Gender incongruence: not representative of current knowledge and evidence, and nor of best practice

This article falls startlingly short of the quality and evidence base I would expect from a journal editorial.¹ Where claims are backed by citations, often these are a misreading or misrepresentation of the cited material. One claim is that ‘... there are no robust contemporary cohort studies of younger female-to-male outcomes ...’, citing a paper by Butler et al. However, Butler et al note there has been one study.² This had a natal male to natal female ratio of 1:1.7, and included 201 adolescents referred to the Gender Identity Development Service in London between 2010 and 2014.³ Another is that charities and non-NHS groups are ‘using inaccurate information, including exaggerated risks of suicide’, which cites a blog post from the organisation All About Trans.⁴ There is no inaccurate information in the blog post. It does say that hormones can be ‘life saving’ for young people, but as studies consistently report poorer mental health and increased suicidal ideation in transgender young people, and at least one has shown that transgender children who are supported in their identity revert to developmentally normative levels of mental health issues, this cannot be described as inaccurate.⁵

It states that there are no UK guidelines for generalists, but fails to note the clear guidance in Scotland that patients should be referred by their GP to the local Gender Identity Clinic (GIC).⁶ The suggestion of seeing the patient over a number of appointments without mentioning referral implies that this would be prior to referral to a GIC, which would be poor practice.