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Frequently Asked Questions

Looking for answers to your questions about trans healthcare, gendergp services, or where to find help & support?

Check out our faqs…

What is Gender Dysphoria?

Gender dysphoria is the term used to describe the sense of discomfort experienced by people who do not identify with the gender they were assigned at birth. The discomfort may be constant or sporadic and it may vary in terms of severity.

What causes someone to be trans?

We are not absolutely sure what causes someone to be trans, and it is probably a variety of factors combined. We do understand that it is not something that can be forced on someone, or something that someone can choose to be. It is not something that happens because of childhood experiences and it is not a personal choice. It is inherent, in the same way as sexuality or eye colour.

Is there a way of diagnosing someone as trans?

As it is a subjective experience, the only person that can actually know whether or not they are trans is the person living with feelings of gender incongruence (the feeling that one’s gender does not align with the one they were assigned at birth). There is no psychological test, blood test or medical scan. It is not something someone chooses to be, and it is certainly not a mental disorder.

Why don’t GPs treat trans patients?

There are many reasons why GPs do not feel able to treat trans patients. These can vary from reasons related to prejudice or religion, to a general belief that they lack the knowledge to do so, and a lack of training resources available. Prejudice or personal belief should never be accepted as a valid reason not to treat a patient, whatever their medical needs. Lack of specialist knowledge is also becoming less accepted as an argument against helping trans patients. We are seeing more GPs learning about the subject and as their knowledge and confidence increases, then they will feel more comfortable in helping their patients better, if not directly then with the support of a gender specialist.

Do I need hormones to transition?

Everyone has a different perspective on what they want to achieve in terms of their transition. For some, social transition, which involves presenting themselves in line with the gender with which they identify, is sufficient. For others, looking for physical changes, hormone therapy is enough to give them the inner peace that is missing. For others, surgery is their desired route.

What do I need to start hormone therapy?

Hormone treatment can be started once you have gone through things and worked out the best and safest route for you to take. You may already know this is the right time, and that it is safe, or you may need a doctor or some support to help you with this.

Where can I get a diagnosis of gender dysphoria?

While a GP is able to provide this, not many GPs feel that they have the necessary knowledge or training to ‘diagnose’. Much more work is needed in this area. Other people who can help are local endocrinologists, GPs with a special interest or other gender specialists. You can also get a diagnosis through a Gender Identity Clinic (GIC) but the waiting lists can be very long. Counsellors and psychologists can all give you a diagnosis if that is what you require to achieve your goals.

What is self-medding?

Self-medding is the term used to describe the process whereby a trans individual carries out their own research via trans forums and support groups to try to understand what levels of hormones might be right for their needs. The individual then obtains the “medication” (often without a prescription) and begins to follow a treatment regime. This approach is often not monitored and the medication is often questionable which can carry worrying negative health implications.

Why do people self-medicate?

Many people have been forced to start treatment on their own due to long waiting times and a struggle to access the right healthcare regime for them.

I want to stop self-medicating, what should I do?

If you are obtaining your medication in this way, GenderGP can swap you onto safe prescription medication as well as arranging to have your bloods monitored to check your hormone levels are safe.

Will I be penalised if I get private care?

The British Medical Association policy states: “Patients who are entitled to NHS funded treatment may opt into or out of NHS care at any stage. Patients who have had private consultation for investigations and diagnosis may transfer to the NHS for any subsequent treatment. They should be placed directly on the waiting list at the same position as if their original consultation had been within the NHS.”

I have other health problems, does this mean I can’t have hormone treatment?

A history of liver, heart or blood clotting problems, in you or your family, does not preclude you from accessing hormones but it does mean that your case may require additional monitoring.

Do you treat children and adolescents?

We use the medical definition of child which means prepubertal. Before the onset of puberty children do not require medical treatment and any transition should be managed socially (allowing the child to dress and identify as they wish). Medical treatment other than belief and support is not needed until puberty starts.

At what age do you begin treatment?

We do not classify according to age but rather in line with the onset of puberty. Once an adolescent has reached Tanner stage 2 (the starting phase of puberty), we can work with the adolescent and parent or guardian to support any child suffering with gender dysphoria.

What treatments do you offer to younger people?

