A recent study has highlighted significant challenges faced by UK general practitioners (GPs) in delivering adequate healthcare to patients identifying as transgender or gender-diverse. The research, published in Healthcare, points to a lack of clear national guidelines, inconsistent monitoring of hormone treatments, and insufficient communication between primary and secondary care providers.
Conducted across two large general practices in Southwest England, the study audited the healthcare provided to 176 patients identifying as transgender or gender-diverse. Findings revealed that only 16% of those undergoing hormonal treatments received optimal monitoring, with 20% missing even basic hormone level checks. Additionally, patients who had changed their gender markers in medical records rarely received appropriate reminders for essential health screenings.
Long Waiting Times and Gaps in Care
One pressing issue identified is the prolonged waiting times for NHS gender identity clinics (GICs). Of the patients referred to NHS GICs, 64% remained on waiting lists, with some waiting up to eight years for their first appointment. These delays have led many to seek care from private clinics or self-administer hormones obtained through unofficial sources.
The audit also revealed that some GPs prescribed hormone treatments without adequate documentation from specialists, raising concerns about the safety and oversight of these medications. While NHS guidance does not require shared care agreements for gender treatments, the lack of clarity has left many GPs uncertain about their responsibilities.
Inconsistent Monitoring and Guidelines
The study compared existing guidelines from UK and international sources, uncovering significant inconsistencies in recommended monitoring protocols. Some UK clinics suggest annual blood tests for patients on hormone therapy, while others propose checks every six months or two years. There is also no national consensus on screening for conditions such as breast cancer, osteoporosis, or cardiovascular disease in patients undergoing gender-related treatments.
In practice, these inconsistencies have led to gaps in patient care. The study found that a large proportion of patients identifying as transgender were not receiving adequate monitoring of blood pressure, weight, or hormone levels. Among those prescribed testosterone, only 47% had received full recommended blood tests, and only 18% had all necessary annual checks.
Mental Health and Complex Medical Needs
The audit also shed light on the high prevalence of mental health and neurodevelopmental conditions among patients identifying as transgender or gender-diverse. Anxiety and depression were recorded in 74% of patients, with 16% diagnosed with autism spectrum disorder (ASD) and 13% with attention deficit hyperactivity disorder (ADHD). Furthermore, 43% had documented adverse childhood experiences, including bullying and abuse.
Despite these high rates of mental health issues, GPs reported difficulties in coordinating care between gender clinics and mental health services. Many patients with complex medical needs were left navigating multiple, fragmented healthcare pathways.
Calls for National Guidelines and Improved Support
The study concludes that UK GPs urgently require clear, evidence-based national guidelines to ensure consistent and safe care for patients identifying as transgender. It calls for improved data systems, better training for primary care providers, and increased resources for both NHS and private gender clinics.
Keith Jordan, spokesman for Our Duty responded to the report by saying “Our UK parents were fully aware of the issues highlighted in this report. We understand that the sooner the NHS moves away from seeking to provision services assuming ‘gender’ can be medicalised, the better. Gender clinics do not help anyone. Our children are suffering from harmful ideations and those should be treated appropriately”.
While the research focuses on UK general practice, the findings reflect broader challenges in healthcare for gender-diverse populations worldwide. With growing numbers of individuals seeking gender-related medical interventions, healthcare systems must adapt to provide safe, effective, and well-monitored treatments.
As debates over healthcare for gender-diverse individuals continue, this study highlights the pressing need for systemic improvements to ensure all patients receive the care they need.
