The final chapter of this book might well have been the first. It provides the rationale for the compilation of these articles, the purpose of which is to offer training to community-based clinicians involved in transgender treatment. In 2003 the Gender Dysphoria Program at Vancouver Hospital was replaced by a community approach: hence the need for a training initiative. Each chapter covers separate areas, such as physical and mental health assessment, hormonal treatment, the ‘real-life experience’ and surgical interventions. The authors succeed admirably in their ambition and provide technical information of the type needed by a general practitioner (GP), mental health worker or general psychiatrist. Although the book is written for a North American audience, it is relevant to the UK setting. Increasingly, commissioners require patients to be assessed by their local mental health team before their GP can make a referral to a gender identity clinic. This book provides the basic information needed to carry out the initial assessment and will help the generalist understand the issues associated with hormonal and other treatments.
The strength of a compilation of this sort is the ability to dip in and out as needed. The weakness is the frequent repetition of basic facts. It is unfortunate that the authors do not follow their own three-tiered approach to training when organising the content of the book. Had they done so, it would be easier to use the book more effectively in a clinical setting. It is tantalising in its reference to some of the core dilemmas in offering treatment to people with gender dysphoria not least among which is whether it represents a disorder in the usual psychiatric sense. Many transgendered people reject this assumption and question why it is not treated in the same way as sexual orientation or accepted as a variant of the human condition just as valid as any other. Adopting that approach would leave little room for National Health Service involvement with no role for the psychiatrist or psychologist, the two disciplines accounting for the majority of specialists in the UK.
Although the book makes reference to various ethical dilemmas, the authors do not tackle them in any great depth. This is unfortunate as it is these very issues that can prevent a healthcare worker giving the most appropriate help to transgendered people (referred to as transphobia). Other ideas are raised briefly without explanation; a discussion of the nature of the ‘multigendered’ would be most welcome. Similarly, they refer to complicating scenarios where the patient may suffer personality disorder or learning difficulty but seem to leave resolution of these issues to the ‘experts’.
Transgendered people often complain that psychiatrists cannot fulfil the dual role of therapist and gatekeeper for gender reassignment services and this book is helpful in acknowledging that fact. Given that these guidelines are based on shared international criteria, the book will be of greatest value to the GP or mental health professional who is new to this topic.
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