This paper and the service from which the statistics are drawn appear concerning on a number of levels. It appears unlikely that the fundamental assertion which underpins the statistics in this paper is accurate, namely that ‘our case note review was able to capture all patients referred within a certain time period in this geographical area’.

The authors state that: ‘All individuals who request treatment for gender dysphoria in Oxfordshire are referred to a single clinician (C.B.) for psychiatric assessment and subsequent referral to a specialist centre’, and later, ‘there is a single point of access in Oxfordshire for onward referral to specialist gender clinics’.

This referral pathway is not consistent with mainstream practice in other areas of England and is not supported by current protocols and guidelines representing best practice. The 2013 College Report Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria emphasises referral by or via a general practitioner, with no other gatekeeping requirement.

The requirement for a general psychiatric assessment is at best unnecessary and at worst risks psychopathologising the experience of transgender people who are presenting with gender dysphoria, an experience of discomfort or distress which is not psychiatric in nature.

There is local awareness of the unusual nature of the arrangement in Oxfordshire. The Oxford University LGBTQ+ society advises on its website: ‘N.B. A lot of GPs will seek to refer trans customers to psychiatrists (in Oxford, this is usually Dr Chris Bass), but this is a completely unnecessary procedure. If you're seeking referral to a Gender Identity Clinic to receive hormone treatment or surgery, this will only lengthen the process. Psychiatric assessments are not required by Gender Identity Clinics, and your GP is qualified to make the referral’.

Given the high proportion of students who will have families of origin outside Oxfordshire and the high level of awareness within Oxford University that a psychiatric assessment is unnecessary, it appears likely that a significant number are bypassing the service.

Another factor not considered by the authors is the almost exponential rise in people presenting to gender identity services who are under the age of 17. Provision is via a centralised national service for young people. At 17, their care is transferred to an appropriate gender identity clinic. Transfers of care now comprise an increasing proportion of referrals to the Northern Region Gender Dysphoria Service. As this is the case nationally, such patients will also bypass Dr Bass and will not feature in the statistics presented.