Gender incongruence in children, adolescents, and adults

More individuals are requesting medical assistance for gender uncertainty or dysphoria and provision of adult NHS gender identity services (GIS) is changing.¹ Despite minimal medical input to polarised debates, several issues are potentially concerning: reports of poor care; rapid rises in referrals of children and young people to GIS;² public conflation of biological sex with socially influenced gender roles; and extensive uncertainty in the evidence base to guide practice.³

Medical practice should happen within robust human rights frameworks where individual patients always have their concerns heard. Generalists, with expertise in whole-person care, handling uncertainty and complexity, have a key role when consulted by identity-questioning and transgender individuals for routine care, gender identity concerns, treatments recommended by private or NHS services, or for referral. Presentations with prior emotional trauma, co-existing mental or neurodevelopmental issues, or ‘bridging hormones’ requests may make primary care professionals uneasy. Without a considered approach to practice, high-quality evidence and guidance, a policy of active ‘affirmation’ and ‘treat or refer’ may lead to more people receiving medical interventions with uncertain outcomes.