gender reassignment policy nhs

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On this page.

• Equal Pay Statement
• Equality, Diversity and Human Rights
• Gender Based Violence

The Equal Pay Statement was agreed in partnership, and outlines NHS Greater Glasgow and Clyde’s support for the principle of equal opportunities in employment.

NHSGGC is committed to the principles of equality of opportunity in employment and believes that staff should receive equal pay for the same or broadly similar work, or work rated as equivalent and for work of equal value, regardless of their age, disability, ethnicity or race, gender reassignment, marital or civil partnership status, pregnancy, political beliefs, religion or belief, sex or sexual orientation.

NHSGGC recognises that in order to achieve equal pay for employees doing the same or broadly similar work, work rated as equivalent, or work of equal value, it should operate pay systems which are transparent, based on objective criteria and free from unlawful bias.

• Board Equal Pay Statement
• Please contact the  HR Support and Advice Unit  if you wish clarification on the application of this policy statement.

NHS Greater Glasgow and Clyde’s vision is to be a just and inclusive organisation in which everyone who receives services or works for us has the opportunity to fulfil their potential.

This cannot be achieved if there is prejudice, discrimination, alienation, or social exclusion. Services need to be accessible, appropriate and sensitive to the needs of all service users. No-one should be excluded or experience particular difficulty in accessing and effectively using our services due to their age, disability, gender reassignment, marriage/civil partnership, pregnancy/maternity, race/ethnicity, religion or belief, sex or sexual orientation.

As an Equal Opportunities employer we strive to have staff with the right skills to deliver equitable and quality services. We are committed to ensuring that our employees are not discriminated against and are appropriately supported in the workplace.

NHSGGC is committed to developing an organisational culture that promotes Equality and Diversity.

• Board Equality, Diversity and Human Rights Policy
• Gender Reassignment Policy

NHSGGC is committed to meeting the needs of its diverse workforce.  The Gender-Based Violence Policy is aimed at ensuring staff at all levels in the organisation are safe to disclose their experiences of abuse in order to access support and increase safety for themselves and others.

Board Gender-Based Violence Policy

The Policy is supported by guidance for managers.

If you have any questions in relation to this policy please contact the  HR Support and Advice Unit.

Managers Guidance

Our policy includes a guidance section that can help you to manage these difficult conversations.

Board Gender Based Violence Manager Guidance

Gender Based Violence (GBV) Policy

The term ‘gender based violence’ covers a number of different types of abuse. GBV includes domestic abuse, sexual harassment and sexual assault.

Although primarily experienced by women, the policy recognises that men too can experience abuse.

 An employee might speak to a colleague, their manager, one of our HR team or Occupational Health and disclose abuse. At all times, the support and advice offered will be non-judgemental and sensitive to the employee’s needs.  

An employee who is experiencing abuse (e.g. psychological abuse, threats, stalking, harassment) may have an urgent need for a workplace risk assessment and safety planning to assess potential risks.

While the primary purpose of the policy is to outline the support available to employees who are experiencing abuse, the policy also provides advice and guidance on dealing with perpetrators of gender based violence.

Top Tips on using the Gender Based Violence (GBV) Policy ……..

• Our managers are expected to be available and approachable; to listen and reassure; respond in a sensitive and non-judgemental manner and discuss how the Board can support employees.
• Don’t jump to conclusions. Colleagues and/or managers might notice that one of the team isn’t quite their usual self. You may think there are signs that abuse is happening. You might notice bruises – but don’t jump to conclusions.

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Mental health, learning disabilities and speciality services

Northamptonshire Gender Identity Clinic (GIC) is one of 7 specialist clinics currently operating in England. From undertaking assessments and making recommendations to providing ongoing support throughout treatment, transition and gender reassignment, we strive to create a safe space where our patients are at the centre of what we do.

Our current estimated wait time

Our estimated wait time for initial assessments:

Our service is currently experiencing a high volume of patient demand. We appreciate your patience as we work to provide the best care possible. Please expect longer waiting times and we will do our best to attend to everyone’s needs as efficiently as possible.  

We are currently seeing patients who were initially referred to us in 2019.

The Northamptonshire Gender Service (NGS) is a multidisciplinary team, based at Danetre Hospital, Daventry, who aim to work closely with people to achieve good outcomes for the whole person.

How do I register for this service?

Meet the team, reviews and feedback, accessibility information, useful resources and links.

Northamptonshire Gender Identity Clinic (GIC) is one of 7 specialist clinics currently operating in England. Our multi-skilled team of professionals looks to provide support for people's gender diversity.

From undertaking assessments and making recommendations to providing ongoing support throughout treatment, transition and gender reassignment, we strive to create a safe space where our patients are at the centre of what we do. 

Who is this service for?   People wanting support with gender dysphoria

Your location could not be determined. To get directions please enter your postcode, below.

We accept referrals from your GP or NHS healthcare professional. We also accept self-referrals to the service. Referrals can be made using the referral forms. 

We only accept referrals for people aged 17 and above.

If you are self-referring we would ask that you discuss this referral with your GP as if they are not in agreement with long-term prescribing and monitoring this may affect future care.

• GP referral form for Gender Identity Clinic[pdf] 267KB
• Self referral form for Gender Identity Clinic[docx] 104KB

Disclaimer: Care has been taken to ensure information on this webpage is correct, however it is subject to change.  

More information on referrals

The referral should include the below:

The relevant referrer has completed either:

The service user must be 17 years old at the time of referral

A service user’s GP must be in agreement to the referral being made and has indicated on the referral form that they are willing to collaborate with the clinic by providing the treatment and monitoring required as part of the care plan. By doing this they are agreeing to prescribe and administer medicinal treatments that are advised by Northamptonshire’s GIC Consultants.

 Although the GP’s agreement to provide treatment is a non-binding agreement of shared clinical responsibility, without GP collaboration Northamptonshire GIC will be unable to progress further than providing a diagnosis, as the clinic is not commissioned or funded by NHS England to prescribe or administer medicines directly.

