According to a report compiled by charity Trans Actual, over 200 trans people in the UK have been denied hormone replacement therapy by GPs in the last year. In almost a third of the cases, they were refused despite having a recommendation from a gender clinic.

As per current care pathways in the UK, after trans patients are discharged from an NHS gender clinic, they are supposed to continue to receive care through their GPs. The current NHS England Guidance outlines that UK GPs are to cooperate with Gender Identity Clinics in the prescription of hormone replacement therapy.

However, earlier this year, reports started to emerge of trans people who were refused hormone replacement therapy prescriptions by GPs in the wake of the Cass Review and a heavily criticised statement released by the Royal College of General Practitioners (RCGP). In May 2024, TransActual launched a survey with the goal of monitoring the situation.

According to their findings, published on October 14, 215 people in the UK reported being refused hormone replacement therapy by GPs. While the data set primarily focused on England, some of the cases took place in Scotland and Wales. No recorded data is currently available for Northern Ireland.

Three in four of the people who participated in the survey were already on hormone replacement therapy when it was refused to them, with over half of them having been on it for over five years. 14% of these patients were denied the treatment despite the fact that withdrawing from it could have long-term health implications.

Moreover, 56 out of the 215 participants were refused hormone replacement therapy despite having a recommendation from an NHS gender clinic.

The main reported reason for denying such treatment was that GPs “didn’t feel competent to prescribe it”. However, a high number of trans people said their GP denied the prescription on the grounds of “personal beliefs”, while others said there was no policy that established that “they had to”. One person was told by their GP that “they did not ‘recognise’ the NHS gender identity service.”

According to a letter shared on social media by a trans person, their GP used guidance from both the General Medical Council’s Good Medical Practice guidance and the Royal College of Practitioners 2019 position statement on trans healthcare as reasons to cease prescribing hormone replacement therapy.

Speaking to QueerAF about the report, strategy director at Trans Actual Keyne Walker said: “Some GPs admitted it was due to their personal beliefs.

“Transphobic GPs, especially in England, are feeling empowered to unilaterally deprive their patients of critical medicines for reasons of their own bigotry, and every part of the NHS must take some responsibility for letting this happen.”

A spokesperson for the Royal College of General Practitioners said that, following the increase in such reports from trans people, they had added clarifications and edits to their guidance. “After carefully reviewing and considering the feedback, we have added two clarification sections highlighted in our statement below, together with some minor edits to relevant sections of the statement itself to reflect our clarification points,” their statement reads.

“We recognise the deep sense of hurt and frustration that many of our transgender patients are feeling, and the college remains strongly committed to the improvement of services for patients with gender incongruence,” it continued.

TransActual welcomed the statement, however, they demanded “accountability from the RCGP for the harm their guidance has caused and the need to go much further in their guidance to ensure that rogue GPs stop toying with the critical medicines of trans people and have a clear responsibility to comply with the prescription of HRT by gender clinics”.