How doctors think about their role in transgender care: a qualitative study of UK general practitioners and endocrinologists.

Abstract

ObjectivesTransgender people in the UK face uncertainties and inequalities in healthcare provision, especially for treatment required for gender transition. Existing studies have found that doctors' ideological tendencies, in particular socially normative conceptions of gender, influence their treatment of gender minority patients. This study explores doctors' understanding of their role in transgender care, their thoughts on the current processes in place to enable gender affirmation, and their theoretical views of sex/gender that underpin these conceptions.DesignOne-on-one, semi-structured online interviews. Clinicians were recruited through societies representing both specialties and then snowballed. Recruitment stopped with data sufficiency, according to the tenets of 'information power'. Data analysis was conducted in line with Braun and Clarke's Reflexive Thematic Analysis guidelines.SettingUK doctors working in general practice and endocrinology.ParticipantsConvenience and purposive sampling of 16 participants (8 endocrinologists and 8 general practitioners).Main outcome measuresOur dataset explores clinicians' conceptions of their role in transgender care and identifies current structural and organisational obstacles.ResultsThe interviews found that the division of labour in transgender care is contested. GPs felt their role was to understand the patient's narrative, and therefore were reluctant to prescribe, believing this to be within the purview of specialists. Endocrinologists described themselves as 'technicians' simply carrying out the task of providing hormonal treatment. Almost all interviewees emphasised the importance of multidisciplinary involvement, and none were willing to treat without a mental health professional.ConclusionsOur findings suggest that doctors may inadvertently communicate gender norms, but that they do so within the constraints of a system over which they have limited control, and that their conceptions of transgender care are informed by serious resource pressures. We offer some practical suggestions for how these pressures could be ameliorated.