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Risk Assessment and Management

Helping you to provide care that is safe and well-regulated.

The evidence for affirmative trans healthcare

Any pharmacy looking to provide care to this patient cohort must be able to satisfy themselves that they are working with organisations that are safe and well-regulated. This page provides an overview of the key information to enable you to carry out a robust risk assessment.

Evidence base for the affirmative treatment of all trans and non-binary individuals.

World Professional Association of Transgender Health

The criteria currently listed for Gender Dysphoria are descriptive of many people who experience dissonance between their sex as assigned at birth and their gender identity.

The World Professional Association of Transgender Healthcare (WPATH) provides a clear overview of the medical necessity of treatment for this population. The statement can be found here.

Legal interpretation – Tavistock v Bell

The recent High Court determination raised concerns around the way in which the NHS Tavistock clinic relayed information to its patients. GenderGP consent processes are explained in full here. GenderGP operates a different model to the Tavistock, and more information can be found here.

The WPATH statement on the harm that may be caused by this ruling can be found here.


It is well known that many medications that are prescribed are unlicensed for use in trans healthcare. You can read more about this here.

However, it is important to note that the medication used and the monitoring required within this patient group, is no different to patients who are being treated for menopause, endometriosis, prostate cancer, precocious puberty, constitutional delay in puberty.

Gender dysphoria is not a highly specialised field that involves dangerous medication requiring comprehensive monitoring. The benefits of having access to care far outweigh the denial of care, particularly in light of NHS waiting times that are in breach of the NHS constitution.

Government guidance for UK based pharmacists on dispensing prescriptions from the EEA and Switzerland

If you are asked to dispense an EEA or Swiss prescription, you should:

Identify the prescriber in the same way that you do now. The name, professional qualifications and contact details of the prescriber (including work address, email address and telephone or fax number with the appropriate international prefix) should be clearly stated on the prescription along with the name of the country in which the prescription was issued.

Refer to the prescribing-approved countries and professions list to check whether:

  • the prescription was issued in an approved country
  • the prescriber is practising in a profession recognised by the UK in relation to that country

You may contact the competent authority in the country in which the prescription was issued in order to check the registration of the prescriber and whether they are authorised to issue a prescription of that kind in that country. You may dispense the prescription if it has been issued in an approved country on the list and is signed by a qualified prescriber practising in an approved profession on the list.

If the prescription is from a country or prescriber that is not on the list, you should not dispense the prescription and instead use your professional expertise to help the patient.

This does not affect your right to exercise your professional discretion to refuse to dispense a prescription if any of the following apply:

  • it would not ordinarily be dispensed in the UK
  • there are doubts over its authenticity
  • there are concerns about the clinical appropriateness of the medicine(s) for that patient
  • it would cause any issues of health and safety


Risk of barriers to care

In balancing the risks of providing essential pharmacy services to this patient cohort, there must also be an analysis of the risk of NOT providing services. Patients who struggle to get access to medical and pharmaceutical healthcare services often turn to the grey or black market.