If there is a clinical history of mental health difficulties or physical conditions, the referral must clearly document this, any diagnosis, and indicate any interventions or treatments that are currently in place to manage any identified risks.

Our team is not commissioned or resourced to provide Crisis Management. Therefore, in times where someone is experiencing distress to the point that their own safety or the safety of others is at risk, we would want you to have the best support possible and so we would ask that the relevant services are in place to support you. This would not affect your later treatment with the clinic, it is important that those accessing our service have the best support for any other issues or concerns. If you find yourself in crisis please visit one of our Crisis Cafes , ring the Mental Health Number or if your are in danger call 999.

Gender Clinic Danetre Hospital H Block London Road Daventry Northants, NN11 4DY

Email:  [email protected] Telephone: 03000 272858

Mon-Fri: 09.00-17.00 (Appointment only)

How to find us

The Northamptonshire GIC is based at Danetre Hospital’s Mental Health Resource Centre in the small town of Daventry.  It is easily accessible from the M1 and M6 motorways.  There are nearby railway stations at Long Buckby and Northampton and a regular bus service from Rugby, Banbury and Northampton for those travelling by public transport.  You can find the local bus timetable online.

Parking is free and the clinic enjoys access from both front and rear hospital entrances for those arriving by taxi or car.

If you need help with travel, there may be help available. Let us know so we can help you complete the NHS help with health costs form  with you. Help with ravel costs may be available.

Our skilled and compassionate team includes:

• Speech and Language Therapy (Voice)
• Peer Support Worker
• Administrative Team

We have agreements with Oxford and Leicester Universities to take clinical psychology students on placement. We have agreements to take student nurses on placement.

It is important for us to hear from our clients about the service they have received so we can continually improve the service we provide.

You can access a feedback form  to give your comments or suggest any improvements for our service.

Thank you for taking the time to leave a response.

AccessAble provides information about accessibility at Danetre Hospital

The Equality Act 2010

The Gender Recognition Act 2004

Transgender Policy Guide for Employers 2015

The Workplace and Gender Reassignment: A guide for staff and managers

Providing Services for Transgender Customers

Interim NHS England Gender Dysphoria Protocol and Guideline 2013/14

Guidance on Prosecuting Cases of Homophobic and Transphobic Crime

A list of regional helplines

Beaumont Society

Gender Identity Research and Education Society

Gendered Intelligence

Press for Change

The Transgender Zone

LGBT Foundation

The Transitional Male

Switchboard LGBT+

Mind - Transgender helpline

More about our service

We provide a service for people seeking support around their gender diversity, we are commissioned to:

• Undertake diagnostic assessments for Gender Dysphoria
• Offer advice on hormone treatments to GPs with whom clinical responsibility is shared
• Provide specialist interpretation of blood test results that are undertaken by the GP
• Undertake physical examinations to ensure any risks are minimised and controlled
• Provide second opinion assessments for other Gender Identity Clinics
• Undertake assessments and make recommendations for gender reassignment surgeries
• Provide on-going support and monitoring throughout treatment, transition and gender reassignment.

The clinical team aim to provide a high quality gender identity service that:

• Follows NHS England Protocols on gender dysphoria to provide the framework for the clinical pathway through the service
• Is patient centred
• Promotes multidisciplinary working
• Advocates patient and health professional collaboration in formulating individualised care plans
• Supports and advises our primary care colleagues in the safe and effective delivery, monitoring and treatment of patients with gender identity needs
• Offers fair and equal access to the service;
• Signposts patients and other health professionals to appropriate information and support resources;
• Promotes positive awareness of gender issues and the legal rights of people who are transgender, in line with the Equality Act 2010.

Contact with the clinic

Appointments

It is very important that you attend your appointments at the scheduled time, we ask that you present to Reception within the Mental Health Resource Centre so that you can be booked in. If you are not able to attend an appointment please let us know at the earliest opportunity so that we can rearrange your appointment, also your cancelled appointment can be offered to someone else who is waiting to be seen. One further appointment will be offered by the clinic following a DNA (did not attend), but if that second appointment is not attended then you will be discharged from the service and referred back to your GP.  Where appointments are cancelled without notice, contact via the telephone will be made. If you are travelling a long distance to your appointment we recommend that you contact us prior to setting off to ensure your appointment has not been cancelled.

Clinic Letters

Northamptonshire GIC copy all correspondence sent to primary care (GP) colleagues to the service user at their home address, unless requested not to do so. Please let the GIC know how you would like your letter addressed; for instance gender, name, title, address. You can discuss this with your clinician at your appointment. We can also arrange for shortened versions containing just your treatment plan to be sent out if you should wish.

Prior to your first assessment with the GIC it may be that appointment letters or similar are addressed using the details we have on record, which may differ to someone’s preference. This will be due to what is recorded on our system but can be amended following your first contact.

We recognise that postal services can be unpredictable and clients who fail to attend appointments sometimes have informed us they had not received their appointment letter. We are aware that clinic letters following appointments are not always received as quickly as would be preferred. Unfortunately the length of time can vary due to staff capacity and number of appointments within a given period.

If you are expecting a clinic letter and have not received this within the expected time frame, please contact us via email/telephone.

GIC Emails/Telephone

The GIC can also be contact by email [email protected] . This way of communicating with the clinic can be used for queries such as appointments, letters, emailing blood results, GP queries, etc. Emails sent to the GIC will be responded to as quickly as feasible, but due to limited administrative support, the complexity of a matter, or advice required, this may take some time.

We would ask if the matter is urgent that you communicate by telephone on 03000 272858, and follow up with an email. If the matter is more urgent, typically this will concern prescriptions of hormones or blood results etc., it is likely that one of staff in the clinic will ring you directly and we would be grateful if you would keep the clinic informed of your current mobile number. This also speeds up communication about appointments, which unfortunately from time to time might need to be changed.

