Intended for healthcare professionals

Rapid response to:

Practice Practice Pointer

Safeguarding LGBT+ adolescents

BMJ 2019; 364 doi: (Published 31 January 2019) Cite this as: BMJ 2019;364:l245

Linked Opinion

NHS staff are in a perfect position to be advocates for LGBT+ people when they most need it

Rapid Response:

In response to Bewley et al

The purpose of this article is to highlight the complex psychosocial factors affecting LGBT+ young people and propose ways in which the non-specialist healthcare professional can help to safeguard them. This response goes into detail about the treatment of transgender/gender non-conforming young people despite this not being discussed at all within this article. Our article is specifically aimed at healthcare professionals who care for young people outside of specialist gender identity development services. The role of the GP or the paediatrician is not to make a diagnosis or initiate treatment for transgender/gender non-conforming young people but rather to safeguard the young person from the risks outlined in our article and ensure appropriate steps are taken. Our recommendation is in line with international best practice: that transgender/gender non-conforming young people are referred to gender identity development services where they can receive appropriate support from a highly specialist multi-disciplinary team.

With regards to the terminology used, our definitions of ‘cisgender’ and ‘transgender’ are in line with those used by the World Health Organization and the World Professional Association for Transgender Health. We do not conflate intersex people and transgender people - indeed, we specifically highlighted them as a separate group. We whole-heartedly agree with the point raised on the harmfulness of surgery on babies and children with ambiguous genitalia, who cannot give consent. However, we have not discussed this here due to the limited scope of our article.

We urge readers to focus on the purpose of our article – to equip generalists with the knowledge to be able to safeguard a vulnerable group of young people. It is the responsibility of all staff caring for young people to be aware of these risks and act accordingly. More information on the care of trans and gender non-conforming young people is available from the gender identity development service (

Competing interests: No competing interests

22 February 2019
Jessica A Salkind
Academic Clinical Fellow in Paediatrics
Rosanna Bevan, Ginger Drage, Donna Samuels, Gayle Hann
Imperial College London