Endocrine Abstracts

Background: A growing number of people in the United Kingdom are seeking medical treatment to align their sexual characteristics with their gender identity. With waiting lists for specialist clinics currently lasting over four years, endocrinologists are increasingly called upon to manage transgender care as part of their general duties. While surveys and qualitative studies from North America have investigated doctors’ ideas and experiences of transgender care, little is known about endocrinologists’ experiences in the UK.

Method: UK endocrinologists and general practitioners (n=16) with past or current experience of caring for transgender patients were recruited through societies representing both specialties, and through snowballing. The doctors’ experiences of transgender medicine were explored through in-depth semi-structured online interviews. Data was coded using NVivo for Mac and analysed according to Braun’s and Clarke’s guidelines for reflexive thematic analysis, wherein themes were iteratively refined as interviews progressed.

Results: Seven themes were identified: 1) the desire for more comprehensive training, 2) concerns with current prescribing practices, 3) problems emerging from lack of access to specialist clinics, 4) the etiology of transgender identity, 5) the special challenges of treating non-binary patients, 6) the place of patient choice in transgender care, 7) uncertainties surrounding each medical specialty’s role in the process. This report focuses on clinicians’ thoughts on their training needs, their conceptions of the current barriers to treatment—including the divide between primary and secondary care—and their ideas for improving transgender care.

Conclusion: Transgender care is likely to remain a part of a general endocrinologists’ duties. Further training is necessary to support clinicians to develop their competence and increase their confidence in this area.