The role of the GP

Your GP is pivotal in the provision of your treatment pathway, hormone treatment and referral to other services, including secondary care services when there are co-morbid health concerns. Typically this might include unstable diabetes or hypertension, mental health and communication difficulties.

We recognise however that GPs from the wider referral base may have no knowledge of the field and from time to time GPs are reluctant to initiate treatment as they are unfamiliar with the use of this drug in particular outside of its licensed indications. GPs can seek guidance on our website with the information and links provided or contact us by phone/email found in the Contact Us section.

We will provide individual support to GPs by phone if required, particularly in the use of gonadorelin analogues such as Prostap.  We would ask that any GPs with concerns get in touch directly with the clinic, by phone or email and we are able to provide copies of the National Standards of Care and reference to relevant commissioning documents.

GPs should ensure they are involved in the referral process, particularly if another clinician or healthcare provider is referring (e.g. Tavistock GIDS, CMHT). In particular, it should be checked that the GIC’s referral form has been completed for agreement to collaborate on prescribing and monitoring.

In the case of self referral – we will advise in writing that a service user has self-referred to make the GP aware and request support and collaboration.

Why we require GP involvement

NHS England commissioned Specialist Gender Services are only commissioned and resourced to provide specialist assessment of gender related distress, some specific interventions and advice or onward referral for medical treatment of Gender Dysphoria.  These services and responsibilities are detailed in the NHS Interim Gender Dysphoria Protocol and Service Guideline 2013/2014.

Nationally, Gender Services successfully rely on cooperation with GP colleagues to provide prescribing and phlebotomy services as advised by the Gender Service – which is the case for all patients under our care.  This arrangement benefits the patient as it is convenient and maintains continuity of care with their local GP.  NHS England have made clear that GP or local CCG have the responsibility to ensure that patients have access to the treatments and monitoring that are advised by the Gender Service.  The prescription and phlebotomy advised can usually be undertaken by the GP, but otherwise they can be arranged by the local CCG to be provided between a local hospital and endocrinology service.  The Gender Service do not initiate nor co-ordinate these arrangements and they need to be arranged and managed locally.

The treatments advised are usually familiar to primary care practice, and specific prescribing and monitoring advice is available for the treatment of Transgender patients.  The prescription of medications ‘off licence’, particularly where there are no other suitable medications available for treatment, is common to other areas of medicine.  These roles and expectations are detailed in the Advice to Doctors Treating Transgender Patients .  Where colleagues are concerned about their knowledge and experience in prescribing and monitoring hormone interventions for Transgender patents, we are able to advise on each case individually and we are accessible Monday-Friday by phone and email.  CPD resources related to Transgender Care specifically for GP and primary care colleagues can be accessed here.

As we are unable to prescribe hormone treatments and provide phlebotomy services, we seek agreement with GP colleagues that they will do this prior to accepting the referral.  Given that a high proportion of patients who are assessed seek and are advised hormone therapy as an effective way to address Gender Dysphoria, a diagnosis without treatment is unhelpful and damaging.  Failure to provide the necessary treatment is the responsibility of the GP and local CCG, and if not provided may be discriminatory under the Equalities Act 2010 and will increase distress and harm to the patient.

Therefore we will not be able to progress treatment if there is no agreement in principal regarding the provision of advised treatment and phlebotomy services, or a detailed account of why it is in the best interest of the patient to be seen for assessment only.

Terminology

Diagnosis .

Northamptonshire Gender Clinic uses the ICD-10 classification system and you may see the term "Transsexual F64.0 - male to female" or "Transsexual F64.0 - “female to male” in the diagnosis section of clinic letters.

We recognise that terminology changes and classifications often lag considerably behind and that many service users object to the term "transsexualism" or "gender identity disorder". We are however obligated to use these terms until there is an official change in the classification system. Clinicians will be happy to discuss any particular wish you may have regarding how your condition is referred to in formal correspondence and wherever possible we will attempt to correspond with you in accordance with those wishes. From Jan 2022 the ICD 11 term will be “Gender Incongruence of adolescence or adulthood” (HA60).  When ICD 11 is incorporated into the NHS, this will be reflected in the team’s terminology

This service recognises that people undergoing treatment may not wish to be referred to as "patients" or "clients" and may have already had experience elsewhere in the UK or overseas and may have strong views, for example, of the role of professionals as gatekeepers of service and the relevance of counselling or psychological interventions and what they regard as a normal emotional state. We welcome your views and will seek to reflect that in your individual treatment plan.

Confirming and expressing gender identity should be a positive and empowering experience for everyone.

Gender Dysphoria

In recent years the needs of individuals identifying as transgender and experiencing gender dysphoria has become increasingly highlighted, raising their profile both within the NHS and in wider society through the media. For transgender people, the sex they were assigned at birth and their own internal gender identity do not match.

This incongruence can be a source of significant distress. Indeed, the DSM-5 identifies this distress as ‘gender dysphoria’, where up to 1% of the population reportedly experience ‘Gender Variance’ (WPATH 2011). This highlights an increasing demand for support for individuals experiencing gender dysphoria.

For some individuals who experience gender dysphoria, medical interventions alone, such as hormone therapy and gender reassignment surgery, can alleviate associated distress. Others may need more in depth support around their psychological wellbeing and mental health.

We recognise that there are identities other than the traditional binary identities. People who identify as non-binary may think of themselves as both man and woman (bigender, pangender, androgyne); neither man nor woman (genderless, gender neutral, neutrois, agender); moving between genders (genderfluid); or embodying a third gender.

The Northamptonshire GIC accepts referrals for people who identify as non-binary and this is in line with the guidance given to us by NHS East Midlands, who commission our service.

Non-binary individuals may have different goals to binary transgender individuals. This can lead to challenges regarding the treatments offered. Medical treatments and surgical procedures can create physiological changes that are not yet sophisticated enough to tailor to individual desires. The GIC always aims to explore, and cater to, someone’s goals and aspirations as fully as possible.

