29-03-2025
Family doctors should not be made to prescribe cross-sex hormones to children, say GPs
Family doctors should not be made to prescribe cross-sex hormones to under-18s, the Royal College of GPs has said.
In a 'position statement' update, the Royal College of GPs set out the limitations of the role family doctors should play in transgender healthcare, particularly when it comes to children questioning their gender.
The update, which was agreed by the RCGP council earlier this month, states that the profession should not be prescribing gender-affirming hormones to anyone under 18 years old.
It comes amid various legal challenges attempting to ban the use of cross-sex drugs in children.
While there is a UK-wide ban on the use of puberty blockers – except for an NHS-run clinical trial – it is still possible for children to get cross-sex hormones, such as testosterone and estrogen, which are also known as 'gender-affirming hormones'.
'Unacceptable' risk to the health of thousands
One legal challenge against their continued availability to under-18s is being led by Kiera Bell, a de-transitioner who regretted trans surgery.
The legal case argues that the drugs issued to 16 to 18-year-olds pose an 'irreversible' and 'unacceptable' risk to the health of thousands of vulnerable children suffering from gender dysphoria.
Cross-sex hormones change the physical sexual characteristics of a person, while puberty blockers delay the onset of puberty by suppressing the release of hormones.
The NHS has warned providers to be 'extremely cautious' when considering whether to issue cross-sex hormones to children, because of their harmful side effects, but under current guidance, Children and Young People Gender Services are able to give them to 16 and 17 year-olds.
Often patients who have been seen by a specialist and receive a prescription will continue to receive their treatment via their GP under 'shared care agreements'.
'Following national guidance'
But not all GPs feel equipped to be prescribing the drugs and taking on the responsibility for the patient's care, particularly in children with gender issues, when there are so many unknowns and potential for other health complications and conditions to arise.
The profession has also found itself in the crosshairs of a controversial part of medicine that, as generalists, they are not trained for, with long waiting lists for specialist services meaning they can be the only point of care for many years.
The RCGP's position update said it advised 'following national guidance and drawing on the recommendations highlighted in the Cass Review'.
This means providing 'holistic care, contextualising a person's presentation of gender incongruence alongside an individual's physical, psychological and social health status within the broader environment', its statement said.
But it adds that 'as expert generalists, GPs are not trained to have the specialist skills required to assess and provide care to address specific needs related to gender incongruence'.
'Many GPs will not feel confident'
The RCGP said that while some GPs might have more experience in transgender healthcare and 'feel competent to initiate prescriptions for adults who are on the waiting list for specialist assessment and treatment, many GPs will not feel confident or competent to assess whether or not a prescription is appropriate'.
Furthermore, the Royal College 'considers the role of the GP in relation to children and young people to include promptly referring, where appropriate, to the appropriate secondary care paediatric or mental health services'.
'The RCGP does not consider that the GP role in relation to children and young people would include prescribing gender affirming hormones to address gender incongruence in a patient aged under 18,' it said.
It comes as a controversial GP clinic in Brighton is facing legal action over its decision to prescribe cross-sex drugs to teenagers.
'Social transition'
The Telegraph has previously revealed that lawyers have asked the High Court to prevent Brighton's WellBN clinic from issuing gender-affirming hormones to a troubled 16-year-old and other children.
He approached WellBN without his parents' knowledge after his school began facilitating a 'social transition' to help him align with his chosen female gender.
The clinic said it would 'fully engage on next steps' but was 'confident that any young patients under the age of 18 are assessed in accordance with good medical practice'.
In another legal case, the Telegraph revealed a mother had won an appeal to stop her 16-year-old child receiving the hormone drugs from a private clinic.
The Court of Appeal has overruled a decision in December, which will mean Child Q will not be able to access the drugs until turning 18 or when the court decides otherwise.
