title: Gender identity and the management of the transgender patient: a guide for non-specialists.
abstract: In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality and functional impairment. We show that gender reassignment can be a safe and effective treatment for gender dysphoria with counselling, exogenous hormones and surgery being the mainstay of treatment. The role of the general practitioner in the management of transgender patients is discussed and we consider whether hormone therapy should be initiated in primary care in the absence of specialist advice, as is suggested by recent General Medical Council guidance.
authors.affiliation: 1 Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: Albert
authors.initials: A
authors.lastname: Joseph
authors.affiliation: 1 Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cliffe
authors.affiliation: 2 North West Thames Foundation School, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hillyard
authors.affiliation: 1 Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D005260:Female; D000068116:Gender Dysphoria; D005783:Gender Identity; D058005:General Practitioners; D006801:Humans; D008297:Male; D011287:Prejudice; D057829:Gender-Affirming Procedures / Q000379:methods; D013222:State Medicine; D063106:Transgender Persons / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data; D014189:Transsexualism / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D006113:United Kingdom
keywords: Transgender; gender dysphoria; gender identity; gender reassignment; general practitioner; primary care; transition