The Gender Identity Journey

A diagnosis of gender dysphoria can usually be made after two in-depth assessments carried out by two or more GIC specialist clinicians. However, each person is different and treatment plans vary according to the individual’s needs and circumstances.

Assessment can include:

• Personal history and background
• Exploration of gender identity and gender dysphoria
• History and development of gender dysphoric feelings
• Impact of stigma on mental health
• Availability of support from family, friends, and peers
• Physical health and a physical examination.

The assessment helps determine how someone experiences gender dysphoria and what their needs might be which could include:

• Whether someone has a strong desire to change physical characteristics as a result of gender dysphoria
• How someone manages any difficulties they experience
• How feelings and behaviours have developed over time
• What individualised support and treatment people require.

We recognise that individuals are unique and we would not seek to put service users under pressure to achieve particular arbitrary goals. 

However, we do ask that individuals explore with the clinician they are seeing any barriers to their living in role (typically these would be occupational or relationships with families) so that we may work out an appropriate treatment path and help identify resources for individuals who are experiencing difficulty. 

We generally find clients of this service are living fully in role within a year of presentation, comfortable and able to explore their emotional reaction to change in their appearance and the impact that has on who they meet and whether they feel safe and effective in their new identity. 

If needed we can advise you in applying for changes in your personal details and health service records and there is generally no charge for supporting letters to banks, licensing authorities, passport office etc. Links for further information can be found on on resource and guidance tab.

We also offer a ‘Welcome Workshop’ for people with upcoming initial assessment appointments. The workshop is run on a monthly basis, which people are automatically invited to attend. It is an opportunity to find out more about the gender clinic and to meet others involved. The workshop will include an overview of our service, physical health, and looking after ourselves.

Hormone therapy can be part of the process of changing the body, depending on someone’s gender identity and needs. Hormones usually need to be taken indefinitely, even if surgery is undertaken. The aim of hormone therapy is ultimately for someone to feel more comfortable with themselves. Possible changes from taking hormones are listed below.

Hormone treatments to assist with gender transition can only be commenced after two documented diagnoses of Gender Dysphoria/Transsexualism, alongside a satisfactory physical exam and blood results, as per our GIC guidelines.

Each person's treatment is individually tailored to achieve a safe and effective feminisation or masculinisation and is in keeping with national and WPATH guidelines.

Effects of Taking Oestrogen

• Penis and testicles getting smaller
• Less muscle
• More fat on hips
• Breasts becoming lumpy and increasing in size slightly
• Less facial and body hair

Effects of Taking Testosterone

• More body and facial hair
• More muscle
• Clitoris gets bigger
• Periods stop
• Increased sex drive (libido)
• Voice may get slightly deeper, but may not be as deep as other men’s voices.

Most physical changes, whether feminising or masculinising, occur over the course of two years. The amount of physical change and the exact timeline of effects can be highly variable.

Meetings with a Clinical Psychologist may help to explore and clarify ideas and feelings, improve relationships, develop strategies to manage health pre- and post-operatively, as well as resolve or manage distress.

This could be for purposes such as:

• Exploring gender identity, role, and expression
• Addressing the negative impact of gender dysphoria and stigma on mental health
• Alleviating internalised transphobia
• Enhancing social and peer support
• Improving body image
• Promoting resilience.

These could be addressed through individual or group work as agreed during consultation.

We will discuss the surgical pathway relevant to your individual needs in a very early stage in your attending this service and will be sensitive to someone’s changing ambitions and do not expect or require service users to undergo surgery until they are ready for it, or if not part of their treatment goals.

The Northamptonshire GIC will make referrals endorsing and recommending surgical procedures to appropriately qualified physicians on the basis that it is their clinical opinion that the patient is both eligible and ready to undertake such procedures.

Whilst individual time spans can vary, the following guidelines apply:

• Upper body surgery (Bilateral mastectomy/Breast reconstruction) - Upper body surgery requires one documented clinical recommendation from a GIC Specialists who know the patient. This must be no sooner than 6 months after assessment with Northamptonshire GIC
• Lower Body surgery – Lower body surgery requires two recommendations from a GIC Specialist. This must be no sooner than 12 months after assessment with Northamptonshire GIC.

Not everyone experiencing gender dysphoria will feel they need surgery, or may only require very specific procedures. Individual needs are discussed throughout contact with the clinic.

The aim is to increase someone’s comfort with themselves and reduce gender dysphoria through surgery.

Masculinising surgery may involve

• Bilateral mastectomy (removal of both breasts)
• Hysterectomy (removal of the womb)
• Salpingo-oophorectomy (removal of the fallopian tubes & ovaries)
• Phalloplasty or Metoidioplasty (construction of a penis)
• Scrotoplasty (construction of a scrotum) and testicular implants
• Penile implant.

Feminising surgery may involve

• Orchidectomy (removal of the testes)
• Penectomy (removal of the penis)
• Vaginoplasty (construction of a vagina)
• Vulvoplasty (construction of the vulva)
• Clitoroplasty (construction of a clitoris with sensation).

Voice Modification

Voice modification.

We have a Speech & Language Therapist (SaLT) based within our hospital sites in Northampton and Daventry who can provide sessions for people if required.

The methods used are likely to vary depending on your needs but may involve moderating pitch, intonation, resonance, and articulation as well as non-verbal aspects such as posture and breathing.

Speech and Language Therapy (Voice Modification)

The Speech and Language Therapy – SLT (sometimes referred to as SaLT) department at Northamptonshire Gender Identity Clinic works with individuals who wish to achieve vocal change through voice and communication therapy. Current patients of the GIC can request referral to this service during a GIC appointment or by emailing the clinic.

Content: Voice and communication therapy with us typically involves work on resonance, pitch, articulation, intonation, pacing, volume and projection, as well as other voice and communication aspects. You do not need to have any prior voice knowledge or vocal training. The content of the therapy however is largely guided by the individual and their specific requirements. Voice therapy begins with a 1-on-1 initial session, which is where you will be able to meet your therapist, discuss what you’d like from therapy, your voice and communication objectives and learn more about what therapy entails. It is also a chance for you to ask any voice-related questions.

