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 (www.gids.nhs.uk).
Competing interests: No competing interests