TL;DR: New data from Trans Actual seen exclusively by QueerAF and What The Trans shows that hundreds of trans people are being refused hormone care, sometimes because of GP’s personal beliefs alone. These decisions, which include people who have been on HRT for over five years, could essentially force people to de-transition.
Over 200 transgender patients have been refused hormone replacement therapy (HRT) by GPs in England in the last year, QueerAF can reveal.
Some 215 people across the UK have reported their GP has refused to provide HRT, according to a new summary report by Trans Actual which we've seen as part of a broader investigation by QueerAF and What The Trans into GPs refusing to provide HRT to trans patients. The data set, which is primarily focused on England, includes a handful of refusals that have taken place in Scotland and Wales, too. The organisation tells us this data is likely only the tip of the iceberg.
Why are GPs refusing to prescribe hormone replacement therapy (HRT)?
Three in four of the trans people were already on HRT when it was refused to them - and over half of that number have been on HRT for more than five years. More than one in ten (14%) were refused HRT despite the potential long-term damage and health implications withdrawing from the treatment could cause.
While the reasons varied, the most common was that GPs "didn't feel competent to prescribe it". However, alarmingly, a number denied the prescription on the grounds of "personal beliefs", while others - encouraged by a statement from the Royal College of Practitioners from April said they "didn't have to".
One GP told their patient "they did not 'recognise' the NHS gender identity service," while several said there was no policy that says "they have to."
"Some GPs admitted it was due to their personal beliefs," Keyne Walker, Trans Actual strategy director, tells QueerAF.
"Transphobic GPs, especially in England, are feeling empowered to unilaterally deprive their patients of critical medicines for reasons of their own bigotry, and every part of the NHS must take some responsibility for letting this happen."
Transgender patient Charlotte told QueerAF their HRT was withdrawn after their GP from the Surrey Heartland Integrated Care Board which manages the practice, told her that in the wake of the Cass Review, "all transgender shared care was to be pulled, especially for those below 18".
"I was stressed as hell, and it led to a downward spiral for five months that I'm only just coming out of," she tells QueerAF.
Surrey Heartland Integrated Care Board denied advising its practices against using shared care. It said it shared updated guidance for young trans patients following updates to NHS England guidance but that this was not "in relation to stopping treatment or shared care arrangements for adults."
What does NHS England say GPs should do with HRT?
Under current care pathways, after transgender people are discharged from an NHS gender clinic, GPs are expected to offer a continuation of care. Meanwhile, the current NHS England Guidance outlines that GPs should cooperate with Gender Identity Clinics in the initiation and ongoing prescribing of hormone therapy.
But one-third of those who Trans Actual gathered information from were refused HRT by their GP were done so after being discharged from a gender clinic, using either a personal belief reason or under the pretence they didn’t have the expertise.
One letter, which was shared widely on social media, used guidance from both the General Medical Council's Good Medical Practice guidance and the Royal College of Practitioners 2019 position statement on transgender care as reasons to discontinue HRT care. This position has become a particular sticking point, as it references a “high level of expertise” needed in HRT prescribing, which was afforded to GPs in their training.
A spokesperson for the Royal College of GPs, however, said following increasing reports of GPs' refusals to provide HRT and the use of their guidance in the widely shared letter we provided to them, they have now added two clarifications and some minor edits to their guidance. However, the impact of this has been ineffective, remaining essentially the same as the 2019 position statement that the letter shared on social media cited.
The General Medical Council declined to comment on the use of its guidance in this way by a GP. It cited its transgender equality hub, which says GPs "have a responsibility to make your practice inclusive and provide high-quality care to all patients." Both organisations cited their ongoing call for significant expansion in resources and dedicated services for transgender people.
The initial statement by the RCGP was also the source cited in multiple reports of GPs refusing to prescribe HRT before the Cass Review’s release, notably with trans activist Charlie Craggs, as some GPs indicated funding reasons were why they wouldn’t prescribe HRT.
However, this is a long-running issue, particularly when it comes to bridging prescriptions, showing that Cass’s report has only exacerbated this issue rather than simply being indicative of it.
Analysis: Trans people are putting off getting any healthcare for fear of losing their HRT
The mental health implications of gender dysphoria, stress and gender-related health concerns for patients like Charlotte have repeated over and over again in every region of the UK. This was something people on extraordinary waiting lists to get care had to face, with the only promise being that once they'd done their time they'd get the help they deserved.
But since the Cass Review, this has now become a reality for hundreds of those who have even already been through that painstaking process and the extensive waiting lists to get the care they need.
This issue is multifaceted because, as the summary report by Trans Actual that we've seen sets out, in addition to mental health concerns for gender-related reasons, it creates a variety of other health issues too:
"Trust and interaction with GPs and the wider NHS is at an all-time low, with many people delaying and putting off vital checkups entirely; this will only exacerbate that." jane fae, whose book, Transitions: The Unheard Stories was recently published, tells QueerAF.
"Closely linked is the devastating impact on mental health. I can personally attest to this: I have been putting off key checkups for months; and earlier this year I ended up with a referral to mental health services as a direct result of anxiety and panic attacks about my continuing HRT."
What's striking about all of this is how misinformation and personal beliefs are being used to override national bodies, who have set out clear guidance in this space - including by NHS England. And the reality for many people who are being refused HRT, is that they will be forced to detransition.
The detrimental impact of the media storm, political cashing-in and moral panic about transgender people is hitting the fragility of transgender lives in a profound way. Since the pivotal Cass Review, this has shifted quickly from trans youth to all transgender people right across the UK.
In the meantime, trans activists are organising and sharing best practices on how you can respond and write to your GP if they tell you they’ll no longer prescribe you HRT using language doctors will understand.
We gather information, so you can use it as a tool for liberation
To put this story together, we have had our ears to the ground, gathering, looking for and collecting personal stories and accounts for months.
We then had to go to all the professional and local care bodies involved. We worked closely with transgender podcast What The Trans to share information and leads.
Now, with the addition of Trans Actual's incredible data set and summary report, we're brought this to you in a concise story, including ways to fight back against this if it happens to you.
Journalism like this demands tremendous resources, not least in time and effort, especially from those gathering the information. We take this work on at significant cost.
One of our sources said this work has kept them up at night thinking about all the fellow transgender people who will be devastated by the report.
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