Each individual is considered on a case by case basis. Treatments available to adolescents, in line with international best practices, are puberty blocking medication and when indicated, gender affirming hormones.

Are puberty blockers reversible?

Medication to stop puberty is totally reversible. Please see our myth buster for more information.

Are cross sex hormones reversible?

No. Prescribing these hormones has long-lasting and irreversible implications, however these changes do not occur overnight. Gender affirming hormones are classed as being partially reversible. No doctor would ever choose to actively prescribe such medication unless it was in the best interest of the patient.

How much does the service cost?

Please see our fees page for a breakdown of fees.

How long does the process take?

This varies with what you are trying to achieve. If you are sure of your gender and the steps you wish to take, have access to blood tests and support, then the process can take as little as four weeks.

I am having regular counselling, do I still need to pay for regular follow up sessions as well?

We just need to know that everything is going well for you and that you are happy and safe. If your counsellor is happy to give us a report to say that then that is all we require.

Does a family member have to be involved in my treatment plan?

We want everyone to be supported in their gender journey, some have more support than others. If you don’t have someone close to you to help then we will be there to support you. Not having someone who understands this is not a reason why we would not give you care.

How often do my bloods need to be tested?

Some people like to have their bloods measured very closely while we get to the dose that is right for them. For some this happens quickly and bloods can then be monitored every three months or sometimes less if everything is very stable.

What is included in the monthly subscription?

Your monthly subscription fee covers the cost of any ongoing support and advice we provide to you or your GP, or your specialist. It covers the monitoring of your blood results and your prescription creation (NB: this does not include the medication which is purchased separately), as well as all advice and information from the team.

What is an IGS? Why is it necessary?

IGS is short for Information Gathering Session, which is carried out with our therapy team, either in person or over video. The IGS enables us to meet you ‘face to face’ and learn more about your situation and how we might be able to help. The information is shared both ways, you tell us about you and we tell you about us.

I don’t need or want counselling, is it obligatory?

Counselling in the traditional sense of the word is not obligatory with GenderGP. Counselling sessions are available with our excellent team of therapists and may people find it to be hugely beneficial. However, it is up to you to decide what psychological support you need. We do require you to have a follow up session every so often so that we can see how you are doing and ensure we have regular contact outside of email conversations. These are carried out by video consultation, or can be done in person if you prefer.

Why do I need a follow up session?

These appointments provide an opportunity to see what physical and psychological changes service users might be experiencing and to see if there is any help, advice or sign posting we can offer to enhance their transition and progress. We want the best for you and to keep an eye on how things are going.

Do I need a diagnosis to access hormone therapy?

At GenderGP we do not ‘diagnose’, as we feel it is disrespectful to your identity. You are the expert in your gender experience. Instead, what we do is take each of our service users through our Appraisal Pathway which includes getting to know you, taking a thorough history and exploring your relationship with gender to ensure we are able to provide you with the best possible recommendations for your treatment. Whether that is being provided via GenderGP or your directly through your doctor. If you want a formal diagnosis, however, then we can provide you with a confirmation of that.

Do I have to live in a particular role to get treatment through GenderGP?

People should be allowed to express themselves in a way that makes them feel most comfortable, and to transition as slowly or quickly as is medically safe. They shouldn’t have to dress in a particular way or live in a way that makes them feel uncomfortable in order to gain the correct treatment. This is not something we enforce at GenderGP.

Why do I need to have my bloods tested?

Regular blood testing enables us to monitor your hormone levels to ensure you are within the required range for the gender with which you identify.

Do you work at the weekend?

Our core team works from 0800-1800 Monday to Friday with a reduced service operating at weekends. This allows us to work closely with the opening times of our online pharmacy, Clear Chemist and our partner laboratory: The Doctors Laboratory.

Is Portal still working?

Yes! Your account in Portal is still live but we have disabled the messaging function as it was causing unnecessary delays to your care. The next exciting phase is to integrate the Help Centre with Portal in order to bring everything back into one place. For the time being, please keep copies of the letters and messages we send you.

Why can't I log into my Portal account?

We are currently working behind the scenes on integrating our Help Centre with the GenderGP Portal, so that you can access all of your care in one place. Until this exciting phase is complete and fully tested, access to Portal will be limited. You can still access your account via links in your previous communications from GenderGP.

