“The best way for doctors to prescribe is through a shared-care approach with a gender specialist”

which states that seeking patients’ consent before disclosure of information “shows respect, and is part of good communication between doctors and patients”.

Prescribing The GMC has helpful prescribing guidance in their trans healthcare hub. The key messages set out are:

• You can prescribe unlicensed medicines following the steps set out in GMC guidance

• You must take care to discuss the risks and benefits of treatment with your patient

• You will need to collaborate with experienced colleagues to provide care that best serves your patient’s needs.

In our scenario, James is not currently under the care of a gender identity clinic (GIC) and is

asking Dr B to prescribe unlicensed medicines. The GMC advocates a harm-reduction approach in keeping with the RCPsych’s guidance which states that clinicians “may prescribe ‘bridging’ endocrine treatments as part of a holding and harm reduction strategy while the patient awaits specialised endocrinology or other gender identity treatment and/or confirmation of hormone prescription elsewhere or from patient records”. It adds that a bridging prescription may be

appropriate, provided blood tests and health checks are undertaken to screen for contraindications. A bridging prescription may be issued until

the patient can be seen in a GIC to prevent self harm, either due to mental illness or from purchasing unregulated drugs. Doctors should only consider a bridging

prescription in the following circumstances: • the patient is already self-prescribing or

seems highly likely to self-administer from an unregulated source

• the bridging prescription is intended to mitigate a risk of self-harm or suicide, and

• the doctor has sought the advice of an experienced gender specialist and prescribes the lowest acceptable dose in the circumstances.

The best way for doctors to prescribe is

through a shared-care approach with a gender specialist, however GIC waiting lists can be long. For James, it would be appropriate for Dr B to assess his mental state and offer to discuss his case with a gender specialist with a view to prescribing at a future visit. It would also be advised to discuss prescribing, and any other areas you are unsure about, with your GP trainer.

Resources: • General Medical Council trans healthcare hub:

• Royal College of Psychiatrists guidance:

Dr Susan Gibson-Smith is a medical adviser at MDDUS and editor of GPST

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