Format: A course of therapy here usually comprises 1-on-1 sessions. Group sessions may be offered after this, where available and if appropriate for the individual and their voice objectives. Remote voice sessions are often possible via prior agreement with the therapist.

We are committed to working with each patient to establish the most suitable therapy content and format for them to meet their voice goals and support them in developing the right voice for them.

What happens in an initial voice therapy appointment?

The initial appointment is mostly an information-gathering session for the therapist, but also for the patient. The therapist will ask you questions related to your voice. This will include questions like: Have you ever had speech and language therapy before? What is your current voice use like? What would you like from voice therapy? You do not need to prepare anything beforehand. The patient and therapist will set some short term voice goals and suggest aspects you could work on together in order to meet these goals. The therapist will also explain the format and timescale of the sessions. Usually the therapist (with consent) will take one or two very short (< 1 minute) audio recordings of your voice as a baseline.

Is it true that voice modification therapy is for trans women only?

No. We work with any GIC patient to help them develop the right voice for them. This includes non-binary individuals and trans men.

I would prefer to have voice modification therapy closer to where I live. Can I access voice therapy locally?

You can request referral to your local Adult Speech and Language Therapy service via your GP. If the referral is accepted, local voice therapy can be provided closer to your home.

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Treatment - Gender dysphoria

Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

What this means will vary from person to person, and is different for children, young people and adults. Waiting times for referral and treatment are currently long.

Treatment for children and young people

If your child may have gender dysphoria, they'll usually be referred to one of the NHS Children and Young People's Gender Services .

Your child or teenager will be seen by a multidisciplinary team including a:

• clinical psychologist
• child psychotherapist
• child and adolescent psychiatrist
• family therapist
• social worker

The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.

Depending on the results of the assessment, options for children and teenagers include:

• family therapy
• individual child psychotherapy
• parental support or counselling
• group work for young people and their parents
• regular reviews to monitor gender identity development
• referral to a local Children and Young People's Mental Health Service (CYPMHS) for more serious emotional issues

Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.

Hormone therapy in children and young people

Some young people with lasting signs of gender dysphoria who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist). This is in addition to psychological support.

Puberty blockers and gender-affirming hormones

Puberty blockers (gonadotrophin-releasing hormone analogues) are not available to children and young people for gender incongruence or gender dysphoria because there is not enough evidence of safety and clinical effectiveness.

From around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones alongside psychosocial and psychological support.

These hormones cause some irreversible changes, such as:

• breast development (caused by taking oestrogen)
• breaking or deepening of the voice (caused by taking testosterone)

Long-term gender-affirming hormone treatment may cause temporary or even permanent infertility.

However, as gender-affirming hormones affect people differently, they should not be considered a reliable form of contraception.

There is some uncertainty about the risks of long-term gender-affirming hormone treatment.

Children, young people and their families are strongly discouraged from getting puberty blockers or gender-affirming hormones from unregulated sources or online providers that are not regulated by UK regulatory bodies.

Transition to adult gender identity services

Young people aged 17 or older may be seen in an adult gender identity clinic or be referred to one from a children and young people's gender service.

By this age, a teenager and the clinic team may be more confident about confirming a diagnosis of gender dysphoria. If desired, steps can be taken to more permanent treatments that fit with the chosen gender identity or as non-binary.

Treatment for adults

Adults who think they may have gender dysphoria should be referred to a gender dysphoria clinic (GDC).

Find an NHS gender dysphoria clinic in England .

GDCs have a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including:

• psychological support, such as counselling
• cross-sex hormone therapy
• speech and language therapy (voice therapy) to help you sound more typical of your gender identity

For some people, support and advice from the clinic are all they need to feel comfortable with their gender identity. Others will need more extensive treatment.

Hormone therapy for adults

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery.

It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team.

In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen.

Both usually have the additional effect of suppressing the release of "unwanted" hormones from the testes or ovaries.

Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating.

It's also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.

The effectiveness of hormone therapy is also limited by factors unique to the individual (such as genetic factors) that cannot be overcome simply by adjusting the dose.

Find out how to save money on prescriptions for hormone therapy medicines with a prescription prepayment certificate .

Risks of hormone therapy

There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP.

The most common risks or side effects include:

• blood clots
• weight gain
• dyslipidaemia (abnormal levels of fat in the blood)
• elevated liver enzymes
• polycythaemia (high concentration of red blood cells)
• hair loss or balding (androgenic alopecia)

There are other risks if you're taking hormones bought over the internet or from unregulated sources. It's strongly recommended you avoid these.

Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.

Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic.

Read more about fertility preservation on the HFEA website.

Surgery for adults

Some people may decide to have surgery to permanently alter body parts associated with their biological sex.

Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery.

In addition to you having socially transitioned to your preferred gender identity for at least a year before a referral is made for gender surgery, it is also advisable to:

• lose weight if you are overweight (BMI of 25 or over)
• have taken cross-sex hormones for some surgical procedures

It's also important that any long-term conditions, such as diabetes or high blood pressure, are well controlled.

Surgery for trans men

Common chest procedures for trans men (trans-masculine people) include:

• removal of both breasts (bilateral mastectomy) and associated chest reconstruction
• nipple repositioning
• dermal implant and tattoo

Gender surgery for trans men includes:

• construction of a penis (phalloplasty or metoidioplasty)
• construction of a scrotum (scrotoplasty) and testicular implants
• a penile implant

Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.

Surgery for trans women

Gender surgery for trans women includes:

• removal of the testes (orchidectomy)
• removal of the penis (penectomy)
• construction of a vagina (vaginoplasty)
• construction of a vulva (vulvoplasty)
• construction of a clitoris (clitoroplasty)

Breast implants for trans women (trans-feminine people) are not routinely available on the NHS.

Facial feminisation surgery and hair transplants are not routinely available on the NHS.

As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.