Can I access my old messages/records?

Yes. All of your old messages and records are accessible via your Portal account if you had one. If not then they will be in your email inbox.

How long does it take to process a prescription?

Please allow 48 working hours for prescription requests to be processed.

My prescription has been sent to Clear Chemist but I haven't heard from them, is there a delay?

Once your medication has been approved by the doctor at GenderGP, a prescription is sent to Clear Chemist who will usually contact you the next working day to let you know your medication is ready for purchase. Please do not order medication until we have told you that we have sent the prescription to Clear Chemist. Find out more about how the process works by visiting our Help Centre.

Can I get a paper prescription?

Yes you can, but it is best to check with your local pharmacy that they are comfortable in receiving private prescriptions from EU doctors for gender-related medication. Many pharmacies are anxious and ill-informed which can lead to embarrassing refusals. Most patients find it easier and cheaper to use our online pharmacy. There is a £8 surcharge for a paper prescription to cover our added processing costs.

Can I switch to a treatment summary with my GP after I have already started treatment privately?

Yes of course, we love working with GPs and are always grateful for their help. On your next prescription request, simply choose the ‘Treatment Summary’ option.

Can I speak to someone?

Ours is a digital service and we operate using our Help Centre and email notifications. However, if you wish to book an appointment with a member of the team you can do so by clicking on the relevant section here.

Do you do shared care?

To find out more about how we can work with your doctor visit https://www.gendergp.com/working-with-your-gp/.

What should I do if I have an emergency?

We do not operate an emergency service. If you feel you have a medical emergency please contact your local emergency services by dialling 999. If you feel that your medication is not right and you are waiting for a response from a member of the team, it is quite safe to stop taking your medication until you have heard back from us.

How do I make a complaint?

If you are unhappy with your experience, and you would like to make a formal complaint, please send us a message via the Help Centre and it will be passed to the complaints department. You are, at any time, free to leave our service and find care elsewhere, we will always provide you with a summary for your next provider and you are welcome to return at any time.

Who is responding to my questions/sending me letters?

We have a full multidisciplinary team of people looking after your care. Your requests are always directed to the best team member, depending on the nature of your query.

My doctor wants to know the name and GMC number of the doctor who is managing my care through GenderGP.

Due to the challenges faced by UK doctors keen to support transgender patients, all of our doctors are based outside of the UK. The GMC is a regulatory body and as such their remit does not cover GenderGP doctors. Each GenderGP doctor is carefully selected on the basis of their qualifications and gender affirmative approach. In line with GenderGP policy, each doctor adheres to best practice outlines in the guidelines that can be found here.

Do you have to ‘pass a test’ to qualify for treatment via GenderGP

We do not ‘test’ our service users to see whether they are trans, because only they know the answer to that. Instead we take our service users through our Appraisal Pathway. This ensures we have all the information we need about them, to keep them safe, and that they have enough information about the process and the care available through GenderGP, to make an informed decision. Find out more here

Why should I seek counselling?

Counselling is a safe and confidential environment in which you are free to explore the issues that may be troubling you. It is a professional friendship which will help you to find the language you need to talk about your feelings and which will give you a greater understanding of your situation, empowering you to make the choices that matter.

What is different about GenderGP’s counselling team?

While some counsellors may claim to be experienced in helping with feelings surrounding gender, many are very new to this area. GenderGP’s specialist gender counselling team is headed up by a trans woman and the team has been supporting gender expansive people and their loved ones for the past five years.

The volume of clients with whom they have interacted during this time makes them the most experienced specialist gender counselling team in the UK.

All of our counsellors are qualified and registered with the BACP or equivalent, and work to the highest standards. They have regular supervision outside of GenderGP and are bound to the counselling ethical framework.

Furthermore, the specialist gender counselling team are heavily involved in advocacy work and actively seek out the trans community, frequently attending events and support groups.

I know who I am, how can counselling benefit me?

Knowing who we are and understanding our gender identity is only the beginning for many transgender people. Creating a pathway and a safe environment to explore their identity fully, without prejudice, can be a challenge.

