it take to become a "gender specialist"? What is the acrreditation process like?

A specialist is someone who has undergone learning and education to have specialist knowledge in a field.

[deleted]

Good question! Sexual identity (the gender you are attracted to) and gender identity (the gender you feel you are) are very different. However, the support for those that identify as anywhere on the gender or sexuality spectra comes from very similar sources, and the LGBTQI community work together for peace and equality for all.

https://twitter.com/GenderGP/status/1072464929284911105

Hi, thanks for doing this! A lot of people are complaining that trans young people (like myself) are damaged by prescription of blockers and hormones. Do you have an opinion on what age group these medicines should be prescribed to, or should it be based off of onset of puberty, as people start at different times?

The evidence that we have is clear that blockers and hormones are safe and effective when used correctly.

Hi Helen,

Do you believe transition should become more of an 'over the counter' process? Have there been any patients you have decided not to treat and if so, what were or would be the reasons?

Hi, 'over the counter' means you can buy it in a pharmacy without a prescription. You can do this in some European countries, but as a doctor, I feel that it is safest to have medical supervision.

I do, however, think it will become - with time - something that is routinely dealt with by your GP. Then tricker cases can be sent to your local hospital to see a consultant, and really complex issues can be dealt with in specialist gender clinics.

Do you think a transperson who undergoes the therapy as a child and regrets doing it should be entitled to massive compensation?

I think that anyone who does not receive the medical care that is safe and appropriate for them is entitled to ask questions and seek answers as to what went wrong and why. I think there will be many law suits in the future for transgender people who did not have access tot he right care at the right time.

Dr. Webberly,

What kind of correlations do you see regarding LGBT patients and childhood sexual abuse? Also, why do people focus on SRS and hormone therapy for treatment? When there is an ailment of the mind, wouldn’t it make sense to change the mind, not the body?

Gender incongruence is not an ailment of the mind.

Sadly, many people experience childhood sexual abuse whether they are cisgender or transgender. There is no causal relationship.

Hi Dr. Webberley!

Is it true gender reassignment surgery does not cure gender dysphoria and that’s why there are high rates of sucides in the transgender community?

Only a small percentage of transgender people feel the need or desire to have surgery.

Suicide rates are highest when a transgender person is not getting the help, support, acceptance that they need in order to live their life in eace.

I've asked this same question before, but I can't seem to find an answer.

​

It's difficult for me to understand why/how transgender individuals don't feel comfortable living with the sex they were born with.

I mean, does being a female mean more than having female sex organs (and same for male)? Perhaps i need to ask myself more existential questions, but I can genuinely say I feel like a woman because of the sex organs i was born with--if i was born with a penis, i think I'd feel like a man.

It's easier for me to relate to the LGB community, because i think you can't help how you feel-you love who you love.

If you could provide some insight that'd be nice. I don't have any friends/family that i know of who are transgender, so i really have no perspective from the other side.

Until you have met and talked to and understood a transgender person, then it can be difficult to understand. Gender is not actually related to your sex organs at all, it is just how you feel inside, and that can't be helped.

What IS your "alternative approach" you mentioned?

My approach is to start with believing that a person knows whether they are transgender or not and this is not something that needs to be diagnosed through lengthy assessments. Informed consent means that you and the patient sit down and discuss the problem and the answers. The patients is an expert in themselves, the doctor is an expert in medicine. Together they work out a plan that is safe, effective, caring and what is best for the patient. Draw on expertise from your team to help along the way and come up with a plan that suits and that is safe.

Hello Dr Webberley,

You are somewhat controversial and some people say you practice medicine irresponsibly. I think you are currently not allowed to practice pending GMC investigation? (sorry if I have that wrong.) How do you personally weigh up the ethical considerations in taking the actions that you do? How did you decide to continue practising despite the publicity/controversy? Is there anything you would accept as a reason to not continue?

Hello, my ambition is simple. To do what I can in my lifetime to use my knowledge and skills as a doctor, and my passion and feelings as a human - to help improve health and social care for transgender patients. I have seen so much injustice and pain, I cannot simply walk away.

