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Best practice guidance for treating gender dysphoria


New guidelines for the assessment and treatment of adults with gender dysphoria have been published by the Royal College of Psychiatrists.

The best practice guidelines – endorsed by 13 organisations including the Royal College of Nursing – have been drawn up by a multidisciplinary working group and have taken around 10 years to develop.

According to the college, the number of people seeking treatment in Gender Identity Clinics is increasing rapidly.

But it also warned that fear of “ridicule, guilt or shame” and concerns about delays in getting treatment on the NHS had led to increasing numbers of people self-medicating with hormones and hormone-blockers bought on the internet.

It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help, the college warned.

The guidelines make a series of recommendations to ensure gender dysphoria patients get the best possible care.

These include that gender treatment should have a multi-disciplinary base, potentially including a number of medical and allied health professionals, and that patients must be offered a choice of clinically appropriate treatments.

People with gender dysphoria should have access to high-quality services without undue and unnecessarily long waits, and have a right to counselling and psychotherapy as part of their overall package of care, the guidance states.

In addition, it adds that treatment “must not be prescriptive” and patients should be given a substantial role in determining the treatments appropriate for them and at what stage during the pathway of transition.

The guidelines are note that the transfer of care of patients from adolescent to adulthood services should be managed so treatments that have been initiated for adolescents “continue without interruption”.

The report also sets out guidelines for hormone treatment, surgical interventions, speech and language therapy, and general clinical care.

Professor Kevan Wylie, chair of the Guideline Working Group, said: “These guidelines have been 10 years in the making, and we are delighted to have endorsement from so many different organisations.

“The document provides guidelines which we hope will optimise the clinical care pathways for those individuals whose phenotype is inconsistent with their gender identity. We hope our guidance will ensure best practice across all NHS organisations,” he said.

“Some people with gender dysphoria avoid seeking professional medical assistance. We hope that by adopting our patient-centred recommendations, patients will be less likely to do this,” Professor Wylie added.

The guideline working group included representatives from psychiatry, endocrinology, gynaecology, urology, general practice, nursing, psychology, psychotherapy and speech and language therapy, as well as patient groups.

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Readers' comments (2)

  • So glad it is a multidisciplinary approach., but I don't think surgery should be carried out too soon as many are still very young, seeking attention and have confusing hormonal changes-a few years down the line, with help and sympathy, they may change their minds, instead of their, still developing, bodies. They are being taught too much too soon. In America, children as young as 7 are having mutilation surgery! They may regret it when they grow up!

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  • I suggest due to some funding issues the treatment is being delayed, and at the moment there is a proforma that people "have to jump through" to confirm to treatment guidelines, that dioes not appear to be in the patient's best interest. I agree with the previous writers comments about age, but there are many in the uk. I suggest are reluctant to seek treatment because of the regime here.
    As A transgender person, I feel that surgery for "treatment" of this problem is in general delayed too long

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