Specialist gender counselling is the perfect place to start this exploration. Gender affirmation is a journey and having a counsellor in your back pocket to help when the ride gets a little bumpy can make all the difference. Counselling is not there to tell you who you are, it’s there to support you, whatever your gender identity, and to offer emotional support and exploration.

I am worried you will try to talk me out of my feelings in relation to my gender

Good counsellors, who understand gender, are only there to help you to discover your true identity, not to convince you to be something you are not. If you have questions, our team of specialist gender counsellors can help you to find the answers. The counselling team acts as a professional sounding board, someone completely unbiased and impartial with whom you can share your deepest darkest secrets, without being judged.

What ages do you support?

Everyone! We all need support at different stages in our lives, this is no different if you are questioning your gender. Age should never be a barrier to accessing counselling, so at GenderGP we help people of all ages.

Do you offer support for parents?

Yes! Experience has shown us that while many parents may be accepting and supportive of their child, whatever their age, helping their child to safely navigate their gender journey can be challenging at times. Being able to talk through their thoughts, fears and even prejudices, in a non judgemental environment, can be a hugely positive step for everyone involved.

What if I change my mind?

Gender is a journey which is personal to every individual. Changing your mind suggests going backwards but change is always a movement forward. The same can also apply to someone’s relationship with their gender, it keeps moving forward. We can change the road, or the direction we are on, but it is not about going backwards. No matter how you are feeling, counselling can help you to make sense of your situation.

Can you talk me - or my child - out of being trans?

No, we can’t and we would never try to talk you out of accepting your gender identity, but we can help you to come to terms with it. Our gender identity is not a choice, it is inherent in who we are.

Do I need to have a session with a counsellor to access medication?

Counselling is not mandatory with GenderGP, though we do feel everyone – trans or cis – can benefit from support! We do ask all service users to take part in an Information Gathering Session (IGS) which is carried out by a member of the counselling team, and this is mandatory.

How many sessions would I need to have with you to feel the benefits?

It is entirely up to you. The amount of sessions is not fixed, many people enter counselling for three or four sessions, others continue for months. It all depends on how you experience the process and if you are finding it beneficial. Working with the right counsellor is really important and can have a big impact on your experience, which is why we have a team for you to choose from.

Does online counselling work?

Emphatically yes! Online counselling does work. Counselling is a commitment made by two people to be there at the same time each week. Travelling can make that commitment difficult for the client and they can falter if logistics prove too challenging. Video calling means all they need to do is log on. The fact that they are also surrounded by their own things, in the comfort of their own home, can make them feel at ease, adding to the therapy experience.

How much does a session cost?

The standard rate is £60 per session. If you are struggling to afford this, speak to our counsellors who may be able to work out an individual plan which fits within your budget.

How long do sessions last?

Sessions are a standard 50 minutes in length.

What happens if I miss a session?

We ask that 24 hours notice be given if you are unable to make your session, in this event a full refund will be given. If you are not able to cancel within this timeframe, we will be unable to rebook your slot and as such payment may be required.

How do I book a counselling session?

You can book a session by clicking on the links which can be found on the counselling page. We have listed all of our counsellors individually, so just choose the one you would like to speak to and click on the link. 

What if I don’t like my counsellor?

A massive 80% of the success rate of your counselling session can be attributed to the connection you have with your therapist. We have a diverse team which can be found here. Have a look and see who you feel might be a good fit for your particular needs. If you don’t feel the match is quite right, you are free to try another member of the team.

Should GPs collaborate with gender specialists if they lack knowledge in this area?

The NHS constitution gives patients the rights to access certain services by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible.

The Specialised Services Circular 1620: ‘Guidance for GPs, other clinicians and health professionals on the care of gender variant people’ states that, ‘GPs are usually at the centre of treatment for trans people, often in a shared care arrangement with other clinicians. GPs may prescribe hormones and make referrals to other clinicians or services, depending on the needs of the particular service user. Sometimes a GP has, or may develop, a special interest in gender treatment and may be able to initiate treatment, making such local referrals as necessary. Otherwise referrals may be made to a specialist Gender Identity Clinic (GIC) where there are multidisciplinary teams of professionals. Private treatment with a gender specialist may be preferred by the service user.’

