GenderCare

26/11/2021

It feels customary to begin each of these updates with an apology for the span of time between it and the previous update. In this case, I’m going to start by clarifying what GenderCare is and, crucially, what it isn’t.

There’s a misconception that GenderCare is the virtual equivalent of a bricks-and-mortar gender clinic, a single organisation (or business) with me the overall boss. I can see how that misconception arises but it’s not what we are.

We’re a directory of solo practitioners, each a separate organisation consisting of one clinician who is their own boss. We have, however, recognised the usefulness of communicating and working together in a professional network – hence GenderCare.

I say this at the outset because a large part of this update is specifically about me – Dr Lorimer – rather than my colleagues. I’ll talk first about GenderCare in general then about my own situation.

GENDERCARE
All the GenderCare clinicians practise remotely, by Zoom or other video platforms. We intend to continue offering this option in the future as it’s proven effective, convenient and highly popular.

At present, our network includes three general assessors:
Myself
Dr Robin Dundas
Dr Vikin Bhatia

We have five options for endocrine support:
Dr Leighton Seal
Dr Jonny Coxon
Dr Peter Hammond
Dr King Sun Leong
Dr Richard Quinton

All are established, accredited UK (and, in the case of doctors, GMC-registered) practitioners, experienced in gender medicine within both the NHS and private sector. Our details, including biographies and contact emails, can be found on the website. Waiting times vary between one and nine months.

DR LORIMER
The adaptations I’ve made in response to COVID-19 have effectively transformed my career.

I adopted remote assessment by Zoom at the start of the first lockdown and found that, having resisted video consultations for many years, I took to them like the proverbial duck to water. After adjusting to the tech, I found I was able to establish a rapport just as well through a screen as in person and, in fact, I was able to develop a more efficient means of note-taking – meaning my reports are now usually ready within a couple of days rather than a couple of weeks.

Video assessment gave me the freedom to make big changes to my NHS career. In September 2020, I joined the Welsh Gender Service and, at the end of the year, after almost two decades at the “Charing Cross” gender clinic (latterly known as “the Tavi”), I handed in my notice. In May 2021, I started working with the TransPlus pilot service at 56 Dean Street, London.

Being part of younger, more flexible community-based NHS gender services has freshened my outlook and approach. I very much want to help the newer services succeed and expand and I am also trying to assist the Good Law Project in their attempts to drive much-needed investment in and overhaul of NHS England’s gender services.

I find that I am, at age 51, busier than ever. Between Wales and TransPlus I’m seeing more patients per session than at any other time in my medical career but, because so much time is saved by not having to commute, I don’t feel overloaded. I am, in fact, more productive than I’ve ever been.

That’s the good news.

The bad news is that my private sector work – GenderCare – is also busier than ever. I receive, in an average week, seven times more enquiries than I and my administrators can accommodate. Demand has comprehensively outstripped supply and we have reached the point where it is not possible to respond to every enquiry, let alone in a timely manner. In this situation, the main issue becomes finding a way to practise fairly within my finite capacity, allocating my time to those I feel most able to progress in their aims and objectives.

Things I’m doing to help the situation:
- I’m actively working to help develop the newer pilot services
- I’ve become more involved in the British Association of Gender Identity Specialists (BAGIS) and am part of their working group looking at ways to encourage and train more practitioners (especially GPs) to work in this field
- I’m in the very early stages of updating the GenderCare website; the current version dates back over a decade and the much-needed upgrade should make my own processes and waiting times clearer
- I’m collaborating on a project for publication, in which I explain in detail the elements of my assessment and why I ask what I ask
- I have a team of excellent administrators – Shaun, Jason and David – who triage and schedule my appointments as effectively as they can and send my reports promptly

Things you can do to help:
- avoid unnecessary questions/correspondence by reading the GenderCare FAQ and this summary of my way of working: https://gendercare.co.uk/using-gendercare-dr-lorimer.shtml
- be aware that I am only able to advise on my own costs (and not those of medical/surgical colleagues)
- ENSURE THAT YOUR EMAIL ENQUIRY ANSWERS MY TEN TRIAGE QUESTIONS AND INCLUDES THE GDPR DECLARATION (FEEL FREE TO CUT & PASTE THE SECTION FROM THE END OF THIS STATEMENT, BELOW THE LINE) AND PUT THE WORD “TRIAGE” IN THE HEADING OF YOUR EMAIL

If you *don’t* provide responses to these ten questions – or if you ask questions outside the FAQ – your enquiry will take far longer for my admins to triage, typically months.

