Sir: I was pleased to read the article by Murjan, Shepherd, and Ferguson (Psychiatric Bulletin, June 2002, 26, 210-212), highlighting the variability of services available for the assessment of individuals with gender dysphoria.
However, I am concerned that their conclusions are not supported by the data provided. They state that “most trans-sexual people have access to NHS services for the treatment of gender dysphoria”. The results presented are that 79/120 (65%) health authorities replied to the survey confirming that they had a commissioning policy, either from local or recognised national centres. It is not stated whether patients were actually referred or seen within a reasonable amount of time. At least one health authority imposes a 5 year “residency criterion” in their area for referral to a specialist service, despite the High Court ruling in A, D and G.
The article offers no evidence base for their description of a “full” service, or whether such services as are provided are effective. Worryingly, the authors refer to the 5th edition of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) Standards of Care for Gender Identity Disorders (1998), which differs significantly from the current 6th edition (2001).
The authors infer that there is a need for a standardised treatment approach across Great Britain, and attribute the negative experiences of patients using specialist gender identity services to inadequate commissioning of local services. Neither inference is justified by the data presented. The implicit call for uniformity is at odds with the HBIGDA standards of care, and potentially wasteful of resources.
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