What are the benefits of GP / Specialist Collaboration?

Collaboration between gender specialists and the patient’s GP has many benefits:

  1. The patient will be able to access timely and safe healthcare for their gender identity while waiting for access to NHS services which have very long waiting lists.
  2. The patient will be able to reduce their own personal risks by eliminating the need to purchase medication from unregulated sources without proper monitoring.
  3. It supports their GP in prescribing and performing and analysing blood tests until treatment that should ordinarily be available to them on the NHS becomes available, but under specialist supervision.
  4. There is a two-way sharing of the patient’s medical history which leads to safer and more comprehensive care and better outcomes.
  5. Once a diagnosis has been established the GP will be advised on which blood tests are necessary to safely monitor the treatment and medication, and at what intervals they need to be performed.

The NHS Specialised Services Circular 1620 dated 22 April 2016 confirms that there is extensive clinical experience of the use of the medications used in the treatment of gender dysphoria, which provides evidence of tolerability and safety comparable with their use for approved indications. https://www.parliament.uk/business/committees/committees-a-z/commons-select/women-and-equalities-committee/news-parliament-2015/transgender-inquiry-report-published-15-16

Why is it said that GPs lack understanding in this area?

In 2016 the Women and Equalities Commission found that ‘The NHS is failing in its legal duty under the Equality Act 2010. Trans people have significant problems in using general NHS services – often because of lack of knowledge and understanding by staff. GPs in particular often lack an understanding of trans identities, the diagnosis of gender dysphoria, and their own role in prescribing hormone treatment.’ https://www.parliament.uk/business/committees/committees-a-z/commons-select/women-and-equalities-committee/news-parliament-2015/transgender-inquiry-report-published-15-16/

What has changed since the Women and equalities Report?

Since the 2016 report, it seems that many GPs have undertaken personal and professional education to increase their knowledge and skills in this area of healthcare. At GenderGP we have seen a steady increase in GPs willing to prescribe and monitor under our guidance. This makes healthcare for trans people much more affordable and accessible, while they wait for NHS services to step in.

What advice is there for GPs who are asked to prescribe and carry out blood tests for their patients?

In January 2018, NHS England published advice to GPs on ‘Primary Care Responsibilities In Regard To Requests by Private On-Line Medical Service Providers to Prescribe Hormone Treatments for Transgender People.’ https://www.gendergp.com/wp-content/uploads/2018/02/GMC-advice-to-GPs-on-online-specialists.pdf

‘A number of trans and non-binary individuals access private on-line medical services, often because of long waiting lists into an NHS-commissioned Gender Identity Clinic. The online provider may make a diagnosis of gender dysphoria through remote contact with the patient and in such cases a private prescription may be issued, or the patient’s GP will be asked to issue a NHS prescription. Either way, it is likely that the patient’s GP will be asked by the online provider to assume responsibility for monitoring and testing and for passing the results of the monitoring and testing to the private on-line service.

‘A number of GP practice staff have asked NHS England to provide advice on the responsibilities upon an individual’s GP in such cases in regard to issuing the prescription, and for monitoring and testing.’

What does NHS England advise regarding the interface between NHS and private services?

In their advice, NHS England quotes three main principles from DOH Guidance:

  1. The NHS should not withdraw NHS care because a patient chooses to buy private care, nor should patients who access private care be placed at an advantage or disadvantage in relation to the NHS care they receive.
  2. The NHS should continue to provide free of charge all care that the patient would have been entitled to had they not chosen to have additional private care.
  3. Where the same diagnostic, monitoring or other procedure is needed for both the NHS and private elements of care, the NHS should provide this free of charge and share the results with the private provider.

What about GMC Advice?

Their advice also summed up GMC advice which states, ‘GPs must cooperate with Gender Identity Clinics and other gender specialists by prescribing medications, providing follow up and making referrals as recommended by those specialists.’

The GMC Advice for doctors treating trans patients aims to help doctors see how the principles of Good medical practice apply in relation to trans patients and also to explain doctors’ duties under the Equality Act 2010 and other legislation.

The GMC’s advice was initially met with a variety of concerns from NHS GPs, and Dr Chaand Nagpaul CBE Chair, BMA General Practitioners Committee penned his concerns to the GMC raising the emotive points that this would, ‘make GPs undertake specialist prescribing, placing them in a difficult position and forcing them to prescribe outside the limits of their competence.’

