RCGP sets out role of GPs in transgender care

Posed by models. Credit: sturti

By Olivia Bowthorpe

The Royal College of General Practitioners has released a position statement on transgender care, outlining the role of GPs and the limits of their responsibilities.

While some GPs may choose to develop additional expertise in this area, the college states that the majority of GPs should not be expected to prescribe puberty blockers or "bridging prescriptions" for patients on waiting lists.¹

"General practice plays a vital role in ensuring these patients receive the care they need," it states. "GPs are expected to approach the holistic care of transgender people, those experiencing gender incongruence and/or questioning their gender identity as they do with every patient - openly, respectfully, sensitively and without bias."

GPs should take into account a person’s presentation of gender incongruence "alongside an individual’s physical, psychological and social health status within the broader environment, and appropriate primary care related to gender incongruence," it adds.

For some patients this may include prescribing non-oestrogen hormonal contraception to prevent distressing periods, it states, and to work with specialist gender identity services in the same way as with any other specialist service.

"However, as expert generalists, GPs are not trained to have the specialist skills required to assess and provide care to address specific needs related to gender incongruence," it says, for example, "GPs should not be required to carry out blood tests on behalf of specialist services".

Once adult patients are under the care of a specialist gender identity clinic (GIC), GPs may feel able to maintain prescriptions "under a collaborative or shared care arrangement".

But the college "does not consider that the GP role in relation to children and young people would include prescribing gender affirming hormones to address gender incongruence in a patient aged under 18".

Instead, it advises following national guidance and drawing on the recommendations highlighted in the Cass Review, to refer in the first instance to a secondary centre service and Children and Adolescent Mental Health Services (CAMHS) if necessary.

The position statement also highlights additional challenges in supporting those whose transition goals have changed after receiving treatment. No guidelines currently cover this group, who "often have unmet physical and mental healthcare needs and may not want to engage with the services that supported them to transition".

Furthermore, IT systems should be updated to record sex assigned at birth and gender, while ensuring confidentiality, to ensure patients are offered appropriate screening according to the organs that they have.

Finally, the statement calls for significant expansion in resources and dedicated services to improve long waiting list times, as well as greater education, guidance and training for GPs.

Reference:

1. Royal College of General Practitioners The role of GPs in transgender care. RCGP position statement. March 2025

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