Prescribing practice…

Can’t/won’t say much more right now. However, i am in conversation with one Health Authority about current prescribing practice and there is likely also to be a story or a development of great interest to the trans community in the not too distant.

At issue, for those not already aware of this rather untoward development, is the apparently growing habit of some HA’s to place hormones on to their red list for prescribing purposes.

That sets up a somewhat screwed situation for the average trans candidate, in the sense that drugs on the red list may not be prescribed by a GP (as opposed to drugs on the amber category, which may be, subject to certain caveats): but in many cases, Gender Identity Clinics, who are expected to do the prescribing instead, either haven’t – or claim they haven’t – the budget to do the prescribing.

Result: no drugs. Further result: self-medication and/or high risk of suicide for some individuals.

Brilliant!

What is not clear, from the various HA’s that have so far gone down this route, is whether they understand the implications of this move – in which case they are a bunch of transphobic bigots who deserve to suffer enormously when this practice eventually – as it will – is brought before a court.

(For it is both discriminatory (has anyone been sent back to Papworth of late to get a prescription for their heart drugs?) and almost certainly breaking precedents that established, some years back, that those with gender dysphoria should be treated).

Or whether they just haven’t realised the implications, in which case with a little patience and explaining, the situation MAY shift to a place that is slightly more reasonable.

Yes. I am going for this as story for publication (and i have already got my pitch in place: we’ll see whether a particular magazine decides to bite). I am, however, also talking regularly to campaign groups worried about this practice.

Not going to publish, for now, any content of conversations i am having: but this is interesting in that it is an evolving dialogue – and i am inclined to think that in at least one HA, this is an outcome that has arisen more by accident than (malicious) design. I am waiting now to see what they come back with.

Would be more than a little bit grateful if folks could drop me a line – not in public – to let me know of HA’s that they know have adopted this practice and, if they are prepared to go so far, the outcome of any dialogue currently being held with those bodies.

The key point, i think, is that we have reached a tipping point on this issue (that seems to be a favourite phrase of late!) with sufficient HA’s trying it that resolution, either in the form of compromise or court action, seems extremely likely.

jane xx

17 Responses so far »

  1. 1

    Rebecca Ashling said,

    This is very worrisome. I get quite ill without hormones. It’s not like my adrenal glands are up to taking up the slack.

  2. 2

    Angela Kay said,

    Jane, this happened to me yesterday. The Clinical Director of The Laurels in Exeter wrote to my GP, requesting that I be prescribed oestradiol. GP sought advice and was told ‘from high up’ (presumably the HA) that he couldn’t prescribe as the drug was not being used for its intended purpose.

    I immediately phoned the clinic and was told that this was a growing problem in Cornwall. Consequently, they will issue the prescriptions (from 100 miles away) and my GP is excluded from the process.

    So it’s all worked out ok for me, but it does seem crazy as the clinically recognised treatment for male-to-female gender dysphoria is oestrogen.

    Angie x

  3. 3

    This does not surprise me one bit. Children have faced this obstacle in Britain and have been forced overseas to the US to even get blockers.

    This goes hand in hand with the ongoing attempt by those in the Psychiatric world in Britain to control the “Transsexual Issue” and it has leaked over to now be the “Transgender Issue”. They believe transsexuals can be cured by therapy. Phillipa Perry the wife of your famous transvestite Potter Grayson Perry is a Psychotherapist at Tavistock and a firm follower of Zucker and idiots like that. They believe in reparitive therapy aka as aversion therapy. I know a little about that crap since I was under aversion therapy for 6 weeks as a 17 year old. Not recommended.

    Tavistock and its pathetic subsidiary The Portman Clinic have a stranglehold on the treatment of transsexuals in Britain and I assume that means the Transgender also.

    Good luck fighting these idiots because as a famed Psychiatrist once said, “if you think Physicians have a god complex I suggest you look at Psychiatrists because we all believe we are god”, in a famous case in NYC where a pedophile was released because a Psychiatrist claimed he had “cured” him. He then raped and murdered two children.

    Good luck Jane.

  4. 4

    k said,

    @ Elizabeth

    “Tavistock and its pathetic subsidiary The Portman Clinic have a stranglehold on the treatment of transsexuals in Britain and I assume that means the Transgender also.

    Good luck fighting these idiots because as a famed Psychiatrist once said, “if you think Physicians have a god complex……”

    Actually the main “centre of excellence” is at Charing Cross hospital.

    The Clinical lead used to be Professor Richard Green who you can see defending John Money in the following film about David Reimer:

    Green is/was also closely associated with Zucker and George Rekers.

    • 5

      NikkiW said,

      And of course, Richard Green’s own early research alluded to the ts condition as being ‘cured’ by therapy. It may not be altogether well known that Green was, and I dare say still is, a transvestite who has on at least one occasion said to a patient (one I know well and is on record on this) something like: “I don’t know why you don’t just stay a transvestite. it works for me”

  5. 6

    […] A growing problem country-wide, according to Jane Fae.   Leave a […]

  6. 7

    Lucy Melford said,

    Hormones on the red list?