If you haven't heard back from us, you are welcome to (re)send your responses to the ten questions.

I’m sorry that the state of NHS trans healthcare in the UK has had this knock-on effect in regard to private sector care and I thank you for your understanding while we work to improve the situation.

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1 What name do you prefer to be known by (when we meet you and/or in written reports)? Have you made an official name change? What pronouns do you use?

2 How old are you?

3 Have you used other gender services, private or NHS?

4 Are you living, day to day, as you'd like to live, gender-wise? Have you made a social transition? If not, what are the obstacles? What needs to change?

5 What do you do during the day (work, study, volunteering, social activity)?

6 Are those close to you (family, friends, partners, colleagues) aware of your gender circumstances? Do they support your plans?

7 Have you had any treatment for physical health conditions?

8 Have you had any treatment for mental health conditions? Have you ever harmed or tried to kill yourself?

9 Are you on any medication for physical or mental health conditions (including contraception)?

10 What is your objective in seeing me?

I take all reasonable steps to ensure that your personal data, both sensitive and non-sensitive, is collected, stored and processed in accordance with the General Medical Council guidelines on confidentiality, the Gender Recognition Act, the Information Commissioner's Office guidance and the General Data Protection Regulation (GDPR). Please familiarise yourself with your data rights as outlined in the Privacy Notice on the GenderCare website.

Although I maintain the highest standards of confidentiality, I have a professional obligation to disclose if a client or others are at risk. I also engage in peer consultation around client care with GenderCare colleagues, in accordance with good professional practice.

I understand and accept this (delete as appropriate in email reply) YES / NO

All paper clinic reports are sent via first class post to you and to agreed outside agencies (for example, your GP). If I need to discuss you with other GenderCare clinicians, we communicate your information between ourselves using an end-to-end encrypted email service (ProtonMail) to provide an extra layer of security.

Email communication with outside agencies (for example, surgeons, your GP or you yourself) cannot be guaranteed the same level of security after your information has left the ProtonMail network.

I understand and accept this (delete as appropriate in email reply) YES / NO

□ email
□ text
□ telephone

GENERAL Everyone who embarks on a gender-related transition does so in their own (entirely valid) way. Similarly, every gender clinician has their own way of practising. Dr Lorimer's approach may or may not suit your transition. This guide is intended to help you decide whether he would be a "good f...

31/03/2021

Congratulations and best wishes on this day to all trans and non-binary people, visible or otherwise.

Dr Robin Dundas mentions his involvement in a related BPS subgroup:

“"In my work every day I see the impact of invisibility for Trans people" on Transgender Day of Visibility , Dr Robin Dundas spoke to us about the group that's been set up at the BPS to raise awareness around Trans issues. https://t.co/Ej2WnSXi0c.....

13/03/2021

It’s been a long time since the last GenderCare update and this one is a mix of changes specific to my own practice and relating to our wider network.

Firstly, my administrator Shaun has assumed the role of practice manager for my area of GenderCare. He’s been doing my post-appointment work – correcting, formatting and emailing my reports – for the past ten months and will now also be the first point of contact for all email enquiries. It’ll take Shaun a few weeks to put my overflowing inbox in order so your patience, in the meantime, is appreciated.

Secondly, I’m delighted to welcome consultant in diabetes and endocrinology Dr King Sun Leong! Like the rest of us, he is carrying out the majority of his work by remote video assessment at the present time. Dr Leong is likely to have earlier availability than Drs Seal, Coxon and Hammond, and can be reached via kingsunleong@protonmail.com.

Obviously, anyone switching to Dr Leong from another endocrinologist within GenderCare should let that other endo know with as much advance notice as possible.

Finally, a brief note on current waiting times to see myself and other psych clinicians. Shaun is currently scheduling my appointments around 5-6 months ahead – booking into August/September – releasing appointment blocks of three months at a time.

Dr Lenihan’s waiting period is broadly similar. Drs Dundas and Bhatia have slightly earlier availability, perhaps 3-4 months ahead. If in doubt, ask your individual clinician.

As ever, I hope you’re all managing in these trying times.

14/10/2020

When I compose statements for Facebook, I am, I suppose, talking on behalf of the GenderCare network. Sometimes it’s difficult to separate that from my NHS work because, obviously, each has a bearing on the other. Within GenderCare, we do our best to maintain consistency, to use the best elements of NHS and private sector approaches.

The following is not a general GenderCare statement; it's specific to my own practice.

