Endocrine Abstracts

Introduction: Transgender medicine is a rapidly expanding field and GPs have historically played a vital role in prescribing hormones therapies for those with gender incongruence. Despite this, some GPs are refusing to prescribe medication recommended by the Gender Identity Clinic (GIC) in London. This problem is persisting despite the GMC guidance that prescribing is the GPs responsibility. The aim of this audit was to establish reasons why GPs are refusing and if there were factors that made refusal more likely.

Method: 53 patients whose GPs had refused them prescriptions were identified and information about comorbidities, drug recommendation and reasons for refusal were collected. These were then compared against 53 controls matched for age and gender.

Results: Refusal to prescribe hormones is uncommon (<0.001%). The most common reasons cited by GPs were lack of knowledge or experience (35.5%), they felt it was a specialized area of medicine (26.6%) and that it was flagged as an amber drug by their local CCG (12.7%). Estrogen was significantly less likely to be refused than other drugs (20.6% vs 34.2%, P=0.007). People on the autistic spectrum were significantly more likely to be refused prescriptions (11% vs 0% P=0.012). On average the time from recommendation by the GIC to GP refusal to reply by the GIC was 86 days. With further correspondence, 87% of patients had been prescribed hormones in primary care.

Discussion: These results show that most GPs will prescribe hormones, often through simple reassurance by the endocrine team and quoting the GMC guidance. This demonstrates that endocrine input is required to support primary care. Delays are exacerbated by community pharmacy advice from CCGs who often unnecessarily classify transgender medications as amber drugs. Moving forward, the NHS must work towards clearer endocrine advice in primary care to ensure timely and effective treatment for transgender patients.