Hi Dr Webberly! I wanted to say I’m so thankful for you and really for any doctor that goes out of their way to provide care to us trans people. Being discriminated against and even denied basic care is sadly our norm, as you’re aware. Given how few doctors work in this area I’m always terrified that if only on or two per major city were to leave, half or even most of the trans population there would have to move. Our lives feel precarious.

My question is concerning estrogen levels/dose for trans women. My doctor recently increased my dose to 2-3 times what other doctors had put me on for years, and I’m finding that this higher dose has fixed many problems that I was having. I’m 30, in good health, and I started HRT when I was 19. My current levels of estrodiol are ~500 pmol/L, which seems normal for my age. But I’m realizing that my previous doctors had me at levels under 200 (around the lowest levels of the cycle for cis women) for most of my twenties, while I suffered from mood problems and lack of energy.

Is under dosing a common trend with trans care providers? I’m aware there are worries about side effects, including blood clots, and that doctors try to aim for the lowest possible dose that is effective. But given that having my estrogen levels around cis normal for my age has massively benefitted me, I feel like many doctors are minimizing the benefits that come from a higher dose. It’s almost like my previous doctors felt that as long as I could ‘pass’ then my dose was high enough, neglecting to pay attention to the other aspects of HRT. How do you approach this issue?

Hi there, thank you for your question. I am not going to give any specific medical advice on here but if you email the team at GenderGP then they will be able to give you the standard blood levels that are considered optimal and the best medicines that can be used if one type is not working.

Hi!

While I'm on the fence about treating kids with drugs, I did watch the Theroux documentary recently and saw how happy the kids seemed to be when they 'got' parts of their body that they felt they were missing.

So given that... Which part of your work with patients is the most satisfying stage? What makes the most difference to them?

The work that I have done with transgender patients is easily the most rewarding that I have done in my whole career. To help someone who is struggling with their gender identity to achieve peace is surely a great honour.

To prevent the progression of puberty in a transgender child who is waiting long months for a gender appointment can honestly save lives.

Hi Helen,

I've been using your service for a year now and I'd just like to thank you so much for giving me the chance to become who I always should have been.

What is your opinion on the impacts of social media on transgender people? Do you feel the high pressure on image (especially for younger trans people) is particularly detrimental or is it just an occupational hazard of our time?

​

Social media in any circumstance has good things and bad things. My advice is only to use it in positive ways and if it (or someone) is hurting you then turn them off!!

Hi Dr Webberly! Thanks for doing an AMA!

I was wondering what your opinions are on progesterone as part of a hormone regimen for trans women? On the NHS I've had no luck convincing CHX or my GP to prescribe, but it seems to be quite regularly in use in other countries like the US and Canada.

The trouble is that there is very little evidence for or against using progesterone. There is a good paragraph on page 28 of the UCSF guidelines which says, 'There is no evidence to suggest that using progestagens in the setting of transgender care are harmful. In reality some patients may respond favorably to progestagens while others may find negative effects on mood.'

http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf

isn't it not true that P4 has a slight GRnH alalog effect reducing LH preoduction which is needed for the primary sex organ to produce the primary sex hormone. could it not be used as a more natural AA along with good doses of E2.

also why no E injections in the UK Clinics, im currently using EV and getting very good results.

~Cloie (im DIY BTW)

Estradiol injections are not available on prescription in the UK for any medical condition.

why tho?

there are several good esters of E2 that can be used.

EB, EV, EC, EEn, PEP, EU....

I don't know! It is down to drugs that are approved by the MHRA.

Hi Dr Webberley

The current NHS GIC system is obviously ill equipped to handle the flood of transgender people that far exceeds the 0.1-0.3% of the population the GICs were set up to contend with. What system would you like to see implemented for Trans Health in the UK instead?

Hi, I answered this a bit earlier on - see if this answers your question: https://old.reddit.com/r/IAmA/comments/a56yjf/im_dr_helen_webberley_gender_specialist_i_have/ebkff5l/

Hi Helen,

​

I am currently undergoing treatment in The Netherlands and was wondering what your thoughts are on a few different things.