Life after transition

Whether you've had hormone therapy alone or combined with surgery, the aim is that you no longer have gender dysphoria and feel at ease with your identity.

Your health needs are the same as anyone else's with a few exceptions:

• you'll need lifelong monitoring of your hormone levels by your GP
• you'll still need contraception if you are sexually active and have not yet had any gender surgery
• you'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment
• you may not be called for screening tests as you've changed your name on medical records – ask your GP to notify you for cervical and breast screening if you're a trans man with a cervix or breast tissue
• trans-feminine people with breast tissue (and registered with a GP as female) are routinely invited for breast screening from the ages of 50 up to 71

Find out more about screening for trans and non-binary people on GOV.UK.

NHS guidelines for gender dysphoria

NHS England has published what are known as service specifications that describe how clinical and medical care is offered to people with gender dysphoria:

• Non-surgical interventions for adults
• Surgical interventions for adults
• Interim service specification for specialist gender incongruence services for children and young people

Review of gender identity services

NHS England has commissioned an independent review of gender identity services for children and young people. The review will advise on any changes needed to the service specifications for children and young people.

Page last reviewed: 28 May 2020 Next review due: 28 May 2023

Gender reassignment discrimination and the NHS

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NHS bodies, in their roles as both employer and service provider, increasingly find themselves subject to complaints of discrimination on the grounds of gender reassignment, due to a growing awareness and understanding within the trans community of their rights as employees and patients.

It is therefore important that NHS bodies ensure that they have adequate training and policies in place for the prevention of discrimination against transgender employees or service users.

The two key pieces of legislation that protect transsexual people are the Equality Act 2010 (EqA 2010) and the Gender Recognition Act 2004 (GRA 2004).

The Equality Act 2010

Discrimination under the eqa 2010.

The EqA 2010 provides legal protection from discrimination and harassment. Gender reassignment is one of the nine protected characteristics covered by the Act. A person has the protected characteristic of gender reassignment if that person is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning their sex by changing physiological or other attributes of sex.

Under the Act, a reference to a person who has the protected characteristic of gender reassignment is a reference to a transsexual person. Therefore, a woman making the transition to being a man and a man making the transition to being a woman both share the characteristic of gender reassignment.

A key point to note about the definition of gender reassignment under the EqA 2010, is that a person who ‘is proposing to undergo’ the process of changing their sex is protected i.e. they need not have undertaken any actual steps towards the process of transitioning. Further, a person living in the opposite gender without having undergone any medical procedures will be protected. Unlike earlier legislation, there is no requirement to be under medical supervision to qualify for protection under the EqA 2010.

There are five types of prohibited discrimination in respect of gender reassignment:

• Direct discrimination – when a transsexual person is treated less favourably than others because of gender reassignment
• Indirect discrimination – where a transsexual person is particularly disadvantaged by a provision, criterion or practice which applies to everyone
• Harassment – when unwanted conduct related to gender reassignment causes an intimidating, hostile, humiliating or offensive environment for that person
• Victimisation – when a person is subjected to a detriment because they have made or supported a complaint about gender reassignment discrimination
• Absences from work – where an employee is treated less favourably in relation to absences from work because of gender reassignment. This is the only type of prohibited discrimination specific to transsexual people

Case example

One issue that employers are likely to face in relation to transsexual employees is use of single-sex facilities. For example, it is likely, and understandably so, that person will want to use the toilet facilities of the gender to which they are transitioning. In the leading authority on this issue Croft -v- Royal Mail Group plc [2003], the Court of Appeal upheld a decision of an employment tribunal that it was not discrimination to require a pre-operative male to female transsexual employee to use the disabled toilet as opposed to the female toilet facilities during the transition process.

However, the approach in this case should not be regarded as best practice. The recruitment and retention of transgender staff guidance issued by the Government Equalities Office (GEO) Guide states that a trans person should be free to select the facilities appropriate to the gender in which they present and that when a trans person starts to live in their acquired gender role on a full-time basis they should have the right to use the facilities for that gender. Further, the Department of Health Guidance for NHS Trusts sets out that it is not good practice to require a transsexual person to use the disabled facilities and it is not acceptable to require a transsexual person to use the facilities of their assigned gender.

Exceptions: when gender reassignment discrimination may be lawful

Gender reassignment discrimination may be permitted in certain limited circumstances. The EqA 2010 provides for an ‘occupational requirement’ exception that employers can rely on in discrimination claims. This enables employers, in limited circumstances, to require that, having regard to the nature or context of the work, only people who are not transsexuals can do the job. The explanatory notes in the EqA 2010 give the following example of an occupational requirement; ‘a counsellor working with victims of rape might have to be a woman and not a transsexual person, even if she has a gender recognition certificate, in order to avoid causing victims further distress.’ This may also apply to NHS staff employed to help victims of rape or other sexual assault.

Application to the NHS

In addition to NHS employees, patients must not be subjected to discrimination by NHS Trusts. The EqA 2010 prohibits discrimination by a service provider (concerned with the provision of a service to the public) against a person requiring the service. Therefore, NHS trusts must not discriminate against transsexual patients because they have the protected characteristic of gender reassignment.

However, there is an exception in the Act for single-sex only services (for example, a group counselling session provided only for female victims of sexual assault) but NHS trusts must be certain that the provision of separate services is a proportionate means of achieving a legitimate aim.

NHS bodies must also have regard to the Public Sector Equality Duty set out in Section 149 EqA 2010, which sets out that they must have due regard to eliminating discrimination prohibited by the EqA 2010 and advancing equality of opportunity and fostering good relations between those who share a protected characteristic and people who do not share it.

Gender Recognition Act 2004

The Gender Recognition Act 2004 (the Act) allows transsexual people to gain legal recognition of their acquired gender by registering for a Gender Recognition Certificate (GRC). The application is made to the Gender Recognition Panel who will determine whether a GRC should be issued on the basis that the applicant has lived in their acquired gender for two years and intends to live the acquired gender until death. An applicant does not have to have had gender reassignment surgery, but have been diagnosed as gender dysphoric. Where a full GRC has been issued to a person, their gender becomes for all purposes the acquired gender.