I’d like to confirm that I have, after almost two decades at the clinic known as “Charing Cross” (latterly based at the Tavistock and Portman), handed in my resignation and it's been accepted. By Christmas, I’ll be gone from that service.

The reasons are complex and various but reflect, for the most part, my wish to devote more time to the Welsh Gender Service and to other NHS projects. I maintain excellent relations with my clinical colleagues in the Tavistock GIC.

GenderCare is somewhat separate and will continue, hopefully, without significant interruption. I’ve expanded the admin side and my current waiting time for an appointment is weeks rather than months.

I hope you’re managing in these trying times and wish you the very best.

24/08/2020

Usually with GenderCare updates, I wait until the website is updated before putting out a statement but, in this case, I can't keep a lid on the good news: experienced and highly-respected consultant endocrinologist Dr Peter Hammond is joining us!

Based in Harrogate (he provides endocrine input to Leeds GIC), Dr Hammond is, like all of us, doing the majority of his work by remote video assessment.

Dr Hammond's details should be up on the site before long but, until then, he can be reached via his administrator Jason on gender.harrogate@protonmail.com

13/04/2020

CORONAVIRUS UPDATE 13.04.20

Further to my 02.04.20 update, I wanted to reiterate that all GenderCare assessments at the current time are carried out remotely, by Zoom or other video conferencing. Please DO NOT try to travel to appointments.

A piece of good news: Dr Kirpal Sahota has joined our clinical network. Another consultant psychiatrist, she is an established colleague at the Tavistock and Portman adult gender service and I am pleased to working alongside her in GenderCare also. She and Dr Bhatia currently have the shortest waiting times for new assessments. Here are links to their respective pages, complete with contact details:

Dr Kirpal Sahota
http://gendercare.co.uk/kirpal-sahota.shtml

Dr Vikin Bhatia
http://gendercare.co.uk/vikinjeet-bhatia.shtml

Whichever clinician you see, bear in mind that although we can still form opinions, diagnose and recommend next steps in treatment, certain of those steps – starting hormones, for example, or undergoing surgery – rely on primary and secondary healthcare services that are fully occupied with the pandemic. It is possible to make plans but many of those plans will necessarily have to be put on hold until the crisis is over.

As ever, I am grateful for your patience.

Stay well, stay inside and wash your hands!

Dr Stuart Lorimer

02/04/2020

CORONAVIRUS UPDATE 02.04.20

The COVID-19 pandemic is affecting all UK healthcare, including the field of gender medicine. The speed and scale of change means regular communication is more necessary than ever and I am going to try to provide an update of this sort at least weekly.

Although my focus here is the private sector, many of us within GenderCare also work in the NHS and our general approach is influenced and shaped by our training and experience there. We strive to mirror best public sector practice and we manage hormones exactly as we would in our NHS work.

The Tavistock and Portman GIC has produced helpful guidelines for dealing with common hormone issues arising from the current crisis:
https://gic.nhs.uk/gp-support/issues-around-hormone-therapy-due-to-the-coronavirus-situation/

In response to COVID-19, the General Medical Council acknowledged that clinicians “may need to depart from established procedures” and has advised us to consider “whether treatment can be delayed, or provided differently (eg remotely)”. Accordingly, GenderCare clinicians have familiarised ourselves with the encrypted video service Zoom and are using it and other means of remote assessment to keep our services running throughout the period of pandemic.

It is important to bear in mind three things:

Firstly, remote assessment has its limitations. The GMC advises that it is most suited to situations where “the clinical need or treatment request is straightforward”; conversely, face-to-face consultation is preferred where someone has “complex clinical needs or is requesting higher risk treatments”. When gauging who is and is not too complex to be seen in a Zoom clinic, GenderCare clinicians are especially likely to err on the side of caution. If we decide a video assessment is not suitable for your needs, please try not to take this personally.

Secondly, primary and secondary care healthcare services are fully occupied with the crisis and are likely to be so for several months. Certain gender treatments – starting hormones, for example, or undergoing surgery – rely on these services and cannot happen until the crisis is over and blood testing and surgical facilities have returned to normal. GenderCare clinicians are still able to form opinions, make diagnoses and recommend next steps in terms of treatment but you must accept that actually making those next steps will, realistically, have to wait.

Finally, as the wider health service struggles to manage the crisis, any NHS clinician – myself included – can and likely will be called upon to help with that struggle, possibly redeployed to the frontline or to other parts of the service that are under strain. If/when that happens, GenderCare processes may run more slowly and, in extremis, some clinics may have to be rescheduled.

