Transgender man on 10 year waiting list denied treatment by his GP due to 'unacceptable risk'

Jacob Jones 30, came to terms with his transgender identity when he was just 12-years-old, but hid the truth from his family and friends due to fear of rejection and violence.

He finally gathered the courage to seek hormone treatment when he was 21 and living in London.

But nearly 10 years later, he has only been seen three times by a gender specialist, and is only a fraction closer to obtaining the hormone replacement therapy (HRT) prescribed to transgender patients to alleviate their gender dysphoria.

Jacob said: “The dysphoria is horrible. Looking at my body and knowing in your heart it’s not the body I should have is horrible.

“Even in the shower in the morning, even when I’m getting dressed, everything I do is affected.

“I haven’t got any mirrors in my flat at all, because I can’t bear to look at my body.”

NHS guidelines state that the maximum waiting time patients should have to face, from referral to treatment, is 18 weeks. However, transgender people are forced to wait for years on long waiting lists at specialist clinics. In England, the clinic with the shortest waiting time for a first appointment is the Tavistock and Portman GIC in London, with a minimum wait of two years and eleven months. The clinic with the longest waiting time is The Laurels, also in London, with a minimum of five years.

If a patient moves to another part of the country during this time and wants to attend a clinic closer to home, they must begin the whole lengthy waiting process all over again.

Following on from this initial meeting, transgender patients must attend several additional appointments, which can come as infrequently as once per year, before being approved for treatment.

Patients are allowed to seek bridging prescriptions from their GPs, which would enable them to receive hormone treatment while waiting to progress through the slow system, however it is up to the GP whether or not such a prescription is given.

Jacob, who lives on Alfred Street, asked his doctor at the Adelaide Street Family Practice to approve a bridging prescription for him following a meeting with the Leeds Gender Identity Service in August last year, after which he was placed on the waiting list for hormone therapy. But his request was rejected, citing ‘unacceptable risk’.

A letter from the partners at the practice read: “We are sorry that we are unable to provide this treatment for you as it is outside of our area of expertise.

“As GPs we must recognise and work within the limits of our competence. We are responsible for our prescribing and should not prescribe where we feel it is unsafe to do so or where there is unacceptable risk.”

Jacob, who has lived as male for nearly a decade and changed his birth name by deed poll in 2016,- said: “I have been diagnosed with gender dysphoria, which is the criteria for hormone therapy. I’m just very frustrated because I’ve been trying to fight for this for years, and every single time I get knocked back. I feel like I’m going round and round in circles.

“It’s affected my mental health so badly I’ve had to have counselling. That’s coming to an end soon, but the cause of my depression, which is the fight that I’m having to go through, is still going on.”

To alleviate his gender dysphoria, Jacob has used an elasticated binder to flatten his chest every day for eight years, which he said was ‘painful and uncomfortable’.

He wears thick, baggy clothes to hide his body and is unable to take them off even in hot weather.

He said: "I think people need to be more educated about the LGBT community and the struggles we face. Obviously trans healthcare is not up to scratch, but there's no excuse for it not being up to scratch. There are always people within the community who are willing to speak out and educate people."

A spokesman for NHS Blackpool Clinical Commissioning Group (CCG), said: “Prescribers are able to consider prescribing bridging treatment and where this happens it would normally be on the advice of a specialist.

“However, primary care clinicians may not feel confident to undertake prescribing of hormonal medication outside its normal licensed use. It is for an individual prescriber to make their own decision regarding this.”

When asked by The Gazette whether any GP practices on the Fylde coast would be willing to provide a prescription for hormone therapy to transgender patients, they said: "We cannot comment as this is for individual prescribers to determine for themselves."

WHAT IS HORMONE THERAPY?

Hormone therapy is the standard treatment provided to transgender people to alter their secondary sex characteristics, therefore relieving their gender dysphoria.

Estrogen and antiandrogens are provided to trans women, and androgens to trans men. Some non-binary people - people who identify as neither male nor female - may also seek hormone therapy.

Physical effects of feminizing hormone therapy include breast growth and increased fat in the hips, thighs and buttocks. The effects of masculinizing hormone therapy include facial hair growth, voice deepening, increased libido, and fat loss in the hips and buttocks.

Hormone therapy for transgender people has been shown in medical literature to be generally safe when supervised by a qualified doctor. Trans people undergoing HRT with the NHS receive regular blood tests to monitor their hormone levels. Taking too much of the prescribed hormone may result in health problems such as increased risk of cancer, blood clots and high cholesterol.

As well as hormone therapy, trans people may undergo sex reassignment surgery.

For trans women this may include breast augmentation and vaginoplasty. For trans men this may include top surgery (breast removal) and phalloplasty.

Trans people do not need to undergo any form of medical treatment in order to be legally recognized as their gender.