rcpsychThe Royal College of Psychiatrists (RCPsych) has published new guidelines for the assessment and treatment of adults with gender dysphoria as the number of people visiting gender identity clinics continues to rise.

A survey of 10,000 people undertaken in 2012 by the Equality and Human Rights Commission found that 1% of the population was gender variant to some extent and RCPsych estimate that up to 40% of people with gender dysphoria may not be receiving appropriate help.

Professor Kevan Wylie, chair of the Guideline Working Group, said: "These guidelines have been 10 years in the making, and we are delighted to have endorsement from so many different organisations.

"The document provides guidelines which we hope will optimise the clinical care pathways for those individuals whose phenotype is inconsistent with their gender identity. Some people with gender dysphoria avoid seeking professional medical assistance. We hope that by adopting our patient-centred recommendations, patients will be less likely to do this."

Increasing numbers self-medicating
The best practice guidelines – which are endorsed by 13 organisations – have been drawn up by a multidisciplinary working group that included representation from psychiatry, endocrinology, psychology, psychotherapy and speech and language therapy.

It is the first time that so many groups have come together to agree a common set of guidelines amid fears that an increasing numbers of people with gender dysphoria are self-medicating using hormones and hormone-blockers that are available via the internet.

The guidelines make a series of recommendations to ensure gender dysphoria patients get the best possible care, including:
• Gender treatment should have a multi-disciplinary base, and may include a number of medical and allied health professionals. Patients must be offered a choice of clinically appropriate treatments.
• People with gender dysphoria should have access to high-quality services without undue and unnecessarily long waits
• People with gender dysphoria have a right to counselling and psychotherapy as part of their overall package of care
• Treatment must be patient-centred and should recognise the individual’s preferences, needs and circumstances
• The transfer of care of patients from adolescent to adult services should be managed so that treatments that have been initiated for adolescents continue without interruption
• More research in the field should be encouraged, and funding should be set aside to offer specific grants.

More person-centred care
The report also sets out guidelines for hormone treatment, surgical interventions, speech and language therapy, and general medical care.

Terry Reed, of the Gender Identity Research and Education Society, said: “The result come at an opportune moment as they have been able to draw on the Standards of Care published in 2011 by the World Professional Association for Transgender Health, and also the advice of the World Health Organisation Secretariat to ‘abandon the psychopathological model… in favour of a model that reflects current scientific evidence and best practice’.

"Combined with the UK’s strong equality and human rights legislation, this enlightened approach will lead to more person-centred care and better outcomes."