I will do my best to keep you informed of any such changes before they happen. I am, as ever, grateful for your patience.

Stay well, stay inside and wash your hands!

Dr Stuart Lorimer

The coronavirus situation in the UK is evolving and changing each day and is impacting everyday life and NHS services. We recognise that issues related to hormone therapy may arise and have put together the following to help address common issues. Testosterone injections Sustanon/Enanthate: If a GP....

19/03/2020

CORONAVIRUS UPDATE (DR LORIMER)

In line with government recommendations on managing the spread of Covid-19, clinicians in the GenderCare network have made a temporary switch from carrying out assessments face-to-face to using remote video services. The following pertains specifically to my own practice:

I’ve been getting to grips with Zoom, a secure encrypted version of Skype. More information on Zoom is available here: https://zoom.us

Here’s how it works: my patient and I agree a suitable date and time, I email a confidential link to a video meeting at that date/time and we “meet” through our respective screens. A little extra time may be needed for information-gathering and managing the technology but, in essence, I interview you exactly as I would in person.

I am gradually contacting everyone booked in to my clinics to tell them not to travel to their appointment and to offer them remote video assessment instead – or, if they prefer to hang on for a face-to-face meeting, we can reschedule once the current crisis has lessened.

If, over the next few weeks, anyone does accidentally turn up for a face-to-face meeting, I’m afraid I won’t be there. They’ll be given instructions to go home, email me and we can arrange a video meeting in the near future. There is no penalty charge for a lost appointment and they won’t have missed an opportunity to discuss, for example, “bridging”.

The bottom line is that, with so much else to be concerned about, no-one need become stressed over their appointment with me. We can sort it out.

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17/03/2020

CORONAVIRUS UPDATE

In response to governmental advice on Covid-19 and with a view to patient safety, several clinicians in the GenderCare network have made a temporary switch, either partly or completely, to remote assessment, for example via the secure encrypted video service Zoom.

If you have upcoming appointments with your clinician, check your email regularly (especially before travel) as they will contact you in advance with any further details.

24/02/2020

A sizeable GenderCare update!

Firstly, Dr Vikinjeet Bhatia has joined our clinical network. He is, like me, a consultant psychiatrist with many years’ specialised training and experience at the Charing Cross NHS gender clinic (soon to relocate, so I should really get used to calling it the Tavistock and Portman adult gender service) and I am happy to be working with him in GenderCare. Dr Bhatia started seeing private patients this month and currently has the shortest waiting time.

More information, including his contact details, here: http://gendercare.co.uk/vikinjeet-bhatia.shtml

Secondly, from the start of April, I will no longer be offering the option of “bridging hormones” to new patients. Although popular, this has always generated a considerable amount of work for my administrators, particularly, and relied heavily on the goodwill of my endocrine colleagues in interpreting blood tests. As caseload increases, “bridging” just isn’t sustainable for me.

I will continue to manage the care of all patients – existing and new – who see or have seen me before April 2020 until they have their endocrine appointment. Everyone seen from April onward, however, will have to wait until their meeting with Dr Seal or Dr Coxon before they can start hormones. It was always a requirement of my process that everyone starting hormones undergo an endocrine review so, in that sense, the situation is unchanged.

In the short-term, this is likely to extend Drs Seal and Coxon’s waiting times but this should balance out over time. We are exploring other endocrine (and psych) assessment options for the longer term.

Finally, from July 2020, my consultant psychologist colleague Dr Penny Lenihan will no longer carry out assessments of eligibility for medical interventions: she will not assess for starting hormones or undergoing surgery. Instead, she will focus on offering a wide range of adult therapy/counselling services including consultation around gender and gender identity, family/relationship therapy, (adult) autism assessment and counselling to transitioners’ parents, partners and significant others. Counselling and psychotherapy options will include face-to-face and remote appointments.

Dr Lenihan’s shift in emphasis will not affect existing patients and those currently on her waiting list between now and July.

A detailed update of the GenderCare site, reflecting these changes, is due in the very near future.

I have a keen interest in gender medicine and started a special interest at Charing Cross Gender Identity Clinic (GIC) to advance my training and experience. I was delighted to be offered a permanent consultant psychiatrist post at the clinic in 2016. Alongside my work at Charing Cross GIC, I also w...

31/12/2019

Apologies for the delay in writing an update: I'm pleased to say my administrator David was in hospital only briefly and has been recovering at home. He's gradually getting back to the GenderCare inbox, dealing with the correspondence backlog. Thank you to everyone for their patience.