Prohibition on disclosure of information

The Act has important implications for NHS trusts, particularly in relation to the provisions on prohibition of disclosure of information relating to a person’s application for a GRC or, if a GRC is issued, their previous gender. Under section 22 of the Act, it is a criminal offence for a person who has acquired, in an official capacity, protected information regarding an individual’s gender identity to disclose that information to any other person. This clearly affects NHS bodies as employers and in the supply of services to the public, as they are likely to acquire such information in relation to their employees or patients.

An example provided by the workplace and gender reassignment: Guide for staff and managers (a:gender Guide) is of someone working in HR with access to an employee’s personal file, disclosing the fact that the employee was born a different gender, without the employee’s prior consent.

Potential defences

There are a number of defences to this prohibition set out in section 22(4) of the Act. These include where the information does not enable that person to be identified and where the person has agreed to the disclosure of the information.

In addition, there is a further defence which will have particular importance to NHS bodies as service providers. The Gender Recognition (Disclosure of Information) (England, Wales and Northern Ireland) (No2) Order 2005 provides a defence in relation to disclosure for medical purposes. It will not be an offence under section 22 of the Act to disclosure protected information if the disclosure is made to a health professional, for medical purposes, and the person making the disclosure reasonably believes that the subject has given consent to the disclosure or cannot give such consent.

Practical considerations for NHS bodies

The a:gender Guide states that ‘it is the antithesis of the intentions of the privacy provision included in the GRA 2004 to ask or expect an individual to evidence they have gender recognition. Given the wider privacy protection applicable to all, it is best practice to assume any transsexual person has gender recognition and treat them accordingly’.

Care should be taken to use appropriate names and terminology in HR and patient records in relation to transsexual people. Where a person is transgender, it is important not to refer to this fact in patient or HR records unless the person has consented to it. In respect of employees, this may involve issuing them with a new set of HR records.

In relation to transgender patients, NHS/Department of Health guidance is that they should be issued with a new set of medical records to reflect their new gender status. NHS trusts may find themselves in a difficult position when there are medical reasons why a transgender patient’s previous gender needs to be referred to. In these circumstances, the medical professionals should seek consent from the patient for their gender history being recorded in their notes and steps should be taken to ensure that access to those notes is limited to those who need to be aware of the patient’s gender history for clinical reasons.

Department of Health guidance recommends that all staff are trained on these issues in relation to transgender patients and employees. Our specialist employment team can provide training on the legislation in this area and its implications for NHS bodies.

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Health and social care

With a team of over 250 lawyers, we are one of the leading firms providing legal advice and support to national and international healthcare and life sciences organisations.

Our leading health and social care lawyers are experts in the following disciplinaries: 

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Gender identity and your rights

Many acts and policies exist around gender identity. These are to protect people who identify as transgender from discrimination.

Visit the Scottish Trans Alliance website for further information

NHS Scotland Gender Reassignment Protocol

The Gender Reassignment Protocol  was issued to NHS health boards on 11 July 2012.

The Gender Reassignment Protocol contains many therapies and surgical procedures. The patient and their gender clinician should discuss these in detail. This helps to find the most appropriate treatment pathway.

The Equality Act 2010

The Equality Act, 2010  protects transgender people from discrimination and harassment. It provides protection in different areas, including in the workplace or in the provision of goods and services.

A person does not need to be under medical supervision to be protected by the Act. For example, someone assigned male at birth who decides to live as a woman, but does not consult a doctor or undergo any medical procedures, would be protected.

The Act also protects people associated with them. This includes family members, as well as others who are perceived to be transgender.

Gender Recognition Act 2004

Under the  Gender Recognition Act of 2004 , transgender people can:

• apply for and obtain a Gender Recognition Certificate  to legally change their gender
• get an updated birth certificate
• marry or form a civil partnership in their gender 
• have their gender recorded on their death certificate

To apply for a Gender Recognition Certificate you must be aged 18 or over. The application process requires you to prove that you:

• have been diagnosed with gender dysphoria
• have lived in your gender for the last 2 years
• intend to live permanently in this gender

Patient Advice and Support Service

The  Charter of Patient Rights and Responsibilities  summarises what you’re entitled to when you use NHS services or receive NHS care in Scotland. It also covers what you can do if you feel your rights have not been respected. This includes reference to the Patient Advice and Support Service.

The Patient Advice and Support Service  (PASS) is an independent service. It provides information, advice and support about NHS healthcare for patients, their carers and families. This information is free, accessible and confidential.

The service can give you information, advice and support if you want to:

• give feedback or comments about healthcare provided by NHS Scotland
• raise concerns or complaints about about healthcare provided by NHS Scotland
• helps you understand your rights and responsibilities as a patient
• works with the NHS in Scotland to improve healthcare provision

The Patient Advice and Support Service can be accessed from any  Citizens Advice Bureau in Scotland .

Support and advice

Help is available if you’re experiencing mental health issues as a result of gender dysphoria.

Switchboard LGBT+

Contact Switchboard LGBT+ on 0300 330 0630, from 10am to 10pm every day.

You can also use their webchat service through the  Switchboard LGBT+ website .

Breathing Space

You can also access support from  Breathing Space  by phoning 0800 83 85 87.

The Breathing Space phoneline is available:

• 24 hours at weekends (6pm Friday to 6am Monday)
• 6pm to 2am on weekdays (Monday to Thursday)

Phone 111 if you’re:

• in a state of despair
• need emotional support

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Last updated: 23 March 2023

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Gender Services Clinical Programme

NHS England has established a National Programme Board for Gender Services. The National Programme Board is responsible for leading the future delivery and configuration of specialised services for individuals with gender incongruence and dysphoria across England.

The Board guides NHS England’s approach to commissioning specialised gender dysphoria services, having regard to the impact of decisions to the populations of Wales, Scotland and Northern Ireland where necessary.