    But how do GPs prescribe mature natal women their HRT? Is there a loophole allowed for them? Presumably yes, and in all parts of England.

    And are trans women who are already fully recognised as women by the NHS (such as myself, since my Deed Poll in November 2009) recognised to the extent of invitations to have their cervix and breasts tested for cancer – also able to benefit from such a loophole? Not so sure, but it might be likely.

    And if a post-op trans woman gets her GRC – so that she not only has the hormonal needs of a natal woman but also full legal rights as a woman – can’t she insist on medical treatment appropriate to one? I’d be shocked if the answer were a definite no. But perhaps I should brace myself!

    I’ll be watching this space.

    Lucy

    • 8

      janefae said,

      hmmm…my take is that this is more complicated than simple anti-transness in the HA’s…though i shall keep digging.

      However, the answer as to why natal women get HRT is that hormones are tested FOR THAT PURPOSE…so even though the drug may be working in exactly the same way in a trans person, we have some very peculiar, almost Sheldonian science here. The drug is assumed to understand the purpose for which it is being applied and therefore its effects and side-effects may vary accordingly.

      Some of you may remain unconvinced by that argument.

      jane xx

      • 9

        Angela Kay said,

        I spoke to one of the Laurels team this morning. The HAs are using the argument that these drugs have not been licensed for the use we require. So, to answer Lucy’s point, they would, of course, be licensed for mature natal women.

        I guess the simple solution to all this is to get the drugs appropriately re-licensed… but I’m sure it won’t be that easy!

        Angie

    • 10

      NikkiW said,

      I would hazard a guess that this is contrary to the case law established in A, D and G v N-W Lancashire Health Authority 1998 that was taken as far as the High Court.

      http://www.pfc.org.uk/caselaw/High%20Court%20judgment%20in%20the%20case%20of%20A,%20D%20and%20G%20v%20North%20West%20Lancashire%20Health%20Authority.pdf

      On the other hand, it may be a way for a PCT to prevent GPs prescribing HRT to women on the NHS since Androgen Replacement Therapy is routinely denied men on the NHS and men have to pay privately.

      The prescribing of HRT to post-op ts people is justified under Clinical Need Criteria in that Osteoporosis is an acknowledged risk to any person unable to produce endogenous testosterone or estrogen and HRT is one method by which osteoporosis is prevented.

      http://www.ncbi.nlm.nih.gov/pubmed/9792472

  7. 11

    Paula TransPanther said,

    How about a pre-op woman with a GRC.. lets see.. I’m due more tomorrow!!

  8. 12

    Thia Jones said,

    Well i’ve just had an interesting struggle to get my GP to prescribe/administer decapeptyl. The initial position, back in December, was “ok, we have authorisation from CX, so can prescribe oestrogen, but we can’t do the decapeptyl because we have nobody here that’s qualified to administer it – i’m going to check with CX to see if they’re willing to do it”. Later, this changed to “we’re not licensed to provide decapeptyl”.

    A week ago, i suggested that this was something that needed sorting out as a matter of urgency, because in my mind the position was clear – *somebody* needed to deliver this treatment and as i understood things, it was her responsibility as my GP to either do it herself or arrange for someone else to do it. On Monday morning, i had a call from the surgery, inviting me to make an appointment for the practice nurse to “give me my injection”, which duly happened this – sorry, yesterday – afternoon.

    Here’s something interesting though – the nurse remarked that “we’ve never had this here before, but we must be changing a few patients on to it, because there’s a big box of the stuff sitting in the dispensary”…

  9. 13

    Paula TransPanther said,

    It’s for prostate cancer Thia🙂

    No change, no problems.. Wigan and Leigh PCT😉

  10. 14

    Carole Cross said,

    I have a problem with my GP refusing to prescribre me decapeptyl on the grounds that he is not prepared to take the risks involved with prescribing unlicensed drugs. He was advised by the PCT not to prescribe it but I think it is probably more because of the cost as he mentioned that in a phone call yesterday. Surely if the PCT have already approved my funding then they should have the funds to pay for it.

  11. 15

    Angela Kay said,

    Thia and Carole, if your gender clinic want you to have decapeptyl then they should be able to issue a prescription for you. If you click the link on my name and look at my blog entry for March 9 it may help.

    Mind you, decapeptyl can have some unwelcomed side effects, so I guess there may be other reasons for your GP’s refusal.

  12. 16

    Sarah said,

    “Mind you, decapeptyl can have some unwelcomed side effects…” – to which side effects do you refer? Nearly all the side effects seem to relate to the lack of testosterone, which it is meant to happen🙂 Decapeptyl and other GnRH analogues seem to have far fewer side effects that the alternatives.

    • 17

      Angela Kay said,

      I agree with you Sarah. I guess I was just trying to be “devil’s advocate” and see things from the GP’s side as there may be other factors that influence a decision. All drugs have side effects and some may become significant if we have other conditions. For instance, if someone suffers from arthritis then the joint pains and muscle spasms associated with Decapeptyl might be significant.


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