Gender Identity Service

This page explains what you can expect after you have been referred to our service.

• 1. Referral
• 2. Initial assessment
• 3. End of assessment appointment
• 4. Diagnosis and care pathway
  • Treatments
• 5. Ongoing support
• 6. Discharge

1. Referral

You can be referred to us by your GP or another NHS healthcare professional. It’s helpful if your GP makes the referral, as they will need to support any ongoing hormone treatments. Learn more about our referral process.

2. Initial assessment

Your first assessment will usually be with a Gender Identity Specialist Nurse. They will ask about your physical and mental health, social circumstances, and gender identity. This helps us understand your journey and prepare for the next steps.

3. End of assessment appointment

After the initial assessment, you will have an end of assessment appointment with a psychiatrist or psychologist. They will ask similar questions to those asked by your Gender Identity Specialist Nurse, sometimes in more depth. At the end of this appointment, you may receive a diagnosis or some recommendations.

If a diagnosis cannot be confirmed, you may need an extended assessment. If a diagnosis is not appropriate, you will be discharged back to your GP with recommendations. You can be referred back to us if needed.

4. Diagnosis and care pathway

If you are diagnosed with gender incongruence or gender dysphoria, you will be accepted onto our care pathway. Depending on your needs, treatments may include hormones, surgery, and voice therapy. Your Gender Identity Specialist Nurse will discuss these options with you.

Treatments

• Hormone treatments
• Surgery
• Facial hair removal
• Speech and Language Therapy
• Psychological therapy

Hormone treatments

Our team of doctors and non-medical prescribers will assess, recommend, and review hormone treatments. If you are a transwoman or trans feminine, you may be eligible for oestrogen therapy. If you are a transman or trans masculine, you may be eligible for testosterone therapy. Hormone treatments are only prescribed if it is safe for you.

Surgery

• Upper surgery: for those wanting a more masculine chest, mastectomy and chest wall reconstruction can be offered. This requires a positive recommendation from a psychiatrist or psychologist.
• Lower surgery: this surgery changes the form and function of your genitalia. You will need two positive recommendations for this surgery.

When you and your clinical team decide you’re ready for surgery, your referral will be sent to the surgical provider by the Gender Dysphoria National Referral Support Service (GDNRSS).

The GDNRSS team includes Clinical Nurse Advisors who can support you with:

• Information about different surgical techniques and teams
• What to expect during recovery
• Possible risks or complications
• Eligibility criteria for surgery (if required by the provider)
• Waiting times
• Help with switching providers if needed

They offer virtual consultations and have a support line you can call for updates on your referral, your chosen provider, and practical details like travel, parking, what to bring, and where to go on the day

Facial hair removal

For those with facial hair dysphoria up to eight sessions of laser hair removal or electrolysis can be funded. This is usually recommended six months after starting oestrogen therapy.

Speech and Language Therapy

Your voice plays a vital role in how you communicate and express yourself. For some people, the way their voice sounds may feel misaligned with how they experience their gender. Speech and Language Therapy offer gender-affirming voice therapy to help you explore and develop a voice that feels more comfortable, expressive, and true to you.

Therapy is shaped around your individual goals and may include work on pitch, resonance, vocal patterns, and communication style. Our approach centres on safe, sustainable voice use and aims to help you feel confident and empowered in how you sound.

Psychological therapy

Psychological Therapy can be offered to individuals at any stage on the care pathway or for those who are not yet on the care pathway but who are accessing the service. Therapy can be offered to clients who require psychological support for difficulties related to their gender identity. For example, therapy can provide a space for clients to explore their gender identity and image. You may also need access to support throughout your transition process or may need support around difficulties with mood, self-esteem, anxiety or worries about treatment.

Gamete Storage

Cross-sex hormones have an impact on fertility, so you may wish to start thinking about whether you want your own biological children. If this is the case, you may wish to store your gametes (eggs/sperm). If you wish to undergo gamete storage, it may be useful to start looking at local clinics and discuss your options with your GP.

Treatments we cannot provide

Our service cannot provide:

• Breast implants
• Breast augmentation
• Voice/laryngeal/Adam’s apple surgery
• Facial feminisation surgery

5. Ongoing support

Follow-up appointments

You will have follow-up appointments with your Gender Identity Specialist Nurse every six months to discuss your physical health, mental health, and social wellbeing. We review appointment frequency if people progress to surgery referral.

Gender Outreach Worker Support

Our Gender Outreach Workers have lived experience of transition. They can offer one-to-one support, advice, and signposting. The Gender Outreach team can be contacted at any point during your journey through the care pathway. Learn more about the Gender Outreach Worker Support.

6. Discharge

There are a few ways you could be discharged back to your GP:

• You have completed all treatments that you wish to access for your transition. You can always be referred back to us if you have received your diagnosis from us or any other NHS gender clinic and we will allocate you to our priority waiting list.
• It is felt that we are unable to offer a diagnosis and subsequent treatments. Recommendations will always be made and your care discussed with you.
• We require people to take responsibility for their care in partnership with us. If you don’t attend or you cancel multiple appointments, you will be discharged.
• If your care team feel that medical transition would be detrimental to your physical or mental health.