It seems that the climate for medicalising transgender ideation is continuing to change in the UK after the publication of The Cass Review. While this report applies to just one medical practice, the precedent has been set, and others are sure to follow.
A patient of one UK medical practice reports receiving a letter explaining why cross-sex hormones will not be prescribed from March 2025. The Cass Review is not mentioned in the letter (presumably because that dealt with children and adolescents), and we know that the Levy review of adult services is yet to get fully underway. Nevertheless, The Cass Review did remind doctors of their professional liability when choosing to prescribe a course of treatment. This GP’s letter points to the General Medical Council’s (GMC) Good Medical Practice and Section 14S of the National Health Service Act 2006 as providing sufficient reason for the adoption of a more cautious approach.
This news has to be welcomed as should anything that makes it harder for those seeking unnecessary and harmful medical interventions. Patients wanting these treatments and who are yet to learn that they definitely do not need them are being dealt a favour.
We have published the text of the letter below, and would urge all NHS General Practitioners to adopt this ground-breaking policy. Why not send a link to this page to your GP?
The letter refers to the 2019 Royal College of General Practitioners (RCGP) guidance, however, this has since been updated and the 2024 version can be found here: The role of the GP in transgender care
Letter from GP Practice
This is the text of a letter reportedly received by a person identifying as transgender from their GP practice.
The letter was originally posted in Reddit r/transgenderUK and subsequently posted on X by @ripx4nutmeg
Re: Discontinuation of Prescribing Hormone Treatments for Transgender Patients
We are writing to inform you of an important and difficult decision that we, as a practice, have had to make regarding the prescribing and monitoring of hormone treatments for transgender patients. You are receiving this letter as it directly impacts you. After careful consideration, we have concluded that we are no longer able to continue prescribing hormone therapy for transgender patients, effective from 1st of March 2025.
We recognize the significant impact that this decision may have on members of the transgender community, and we want to express our deepest empathy and understanding. We are acutely aware of the challenges faced by those undergoing gender transition, and we acknowledge the vital role that hormone treatments play in supporting individuals’ journeys towards living as their authentic selves. This decision has not been made lightly and comes after much reflection and consideration.
As GPs, we strive to deliver the highest standards of care as outlined in the General Medical Council’s (GMC) Good Medical Practice. According to Paragraph 14 of this guidance, doctors are required to “recognize and work within the limits of their competence”. In the case of transgender medicine, we feel that the complexities of hormone therapy and the associated monitoring required are beyond the scope of our expertise and capacity as a general practice. The NHS GP contract, in line with Section 14S of the National Health Service Act 2006, also obligates us to refer patients to specialist services when their needs surpass the expertise available at the practice. The care required for transgender patients undergoing hormone therapy necessitates highly specialized knowledge, which we believe should be managed by healthcare providers with specific training in this area.
We have reviewed the Royal College of General Practitioners (RCGP) guidance, which emphasizes that GPs must work within their competencies and should seek support from specialists when necessary. In their 2019 Position Statement on Transgender Care, the RCGP acknowledged that the management of hormone treatments for transgender patients often requires “a high level of expertise not typically covered in GP training”. This aligns with our position that transgender hormone therapy, which involves complex dosing, monitoring, and laboratory testing, exceeds the resources and expertise available at our practice.
We also wish to highlight that the GMC Good Medical Practice (Paragraph 16) states that patient safety is paramount and that doctors should not provide care that goes beyond their competence. Continuing to prescribe hormone therapy without the robust monitoring systems required would not allow us to meet this standard of care. Moreover, Paragraph 44 of the GMC guidance stresses the importance of continuity and coordination of care, further reinforcing our obligation to ensure that our patients receive the appropriate care from specialized services that are equipped to manage the unique needs of the transgender population.
We believe that the current lack of adequate commissioning arrangements and resources for transgender healthcare presents a significant gap. Without the necessary infrastructure and specialist services, we are unable to safely engage in shared care agreements for the prescribing and monitoring of hormone treatments. We strongly advocate for the commissioning of dedicated transgender healthcare services to address this unmet need.
We will be communicating this difficult decision with your aligned transgender health service and will ensure they have adequate time to communicate with you the necessary next steps. Please be assured that there will be a six-month grace period until the 1st of March 2025, during which we will continue prescribing only for our patients currently on hormone therapy. However, effective from the date of this letter, we will no longer be taking on any new transgender patients for hormone therapy. This period is intended to allow you and your transgender health service the time to process this decision and consider appropriate next steps for your ongoing care.
We must emphasize that it is with a heavy heart that we have come to this decision. We truly appreciate the challenges faced by the transgender community, and we regret that the current commissioning landscape does not provide the necessary resources for general practice to deliver the level of specialist care required. If you would like to discuss this further, please do not hesitate to contact us. We have an open-door policy, and our Prescribing Lead is available to discuss any concerns or questions which are bound to arise from this difficult decision. If you wish to discuss further, please do not hesitate to contact us and we will make the necessary arrangements.
Thank you for your understanding during this challenging time. Our goal, as always, is to ensure that every patient receives safe, high-quality, and appropriate care, and we sincerely hope that specialist transgender healthcare will soon receive the support and commissioning necessary to meet the needs of this community.
