If you read articles about trans people in the popular press, it’s easy to get the impression that the slightest hint of being unsure about one’s gender results in being rushed into hormone treatment and scheduled for surgery. In fact, nothing could be further from the truth. The average waiting time for an appointment at the Sandyford Gender Identity Service in Glasgow is now four years and nine months. Faced with such delays, it’s not surprising that some people choose to access treatment through other routes. While self-medication always entails risk, it’s much safer with regular monitoring – but for some Scots, that just got a lot harder.
Edinburgh blood testing service closes its doors to trans people
Until recently, the Edinburgh Steroid Clinic had been offering trans people blood tests on one day a month but it has recently closed this service, leaving those who were depending on it unsure of what to do.
A spokesperson for the clinic told Bylines Scotland “The Edinburgh Steroid Clinic was established as a specialist NHS clinic to provide a service for people using image- and performance-enhancing drugs (IPEDs). While the service also provided blood tests for those using hormones for gender-related matters, it was not established for this purpose and due to continued and rising pressures, could not continue to offer this additional provision. Patients using hormones in this way should contact their GP.”
The clinic also suggested a number of other services, but none of these offer blood tests. Some are based in England and one has been going by a different name for several years, so it’s unclear when the clinic last reviewed its recommendations.
“If the GP says no, we’re shit outta luck”, wrote one worried individual.
GP services increasingly unwilling to support trans patients
There have always been GPs who have refused to prescribe hormones for trans patients, usually on the basis that they feel they lack expertise, although there is no evidence of identical prescriptions being denied when needed by cisgender patients. According to Wellbeing of Women, over 20% of post-menopausal cis women in the UK use HRT, which is the same medication needed by trans women. Reports suggest that that the number of refusals has, however, increased significantly in recent months, since the UK government banned the use of puberty blockers – a different type of medicine – for young people with gender dysphoria.
As in other situations where patients disagree with their doctors, they have a right to get a second opinion, but some trans Scots say that they can’t find any doctors in their regions who will help. There is also the option of going private, but of course, not everybody can afford to do that. Because of the impact of prejudice on their access to employment, trans people experience high rates of poverty.
Health boards urged to help self-medicators as waiting lists grow
The Gender Identity Health Protocol for Scotland recognises that some trans people self-medicate and encourages health boards to ensure that services are available for them, in line with harm reduction principles.
jane fae, Director of TransActual, told us “Waiting lists for any sort of trans-related treatment within the NHS are at historically ridiculous levels. Those already in the system have been waiting years – often 5 years – and have not yet had a first appointment. Those entering the system now may find themselves waiting 8 or even 10 years. And while we would always recommend that individuals go through expert medical channels, we fully understand why some are too desperate to wait and start to self-medicate.
“This is recognised within the NHS and by the General Medical Council (GMC), and GPs are asked to support individuals who choose this route by means of bridging prescriptions. Because in the long term, this approach is far less risky for the individual.
“However, we know that many (GPs) are now refusing to do this – and they are also refusing to carry out basic blood work on trans individuals on HRT. Either prescribed through a clinic, or through self-medication. This is a peculiar form of discriminatory practice and hints at a level of much greater incompetence on the part of some GPs. Most such blood tests are not trans-specific, but intended to ensure that there is no added strain placed on vital organs, such as liver or kidneys, by HRT. If a GP cannot carry out such a test, are they fit to practice?”
Self-medicators seeking to minimise risks
Trans men and non-binary people using testosterone without a prescription face the highest risk, because the hormone can lead to cardiac complications – this is why men in general face a higher risk of dying from heart attacks than women do. One simple measure they can take to reduce this risk, even without access to blood tests, is to monitor their blood pressure, which can be done with a low-cost home monitor or carried out by a professional, for free, at many pharmacies.
The trans people we spoke to said that they felt the government didn’t care about them, and questioned why, when medical support is available for people using illegal drugs, it is not available to them. Several pointed out that in seeking blood tests they are trying to do the responsible thing. They also questioned why they are still expected to wait years to get treatment through NHS Scotland when Public Health Scotland has committed to having as many of its patients as possible treated within 18 weeks.
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