Hormones for 12-year-olds. Puberty blockers without the wait. Trans healthcare available in every town.
It’s not some swivel-eyed fanatic with a dangerous fringe agenda advocating this. It’s a modest family doctor (General Practitioner or GP) from Wales, UK – Dr Helen Webberley.
And as the British National Health Service (NHS) evolves its gender identity services, her views could well prevail.
The current NHS system puts strict rules around which trans people can get treatment, creates compulsory waiting times and forces them to ‘prove’ their identity. It’s costly and bureaucratic and the delays and frustration push some to despair, depression and even suicide.
Dr Webberley argues passionately for trans healthcare to be firmly rooted at your local doctor’s surgery instead.
The GP from Blaina in Wales describes herself as the ‘kind of doctor who dislikes unfairness’.
She had her first encounter with transgender people in day-to-day healthcare while working with a trans group in Worcester in central England.
A patient came to her showing obvious signs of being trans, although initially they were unwilling to admit this.
She told them about their treatment options. But it quickly became clear the only place she could send her patient as a family doctor in Wales was to London, a three hour drive away. For this particular patient, that simply wasn’t practical.
So Dr Webberley prescribed hormone replacement therapy (HRT) herself – giving the patient the hormones for their true gender.
Doctors in fear
Few GPs take this step themselves, most send trans patients to a specialist.
Why? Dr Webberley is unsure.
She told GSN: ‘It is a mix of lack of knowledge and fear of the current gender establishment. There is no reason for any GP not to.
‘However, transgender treatment is not covered in standard training for endocrinology or in psychiatry – although anyone who wants to learn about it can do so.’
It’s so rare that Webberley’s fame spread in the trans community.
She explains: ‘Over the last two years, I have dealt with 3,000 enquiries for advice and information.
‘Around 550 individuals have commenced treatment, although not all received hormones. Rather, I seek to match the treatment I provide to what patients need.
‘In some cases that will be counseling – or even just being listened to. In some that means hormones. And in a proportion, that will mean referring onward for potentially more radical surgical intervention.
‘This approach is far more cost-effective than the alternatives, as well as far more humane.
‘There are individuals who are looking for little more than some access to hormones, and it is not only cruel but ridiculously expensive to push them through the current system.’
She also tries to train other GPs. She wants to raise knowledge and dispel prejudice.
She is involved in a Welsh NHS Group tasked with designing a Welsh gender identity service, and this month will meet with NHS England about how to design their services.
She tells us: ‘I hope the outcome will be far more GP-centered. In the end the GP approach, with its focus on individual needs, is far better suited to many trans patients than the current carefully guarded conveyor belt.’
This is fighting talk, and Dr Webberley tells how the trans medical establishment has been resisting. She has no love for the current regime, which she describes as ‘brutal’.
She has had one patient refused treatment for wearing the wrong clothes.
She tells of another discharged from hospital for being on hormones, prescribed initially by her. And this was London’s Charing Cross, one of the main hospitals providing specialist trans services in the UK.
Not only did they refuse to treat this patient, she claims, but they went out of their way to contact the patient’s local GP and demand they stop hormones.
Dr Webberley raised this with the General Medical Council, the UK medical watchdog. But they turned this back into a complaint about her – now dropped.
She is, she believes, an ‘embarrassment’ to the medical establishment, and many of them would like to see her shut down, not least for her views on the treatment of trans teenagers.
She says there is no evidence to support fixed age limits for access to hormones. Nor is there evidence that teens benefit by long wait times, having to prove ‘real-life experience’ of being in their gender role, before they can take puberty blockers.
She says: ‘Not every teenager wants or is suitable candidate for hormones. But if an individual presents in my surgery at age 12 or 13 and they are competent to take such a decision, then I should not be refusing to treat them because of arbitrary age limits.
‘The question I have to ask of those who would enforce such limits is: “where is the evidence that these do more good than harm, in terms of increased risk of depression and suicide?”
‘There is also the question of whether these limits are not themselves unlawful, in the light of legal precedent around prescribing contraception.’
This precedent is the ‘Gillick ruling’. In 1985, a court ruled a child under 16 could consent to getting contraception from a doctor. Medical law now says there is no cut-off age at which a teen can consent to treatment. As a child becomes more mature, they get more control, rather than parents always deciding.
Critics and threats
Some trans people too have criticized Webberley for diagnosing without meeting patients face to face (she will often conduct interviews over the internet) and for profiting from her prescribing.
She responds: ‘The internet model is one being looked at more widely across the NHS. It especially makes sense in areas such as [largely rural] Wales, where individuals are often unable to travel long distances to access specialist services.’
As for taking payment: ‘This is inevitable when GPs refuse to treat their own patients. In many cases, local GPs have been prepared to take over prescriptions. Longer term I would like all patients to have access to NHS-funded treatment through their own GP. Until that time, this is a gap that needs filling.
‘The alternative is that many of my patients will go out onto the web and source uncertain supply of hormones from unknown suppliers.’
Is it likely that she will be shut down? Given the scale of her own caseload in this area, she believes she may now have passed the point where this would be practical.
Specialist transgender services are already under threat in the UK with Charing Cross Hospital poised to lose its NHS funding to do trans work.
Dr Webberley says: ‘With the future of Charing Cross uncertain, it would be absolute folly to stop me from working.’
Demand trans health
Still, she believes that if trans people want treatment, they need to be far more militant.
‘Far too many GPs are refusing to take on care of trans patients, even when asked to do so by gender identity clinics. A variety of excuses are put forward, and often these are no more than cover for anti-trans prejudice.
‘This is not like abortion, where GPs may cite an ethical opt-out. The General Medical Council is very clear that GPs have a role in treating trans patients and cannot refuse treatment.
‘They have stated that GPs should provide hormones when prescribed, should carry out tests, and so on. Again, a part of the problem is lack of knowledge, together with some bias, some prejudice.
‘I understand the pressures to go along with this. But over time, if trans people are prepared to complain about how they are treated, then it will make a difference.’
Meanwhile Webberley is challenging the way things are done.
If she gets her way, future trans patients will face far fewer barriers to get the life-saving and life-enhancing treatment they need.