​

First off, my therapist brought up the concept of rapid onset gender dysphoria a while back as something the jury is still out on. I have read that the study whereupon the concept of ROGD is based is flawed however as it suffered from a sampling bias. Similarly I have heard that some clinics adhere to Blanchard's typology of autogynephelia which I have also seen a lot of critiques of. With that my first question is: do you think these theories are worth considering? and if not, why do clinicians seem to be so withholding in disregarding them?

Secondly, one of the requirements (commonly) used for being eligible for HRT here is that you need to go through RLE (real life experience) living as your identified gender. With that my second question would be: do you see value in things like RLE as requirements for HRT and is there a risk in discouraging non-binary people from transitioning by basing RLE upon gendered stereotypes?

Rapid onset gender dysphoria is not a terminology that is at all helpful when describing the history of a person's gender feelings. Some people have a fairly recent realisation of their gender, and their feelings may have grown quickly, but that does not in any way belittle it or make it unreal.

RLE can be very difficult for some people, and there is no medical evidence at all that it is beneficial. People should be allowed to socially and medically and surgically transition in a way that best suits then and is safest for them.

Hello!, do you guys at genderGP offer help for trans individuals in Scotland and if so what is the age limit and prices?

GenderGP offers care and support to patients to all ages from all over Europe. You can email them directly for the detailed information.

Hello Helen,

Was there one particular incident which made you decide to set up GenderGP or was it more of a gradual decision based on how poor provision for trans people is in the UK?

Thank you!

I have always been interested in sexual and gender health. When I was a GP in Wales, I realised that transgender patients in Wales had to travel to Central London to get any kind of medical help, and that was a tall order for many. So I put a page on my website offering advice to transgender patients on how they could get help and advice on the NHS. It all snowballed from there and before long, the need for medical advice, medication, blood tests and support snowballed. So I created GenderGP and I am very proud if it :)

What's your reasons for (normally) using finasteride as an antiandrogen, rather than spironolactone or cyproterone?

Finasteride is safe and regularly prescribed by GPs. In most patients it also reduces testosterone levels really well. If it doesn't then you can move on to the other anti androgens as needed.

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https://twitter.com/GenderGP/status/1072464929284911105

Is there an alternate treatment to Dysphoria? Learning or being treated to accept the original body you're born in?

You cannot cure the feeling that your gender doesn't fit with the one you were assigned at birth. You can come to accept it and live with it, but you cannot 'treat' it.

Hello there, first off, I want to say thanks for your work in making treatment accessible. As a trans girl I had to resort to black market Estradiol Valerate and Progesterone (due to years long wait lists, and ineffective NHS treatment plans), so I can only imagine what it would be like for those who don't understand the dark web.

So my questions:

• What is your stance on DIY treatments? Do you believe it's possible for a person to learn the basics of endocrinology and safely self-medicate?

• Female to Male DIY is impossible to do legally due to testosterone being so heavily regulated. Are you able to provide treatment to FTM patients? Do you run into any legal hurdles with Testosterone?

• What is the worst hate mail you've ever received?

DIY - many patients know far more than their doctor about the medication and blood tests for gender healthcare. However, there is more to a human body than just the basics of endocrinology. Many have found it safer than the desperation of waiting for gender clinics. But I feel that a well-motivated patient working with a well-educated and well-meaning doctor is the best ingredients for a safe and effective medical transition.

Testosterone is safe when used for the right reasons, but as it is also abused on occasion as a muscle bulking drug, there are extra regulations on it. But prescribed properly and monitored correctly, it is very safe.

Hate mail - silly, childish comments from those who don't want to understand or learn about transgender issues are easily ignored :)

What are the stats for reduction of mental health issues for patients that have transitioned?

Basically, does transitioning fix them?

Happily transitioned people have far less mental health issues.

Dr Webberley,

A geneticist friend of mine is working at the Crick institute and is looking at the genetic causes of the development of biological sex and how that can lead individuals to develop intersex characteristics or develop a gender identity distinct from their assigned gender based on sexual characteristics.