Susan Goldsmith, acting chief executive of the GMC, replied with reassurances including that they expect GPs to, ‘acquire the knowledge and skills to be able to deliver a good service to their patient population’, which may mean undertaking training and that they don’t believe care for patients with gender dysphoria is a highly specialised treatment area requiring specific expertise.’

The medication for transgender care includes well-known oestrogen therapy used for treating female menopause (estradiol), injections that are given for women with endometriosis or men with prostate cancer (GNRH analogues), a diuretic used for heart failure (spironolactone), anti-androgens used in contraceptives (cyproterone acetate), medication for benign prostate hyperplasia (finasteride) and testosterone replacement therapy used for the management of the male menopause.

These are medications that are well known to GPs who are well-used to their side effects and monitoring needs. Although it is recognised that some of these medications are not currently licensed for use in these conditions, there is sufficient evidence of their efficacy and safety in the management of gender dysphoria.

Are there any specific questions I should ask you?

NHSE advise that GPs ensure that they are comfortable in prescribing under guidance, and recommend some screening questions. In order to make it easy for doctors to assure themselves of our services we have answered those questions here so that you can have the information you need without having to ask.

Do the GenderGP health professionals have sufficient expertise?

All of the doctors, nurses, healthcare assistants, counsellors, therapists, psychologists working with GenderGP are carefully selected for their knowledge, skills and attitude in the field of gender-related healthcare. GenderGP has 3000 transgender patients under our care and probably have more experience than any other centre in the UK.

All of our doctors, clinicians and therapists have many years experience of working with gender dysphoria, and follow strict International guidance for treatment protocols.

Which GenderGP clinician will be responsible for prescribing to my patient?

There is not one clinician with individual responsibility as each clinical decision on follow up is made by a multidisciplinary team that includes doctors, therapists and psychologists. The doctor that signs the prescription may vary as with any large specialist clinic, but the specialist team jointly makes the clinical decisions.

What qualifications do they have?

Each practitioner has the registration, indemnity and qualifications to suit their role. There is no specific training requirement to practice in this area, and no GMC register or GPSI qualification. Gender specialists may come from any field, endocrinology, psychiatry, General Practice, General Medicine. All GenderGP practitioners follow Internationally recognised best practice and guidance.

Gender specialists can come from any medical specialty. In the NHS Document “clinical models operated by England’s gender identity clinics” it states that, “Gender specialists may be from many different clinical backgrounds, some specialising in mental health: psychologists, psychiatrists, counselors or therapists, but they may also be GPs, endocrinologists, nurses etc

In the WPATH Standards of Care Version 7: “With appropriate training, feminizing/masculinizing hormone therapy can be managed by a variety of providers, including nurse practitioners, physician assistants, and primary care physicians (Dahl et al., 2006).”

Which Professional Associations do you have links with?

Our Practitioners are members of the World Professional Association of Transgender Health. We do not have links with NHS-commissioned specialised Gender Identity Clinics because our specialists are located from various countries Internationally as there is a shortage of clinicians working in this field in the UK.

What continuous professional development do your practitioners have?

Our specialists all undergo annual CPD relevant to their role. GenderGP are frequent contributors at International conferences, and all of the relevant learning and teaching can be seen in our newsletters, podcasts and blog posts.

What are the criteria for treatment for adults?

The NHS England’s current commissioning protocol relates to the treatment of adults over the age of 17.

  • All of the health professionals that our patients are referred to for support and evaluation specialise in gender dysphoria and have vast and extensive experience in the assessment of management of patients who may have associated mental or emotional distress.
  • All patients are evaluated by at least two gender specialists, one of which is a medically qualified doctor and only the doctor will make decisions regarding endocrine treatments.
  • Our MDT meets regularly to discuss cases and management and to review and develop the service.

Do you provide counselling and advice re fertility?

Fertility preservation is a key priority and is discussed with all patients along with HFEA advice. More information can be found on our dedicated fertility page in the Help Centre.

Do you provide assessment for transgender youth under the age of 17?

