Time for measured debate on role of GPs in helping children with gender dysphoria - Dr Angus McKellar and Dr Anthony Latham

As General Practitioner physicians (GPs) we have serious concerns about the recent exponential rise in children, predominantly girls, who present with gender dysphoria to their doctor. Increasingly a form of ‘rapid-onset’ dysphoria is being encountered. The Tavistock ‘Gender Identity Development Service’ in London, had a 20-fold increase in referrals between 2011 and 2019 and now has a waiting list of over 5000 children. The Sandyford clinic in Scotland has a waiting list of over 900 under-18s, a rise of 749 since 2017.

GPs have concerns about the recent exponential rise in children, predominantly girls, who present with gender dysphoria to their doctor.

We are privileged to be able to listen to our patients, understand their concerns and achieve a shared understanding of their problems. It is wonderful to accompany our patients and their families on their journeys, often through many years. We always seek to act in their best interests and to cause them no harm. We acknowledge the great distress that children who have gender dysphoria experience.

We have studied the literature on gender dysphoria in children, and have followed the case of Keira Bell, who recently brought a legal case against the Tavistock clinic which she attended as a child. She, and increasingly many others, have now de-transitioned, affirming their biological sex but having already undergone life-changing, irreversible changes to their bodies from sex hormones and surgery.

It is well established that at least 80 per cent of children who present with gender dysphoria will become comfortable in due course with their biological sex if a watchful waiting policy is pursued. Research shows that most have significant mental health and social issues which need addressing as the main priority. Yet most children with gender dysphoria are still prescribed puberty blockers. Over 95 per cent of these children then go on to have sex hormone treatment and surgery – both of which cause irreversible changes to their bodies. Children as young as 10 have been put through this system.

The questions for us as GPs are: What is our duty of care if the biomedical treatment of children with gender dysphoria is believed to harm the children both physically and/or psychologically? Have such children the ability to make such life changing choices for what is still experimental treatment? What if a GP believes that biological sex is immutable? Are we obliged to prescribe puberty blockers? Are GPs at risk from the litigation that will surely occur?

We have written to our health board and to the Scottish government with some simple questions: Firstly, would we be considered transphobic if we chose not to refer children to a gender clinic (on the assumption that this may harm them, signposting them instead to an alternative referral route, if desired). Secondly, would a professional opinion that sex is immutable be considered transphobic?

Our health board would not give a clear opinion and asked us to clarify this with NHS Scotland. NHS Scotland, after a delay of six months, replied stating that we should seek clarification from our health board.

We are writing this because GPs are under pressure to comply with the current trend to affirm, refer and then treat. If we disagree with this approach, what are the implications?

It is time to have a measured debate on the role of GPs in helping children with gender dysphoria.

Dr Angus McKellar (GP in Harris) and Dr Antony Latham (GP in Harris and Chair of the Scottish Council on Human Bioethics)