Anyhow, my question is, what reassurances can you give people, such as myself, who are uncomfortable with the idea of private healthcare, but otherwise face the obstacles placed by the NHS systems? I can't help but feel uncomfortable, especially being a person whose mental health problems have led to me having low incomes jobs despite postgrad education. For what it's worth even the reduced rates offered by GenderGP leave a lot of people in my income bracket without too many options. I do of course appreciate that you need to make a living and pay your staff. I am considering GenderGP as an option.

Secondly, any advice on dealing with a health board run GP surgery? I have no permanent GP anymore, and so far only one GP I have seen regarding issues has been at all helpful, but he's only there two days a week and most of the time I try to get an appointment with him he's either booked up or not taking patients (the surgery only accepts on the day bookings, so I can't plan it to fit in with work etc.).

Thanks for taking the time to do this. And I hope I didn't come across as rude or unpleasant.

Hello, there should be no need for private services at all. The care you need should be available to you on the NHS within the terms of the NHS constitution.

Your GP - any GP - should be able to advise you and refer you appropriately.

https://www.nhs.uk/live-well/healthy-body/how-to-find-an-nhs-gender-identity-clinic/

I hope you get what you need and deserve :)

How should I address transgenders ( as in should I say he or she or something else)?

You could ask a question if it is not immediately obvious from the way they present themselves, 'do you mind if I ask which pronoun you would prefer me to use?'

Any tips for a nonbinary health care professional who is still in the closet? I'd love to be addressed with the correct pronouns and not be misgendered, but I fear that's not an option because it would distract patients/staff, and the clinical encounter is about them and not me. But maybe your staff already have some experience with this...

While on this subject - tips on how to address gender with patients would be greatly appreciated. Most people look at me confusedly when I ask what gender they identify as (I'm in internal medicine, our EHR only has the options male/female). Given that over 10% of the population self-reports as being trans, I'd rather not just assume, but it seems that the subject is so political that the other 90% feels weirded out by it...

And I was wondering why you seem to consider nonbinary as being 'in between' as I can gather from your posts in this AMA - the whole point is that we fall outside the binary of man/woman... :)

Hi, apologies for the in-between / outside reference. When I am trying to explain the concept in simple terms, it seems to work the best.

We have a great learning module that may help to educate your EHR and see if things can get changed.

As for coming out, it is a fear - whether you rein the profession or not. Start with simple steps and tell a few safe, close people? Educate and liberate. Good luck :)

Is it hard to specialize in a binary field?

Hi, can you expand a little on that question?

It seems they're trying to deride non-binary identities by asserting that there are "only two genders."

Like many other human attributes gender is a fluid spectrum. People can identify as 100% female or 100% male or anywhere in the middle (100% is actually very rare). And this point may shift and vary with time and day. Gender cannot be thought of as a binary identity.

A therapist friend of mine has a working theory that for any kind of sex misalignment to happen, two things are required: 1. The genetic part (This “boy” has “girly” attitudes, for example) but mostly 2. A scarred relationship with a parent where the child feels neglected or not accepted.

My coleague says that her (very limited) findings have, so far support this theory 100%. Meaning that every single person struggling with sex identity she has attended has met both requirements.

But that only ammounts to, let’s say, at best 100 people, AND in a specific area of course. Also she’s not dedicated to that field, she just happens to encounter that kind of patient.

In your experience, does the theory holds any water?

1. A scarred relationship with a parent where the child feels neglected or not accepted.

I totally disagree that gender incongruence is caused by parenting.

Transgender people have a startlingly high suicide rate; nearly 40%. No other group of people in recorded history has ever had those levels of suicide, not even Jewish people who were living in concentration camps. Current treatment for gender dysphoria, such as sex change operations, has shown to have very little if any impact on these suicide rates. To me, that screams that whatever we are doing right now for transgender people is not working.

Do you think the current treatment methods of gender dysphoria are satisfactory, and if so, how do explain the lack of decline in suicide rates?

You are wrong. Mental health issues and suicide rates in transgender people who receive gender-affirming care are much reduced.