Young people are assessed in line with the criteria published by The Endocrine Society Guidelines 2017. Puberty blockers are prescribed to transgender youth who fulfil the crtieria, once they have started puberty. Gender affirming hormones are prescribed to youth under the age of 17 if there are ‘compelling reasons to do so’ as agreed by the Endocrine Society 2017.

NHS England will, as part of the Gender Identity Development Service for Children and Adolescents, commission cross sex hormones for young people with continuing gender dysphoria from around their 16th birthday subject to individuals meeting the eligibility and readiness criteria.

The Endocrine Society 2017 Guidelines, and the WPATH Standards of Care Version 7 are internationally recognised as providing excellent guidance in the management of transgender patients.

All of our prescribing physicians have extensive knowledge and experience in endocrinology and are fully qualified to treat children and adults. Both NHS and private gender specialists come from many backgrounds, counselling, psychology, general practice, general medicine, psychiatry, endocrinology, paediatrics.

The WPATH criteria for mental health professionals working with children include:

  • Meet the competency requirements for mental health professionals working with adults;
  • Trained in childhood and adolescent developmental psychopathology;
  • Competent in diagnosing and treating the ordinary problems of children and adolescents.

The Endocrine Society Guidelines 2017 advise the following ‘We advise that only MHPs who meet the following criteria should diagnose GD/gender incongruence in children and adolescents:

  • training in child and adolescent developmental psychology and psychopathology,
  • competence in using the DSM and/or the ICD for diagnostic purposes,
  • the ability to make a distinction between GD/gender incongruence and conditions that have similar features (e.g., body dysmorphic disorder),
  • training in diagnosing psychiatric conditions,
  • the ability to undertake or refer for appropriate treatment,
  • the ability to psychosocially assess the person’s understanding and social conditions that can impact gender-affirming hormone therapy,
  • a practice of regularly attending relevant professional meetings, and
  • knowledge of the criteria for puberty blocking and gender-affirming hormone treatment in adolescents.

and

  • ‘We suggest that adolescents who meet diagnostic criteria for GD/gender incongruence, fulfill criteria for treatment, and are requesting treatment should initially undergo treatment to suppress pubertal development.
  • ‘We suggest that clinicians begin pubertal hormone suppression after girls and boys first exhibit physical changes of puberty.
  • ‘We recommend that, where indicated, GnRH analogues are used to suppress pubertal hormones.
  • ‘In adolescents who request sex hormone treatment (given this is a partly irreversible treatment), we recommend initiating treatment using a gradually increasing dose schedule after a multidisciplinary team of medical and MHPs has confirmed the persistence of GD/gender incongruence and sufficient mental capacity to give informed consent, which most adolescents have by age 16 years.
  • ‘We recognize that there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence, even though there are minimal published studies of gender-affirming hormone treatments administered before age 13.5 to 14 years. As with the care of adolescents ≥16 years of age, we recommend that an expert multidisciplinary team of medical and MHPs manage this treatment.’

What are the risks of withholding treatment for trans adolescents?

Women and Equalties Report 2016:

‘We recognise that there are legitimate concerns among service-users and their families about the clinical protocols which the clinic operates regarding access to puberty-blockers and cross-sex hormones. Failing to intervene in this way, or unnecessarily delaying such intervention, clearly has the potential to lead to seriously damaging consequences for very vulnerable young people, including the risk of selfharm and attempted suicide.

‘There is a clear and strong case that delaying treatment risks more harm than providing it. The treatment involved is primarily reversible, and the seriously dangerous consequences of not giving this treatment, including self-harming and suicide, are clearly well attested.

‘Accordingly, we recommend that, in the current review of the service specification and protocol for the Gender Identity Development Service, consideration be given to reducing the amount of time required for the assessment that service-users must undergo before puberty-blockers and cross-sex hormones can be prescribed.’

WPATH:Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence (Nuttbrock et al., 2010), withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents. 

What if I don't want to accept responsibility for prescribing, monitoring and testing?

A GP may reasonably decline to accept responsibility for prescribing, monitoring and testing if the GP is not assured that the recommendation for prescribing has been made by an expert gender specialist, as long as the GP is also satisfied that declining responsibility would not pose a significant clinical risk to the individual.
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