“My hormones run out next week and the clinic discharged me — please don’t let me crash”

A trans patient established on hormones whose supply is running out, facing a years-long gender-clinic wait, is a situation in which a BRIDGING prescription should be actively considered as harm reduction — not a reflex refusal. GMC guidance says a GP may consider — it is not an obligation — a bridging prescription to continue established hormones where the patient is self-medicating with unregulated hormones or highly likely to, to reduce the risk of self-harm or suicide, with gender-specialist advice and the lowest acceptable dose (the RCGP’s 2024 position statement is more cautious and does not see initiating hormones as a core GP role without additional expertise); it aims to prevent the harms of abrupt cessation and of patients resorting to unregulated self-sourced hormones, ideally with gender-specialist/endocrinology advice and shared care, plus baseline monitoring, while the specialist referral is in place and chased. Crucially, abrupt cessation risks a mental-health crisis: the hint of suicidal ideation at the prospect of stopping/detransitioning must be assessed and safety-planned — this is a safety issue, not an administrative one. The examinable hidden agenda is fear of rejection and the exhaustion of having to justify herself after previous poor experiences; meet her with respect and affirmation FIRST (correct name/pronouns, no othering), assess and support her whole wellbeing, do not refuse on "not my expertise" grounds while leaving her without treatment, and safety-net with crisis routes and trans-inclusive support. Abruptly stopping established hormones causes significant distress, may precipitate or worsen mental-health crisis (including suicidality), and frequently drives patients to UNREGULATED self-sourced hormones (unsafe, unmonitored). The hint of suicidal thoughts must be assessed — this is a safety issue, not just an administrative one.