The scope of the board covers:

• specialised services for children and young people with gender incongruence
• specialised services for adults with gender dysphoria
• the relationship between primary care services and specialist clinics
• Interface with non-specialised services that form part of the NHS pathway of care.

The Board does not have decision-making powers but makes recommendations to the NHS England Specialised Commissioning National Commissioning Group to which it is accountable.

• Chair: Professor James Palmer – National Medical Director for Specialised Services
• Five patient/parent representatives
• Chair of NHS England Patient and Public Advisory Group for Specialised Services
• National Specialist Adviser for Adult Gender Dysphoria Services
• National Clinical Lead for Gender Dysphoria Surgery
• National LGBT Adviser
• Head of Highly Specialised Services
• Medical Director for Specialised Services (London Region)
• Head of Communications (Specialised Commissioning)
• Deputy Director for Clinical Services, NHS Arden and GEM Commissioning Support Unit
• Deputy Director of Finance, Specialised Commissioning (National)
• Senior Commissioning Manager (regional level)
• Commissioning representatives from: NHS Wales; NHS Scotland
• Secretariat: National Specialised Commissioning Team

Adult Gender Dysphoria Services Clinical Reference Group

The Clinical Reference Group for Adult Gender Dysphoria Services provides independent expert advice to the National Programme Board for Gender Dysphoria Services on the various aspects of the Board’s work.

The clinical members of the CRG are:

• (Chair) Dr Derek Glidden , Consultant Psychiatrist at Nottinghamshire Healthcare NHS Foundation Trust and NHS England National Specialty Adviser for Gender Dysphoria Services (Adults)
• Ms Tina Rashid, Consultant Urological Surgeon at St George’s University Hospitals NHS Foundation Trust and NHS England National Clinical Lead for Surgery (Gender Dysphoria)
• Dr Laura Charlton, Consultant Clinical Psychologist, Leeds and York Partnership NHS Foundation Trust
• Dr Christine Mimnagh, General Practitioner and Clinical Lead for Gender Dysphoria Services at Mersey Care NHS Foundation Trust
• Dr Robert Wilson, Consultant in Public Health Medicine.

Adult gender dysphoria services

In 2018 we published two new service specifications for adult services, formed through a process of extensive stakeholder engagement and public consultation. You can read the  analysis of responses and consultation report ; and the service specifications:

• Gender identity services for adults; non-surgical interventions
• Gender identity services for adults; surgical interventions .

Children and young people’s gender services

A full  independent review of the service   was commissioned in 2020 and is currently ongoing. You can read the  terms of reference for review of gender identity development service for children and adolescents.

The new children and young people gender services will be commissioned against a new interim service specification available below:

• Referral pathway for specialist service for children and young people with gender incongruence
• Interim service specification for specialist gender incongruence services for children and young people

Clinical Policies

• Clinical Policy: Puberty suppressing hormones for children and young people who have gender incongruence / gender dysphoria
• Prescribing of gender affirming hormones (masculinising or feminising hormones) as part of the children and young people’s gender service

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NHS gender identity services: strategic action framework 2022-2024

A strategic action framework for the improvement of NHS gender identity services from 2022 until 2024.

Strategic context

This Strategic Action Framework sits alongside wider work supporting Scotland's recovery from the COVID-19 pandemic (including the NHS Recovery Plan ), as well as work to address inequality and disadvantage experienced by minority population groups.

As our Covid Recovery Strategy notes, individual policies 'cannot be viewed in isolation and all have a part to play in making Scotland a fairer place' - this publication therefore sits clearly in the context of wider strategic plans.

Scotland's National Performance Framework ( NPF ) sets out the vision for how we create a more successful Scotland. It focuses on how the wellbeing of people living in Scotland can be increased across a range of economic, social and environmental factors laying out national outcomes to help achieve its purpose. Of these outcomes this Framework contributes to relevant NPF outcomes which are 'we are healthy and active', 'we live in communities that are inclusive, empowered, resilient and safe' and 'we respect, protect and fulfil human rights and live free from discrimination'.

Additional, relevant wider national policy is listed in Annex B.

Current services

There are currently four GICs providing services to adults in NHS Scotland. These are based in four NHS Health Boards:

• NHS Grampian
• NHS Greater Glasgow and Clyde
• NHS Highland
• NHS Lothian

A separate service for young people, NHS Greater Glasgow and Clyde's Young Person's Service, accepts referrals from across Scotland.

In 2012 we published the Gender Reassignment Protocol ( GRP ), which aimed to improve and standardise gender reassignment clinical pathways in NHS Scotland. The NGICNS was set up in 2014 as a Managed Clinical Network within NHS National Services Scotland to support the implementation of the GRP .

Following a letter from the Chief Medical Officer, NGICNS and NHS National Services Scotland are now working to review and update this clinical protocol. An updated GRP will be delivered in summer 2022. The work to update the GRP and the delivery of the commitments in this Framework are interconnected and each will support and inform the other.

Regional variation in care

People accessing gender identity services have highlighted variation in the time between referral and first appointment between GICs . However, geographical variation in ongoing provision of care after accessing a GIC in the NHS Board areas where people live is also frequently raised.

In keeping with the core principles of Realistic Medicine we recognise the need to address this variation and potential geographic inequalities. Implementation of actions in this Framework from 2022 will ensure equitable access not only to specialist services, but also to subsequent care and support trans people receive from NHS Boards, including through primary care.

Gender reassignment surgery

Due to the specialist nature of gender reassignment surgery, this is provided by the NHS via a four nations contract managed by NHS England.

Under the governance of NHS England, the Gender Dysphoria National Referral Support Service manages referrals for gender reassignment surgery from all UK nations. No NHS gender reassignment surgery currently takes place in Scotland.

We recognise the importance of accessing treatments locally where appropriate, as well as building resilience in provision. We have therefore committed in this Framework to look at the potential for providing gender reassignment surgeries in Scotland. We anticipate that this would complement and be part of the current four nations NHS contract.

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