British doctors are failing to help transgender people

James Barrett, the head of the British Association of Gender Identity Specialists,has penned a scathing missive in the British Medical Journal criticizing doctors for failing to help people with gender dysphoria. Gender dysphoriais defined as a condition wherethere is a conflict between a person's physical gender and the gender he or she identifies.

Barrettwho is also a consultant psychiatrist at one of 11 gender identity clinics in the U.K., says access to hormone treatment for trans people is often delayed or prevented.

"Itseems odd,"he says, "that such effective treatment was ever considered a low priority, or that access to it should have been delayed."

"Currently, however, in the experience of those of us who work at gender identity clinics, as many as one infive GPs won't prescribe for people with gender dysphoria", he says, even after expert advice from a clinic.

Reasons include concerns that hormone prescriptions are "dangerous,""difficult" and "expensive."Barrettwriteshe's heard disturbingly frank admissions from doctors.

"Some of them,truthfully have got, kind of ethical or religious or moral objectionsor find it icky, or are a bit transphobic," he told CBC News. "Or a recent one:We are not trained to change nature."

They are backward comments that saddenand disappointhim. "Precisely the same remarksthat could have been said 10 years agoabout gay people, or 60 years ago, about black people.The arguments are about as invalid as those were."

'People aren't freaks'

"People with gender dysphoria aren't freaks", says Barrett. "They are teachers and accountants, police officers and doctors, parents and taxpayers."He says trans patients deserve respect and decent healthcare as anyone else.

Greta Bauer says its a similar situationin Canada, wherethere's a reluctance amongstfamily doctors to treat their trans patients. Baueris an associate professor in the department of epidemiologyand biostatistics at Western University in London, Ont. She recently led a studythat looked at transgender patients in Ontarioand their access and comfort level with family doctors.

I remember being at the emergency room at one point and being questioned about why I was there, and if I was there because I wastransI was actually asked to leave.- Luke Fox

"There are alot of resources and alot of training available for doctors"in prescribing hormones to transpatients,she says. "But it's something that's unfamiliar and untilthe family doctors start doing it you can see why they might be a little bit nervous to start."

In the Western University study, researchers found that half of transgenderOntariansdidn't feel comfortable discussing transgender-relatedhealth issueswith their family doctor. Reasons included:

• Whether the patient perceived their doctor was knowledgeable about transgender-related issues.
• Negative experiences with family physicians.

"They talked about justa range of negative experiences that they'd had that were really traumatizing,"Bauersaid in an interview. "They talked about being outright denied care, and sent away. They talked about being bumped from doctor to doctor to doctor and the feeling that nobodyreally wanted to treat them."

Luke Fox knows a bit about that. He's a 30 year old trans person.He says he experienced discrimination duringone of his visits to a Toronto hospital.

'I was asked to leave'

"I remember being at the emergency room at one point and being questioned about why I was there, and if I was there because I was trans, even though the reason I was there had nothing to do with being trans," he said inan interview with CBC News. "I was actually asked to leave."

There are more stories. "I've been called in for ultrasounds, X-rays, and I've had the wrong name called out, or the wrong gender marker has been attached to my name," he says. Fox says he's not comfortable talking about how many surgeries he's had, preferring to talk about the challenges accessing gender confirming surgeries.

"Our medical system isn't set up to service transfolks,"he says.

As of March 1,the Ontario government hasbroadenedaccess to referrals for medically necessary gender confirming surgery. In a news release, it saysOHIP"has changed the funding criteria for sex reassignment surgery by allowing qualified providers throughout the province to assess patients for the surgery."

Luke Fox is hopeful."It's great that people are having the conversation. But I think it's just taking it to the next level and saying, OK, now we know this is something that's within our society and these are people who definitelyneed care, so what can we do to make that care more accessible, and more available."

March 31 is Trans Day of Visibility.