Summary

Doctors checked the records of all 68 trans and gender-minority patients at one Cornish family doctor practice to see how their care compared with guidelines. There was no family doctor guideline to check against, and UK gender clinics and international guidelines gave conflicting advice on doses and check-ups. Judged against a US specialist guideline, up to two-thirds had missed some recommended check-ups. Patients waited an average of 26 months for an NHS gender clinic and had high rates of recorded anxiety, depression and self-harm. Of 41 who had started hormones, eight chose to stop, and five of them had notes recording detransition or regret. The authors call for proper family doctor guidance and larger checks like this. With so few patients, one practice and no talking to patients, the figures are a starting point for questions, not national rates.

Key findings

• 在20,136名登记患者中，有68人（每10万人337人）是跨性别或性别少数：42人（62%）为跨性别男性，22人为跨性别女性，4人为非二元性别，年龄中位数为22岁。
• 记录中心理健康问题很常见：76%有焦虑或抑郁，54%有自伤，10%有人格障碍，15%有自闭症。19%有童年虐待、忽视或暴力的记录。
• 等待NHS性别诊所的患者平均已等待26个月。在被诊所接诊的48名患者中，15人（31%）只在私立机构就诊，所有16名自行转诊的人都去了私立诊所。
• 没有供家庭医生对照的指南，英国性别诊所给全科医生的指示在剂量、目标激素水平和检查方面相互不一致，也与国际指南不一致。
• 对照美国的专科激素指南，多达三分之二的患者没有完成所有推荐的检查，主要是因为这些分歧。
• 在开始使用激素的41名患者中，8人（20%）平均在约五年后选择停药。四名跨性别男性的记录描述了去过渡，一名跨性别女性在切除睾丸后记录有后悔。
• 所审查的指南均未就去过渡、后悔或如何照顾停止治疗的患者提供任何建议。

Abstract

Primary care must ensure high quality lifelong care is offered to trans and gender minority patients who are known to have poor health and adverse healthcare experiences. This quality improvement project aimed to interrogate and audit the data of trans and gender minority patients in one primary care population in England. A new data collection instrument was created examining pathways of care, assessments and interventions undertaken, monitoring, and complications. General practitioners identified a sample from the patient population and then performed an audit to examine against an established standard of care. No appropriate primary care audit standard was found. There was inconsistency between multiple UK gender identity clinics' (GIC) individual recommended schedules of care and between specialty guidelines. Using an international, secondary care, evidence- informed guideline, it appeared that up to two-thirds of patients did not receive all recommended monitoring standards, largely due to inconsistencies between GIC and international guidance. It is imperative that an evidence-based primary care guideline is devised alongside measurable standards. Given the findings of long waits, high rates of medical complexity, and some undesired treatment outcomes (including a fifth of patients stopping hormones of whom more than half cited regret or detransition experiences), this small but population-based quality improvement approach should be replicated and expanded upon at scale.

Conclusion

These findings complement secondary care-generated knowledge and suggest room for improvement. Gender minority/trans people will be better served by evidence-based primary care guidance, including monitoring and communication standards. Existing guidance is contradictory. Given the findings of long waits for GIC assessment, and some unwanted outcomes and complications (including detransition), this small but hypothesis-generating primary care-focused, population-based, quality improvement approach should be replicated and expanded upon at scale.