A new special interest group says general practice should be the natural home for gender-diverse patients.
One collective of doctors want to make sure transgender and gender diverse patients can find a home in general practice, without needing necessarily to be referred on to tertiary care.
Melbourne-based GP Dr Michelle Dutton is the inaugural chair of the RACGP’s newest specific interest group, which will look at transgender and gender diverse healthcare.
Endorsed by the college just last week, membership already consists of leading voices in the field, including former Australian Professional Association for Trans Health president Dr Fiona Bisshop and Rainbow Care Clinic GP Dr Holly Inglis.
It formalises the work that Dr Dutton and colleagues were already undertaking in relation to trans healthcare as part of a Facebook community-of-practice group.
One of the core aims, Dr Dutton told The Medical Republic, is to equip GPs with the right skills to take care of trans and gender-diverse patients in the long term and help reduce the pressure on public clinics.
“Historically, a lot of the care has been referred completely through to tertiary gender clinic services,” she said.
“We haven’t been given training in trans healthcare within medical school … so a lot of GPs will quite understandably refer on very early.
“And essentially all of those tertiary services are in major capital cities, and almost all of them had a waitlist of at least a year.”
Pushing all care for patients to tertiary gender clinics isn’t the ideal approach on a number of levels.
Looking past the fact that most of the clinics are only accessible for people in metropolitan areas, not all transgender people necessarily want a high level of medical or surgical intervention.
While not in any way criticising the level of care provided at Australia’s public hospital gender clinics, Dr Dutton said that the controversy in the UK surrounding the NHS Tavistock gender clinic was a clear warning that a rigid, centralised model of care does not work for this population.
“Hormone therapy and the physical effects are very important to some people, but for others that isn’t what they end up wanting or needing,” Dr Dutton said.
“And I think having models that are flexible enough, allow space for people to weigh up their options and have those conversations and consider different ideas without being worried that they will be not taken seriously or have care denied if they’re unsure … is really important.”
The circumstances which led to the Tavistock’s closure, she said, were an example of what can happen when gender medicine is subspecialised, siloed and chronically underfunded.
“The Tavistock [model] was very much around getting assessments and approval … whereas our model in Australia is much more around providing the young person and their family with information about all of their options,” said Dr Dutton.
“We’re also really trying to scaffold good decision-making processes for the young person and making them aware of different options, rather than having it be the initial hurdle of diagnosis that the person has to clear before they can even discuss what their options are in terms of medical treatments.”
With the rise of anti-trans rhetoric in the UK and more than 500 anti-trans bills in consideration across the US, it’s a tense time to be working in gender affirming care.
Dr Dutton said she fears that she, her colleagues or her patients will become the target of people pushing an anti-trans agenda, but ultimately finds it a rewarding area of medicine.
“Trans people quite reasonably do experience a lot of fear that their rights and their access to health care could be taken away,” she said.
“A lot of the progress that we’ve achieved has only really come in the last 10 years.
“There have been some steps forward, but they do always feel very hard won and very fragile.”
