Getting medical treatment as a trans person means that in all likelihood you’re going to see multiple different health professionals, who will have varying levels of knowledge about trans stuff. The treatments available range from counselling to voice therapy to hormones and surgery, and different individuals will choose to have different treatment(s) depending on their personal needs. Not all trans people feel that medically transitioning is necessary for them to be comfortable in their gender, and if you’re one of those people, that’s totally OK and you’re no less trans because of it! This page offers some tips and information for those who do wish to go down that route, and for those who want to find out more.
Talking to your GP
Your first port of call is probably going to be your GP. It’s a good idea to have a very clear idea about what you want from your GP before you go to your appointment. It’s also a good idea to be very direct about what you want from them, such as a referral to a Gender Identity Clinic (GIC). Most GPs will not have much or any experience with trans issues, and you may have to guide them through the referral process. If your GP is not very helpful or supportive, you can swap to another GP, or another surgery - you don’t need to give a reason why. Click here for a link to some Trans-friendly Places in Oxford.
Action for Trans Health have extensive resources, including how to navigate the NHS. We would recommend you look here first before going to your GP. Although some documents are from 2014, there is a lot of really useful information.
Talking to your GP
Your first port of call is probably going to be your GP. It’s a good idea to have a very clear idea about what you want from your GP before you go to your appointment. It’s also a good idea to be very direct about what you want from them, such as a referral to a Gender Identity Clinic (GIC). Most GPs will not have much or any experience with trans issues, and you may have to guide them through the referral process. If your GP is not very helpful or supportive, you can swap to another GP, or another surgery - you don’t need to give a reason why. Click here for a link to some Trans-friendly Places in Oxford.
Action for Trans Health have extensive resources, including how to navigate the NHS. We would recommend you look here first before going to your GP. Although some documents are from 2014, there is a lot of really useful information.
| Support From Your GP - TransActual.pdf |
Referring to a GIC
Your GP may suggest referring you to a psychiatrist for an assessment of gender dysphoria, formerly known as gender identity disorder. This procedure is unnecessary and time-consuming and, unless you want to see a psychiatrist, you can ask to be referred directly to a GIC. If you ask to be referred directly to a GIC, your GP is required to follow your wishes, and even if they’ve never done it before, they are qualified to make the referral.
Each GIC has a different referral process - some simply require a letter from your GP, others want you to fill out a form that can be found on their website - so make sure to find out what the process is for the GIC you want to be referred to. If there’s a form to be filled out, print it out and bring it with you to your appointment. While some GPs will be able to offer their recommendations on which GIC would be most appropriate for you to seek a referral to, most will not, and it’s a good idea to have done some research yourself in advance of your appointment with your GP.
Gender Identity Clinics are few and far between, but there is one not too far away from Oxford at Charing Cross in London. You can find out more about the different NHS GICs in here: https://www.gires.org.uk/health/nhs-gender-identity-clinics-england. Factors to take into consideration when choosing a GIC are distance from where you live, waiting times, treatment the GIC can offer, and the amount of appointments you’re given. Everyone has a different experience with GICs, and it’s likely that you’ll meet people with very different opinions about the same GIC. Try not to worry too much if you hear negative reviews about the GIC you’re being referred to - your experience might be completely different to theirs.
A few weeks after your GP has submitted your referral, contact the GIC yourself if you can to check that they have received it. If you change any of your contact details, such as your address or phone number, make sure to tell the GIC straight away in writing. They normally contact you on a withheld number before sending you a letter, so it’s important that your details are up to date.
If at any stage of the process you are unhappy with the conclusions a medical professional has come to, you can ask for a second opinion. In the event that you are not treated with respect or have another reason for complaint, you can look to the NHS Patient Advice and Liaison Service (PALS).
What kind of treatment is available at GICs?
GICs can provide you with counselling, voice training, hair removal, and hormone replacement therapy (HRT). They are also able to refer you for gender confirmation surgery, and can provide gender recognition certificates. Additionally, they offer support for friends and relatives. You don’t need to know exactly what you want when you first refer to a GIC - part of their job is to help you figure that out if you’re unsure, and to provide you with more information.
Your first appointment will be with a psychiatrist, who will ask you questions about your life to gauge an understanding of your gender history and factors relating to it. They may ask a few questions about how you’d like to transition further, although this is typically discussed in more detail at a follow up appointment with a doctor about 6 months later, when it’s possible to sign for hormone therapy. Some GICs work slightly differently, and require you to have more appointments at slightly shorter intervals. If you haven’t yet come out to your friends and family or haven’t started to socially transition, they will probably ask you to do this first and will try help you initiate the process.
Hormones
If you want to go on hormones, you’ll be required to take a series of blood tests, either administered by the GIC, or by your GP. The purpose is to check your physical health and give them a ‘baseline’ so that they can see if HRT will have any undesired effects on you. You’ll be required to have regular blood tests when you start HRT, to ensure that everything is going smoothly. There are several different types of hormones which are taken in different ways, most commonly in the form of injections or gel for testosterone, or pills, injections or gel for oestrogen. Those seeking oestrogen will also most likely have to take testosterone blockers, and you may also take progestogen. Your GIC will be able to tell you more about the differences and recommend which would be most appropriate for you.
Surgery
Typically, GICs require you to have been on hormones for at least 6 months before agreeing to sign for FTM top surgery, and you’ll usually need to signatures from the GIC, although this can be flexible depending on your circumstances. You will usually have a consultation and a pre-operation appointment with the surgeon prior to surgery. Surgery typically involves a one-night stay in hospital, will be carried out under general anaesthetic, and drains or a post-op binder might be used to reduce swelling. You will probably have a post-op appointment after surgery to ensure that everything is healing satisfactorily.
GICs usually require you to be 12 months on hormones and at least 18 years old before signing you for FTM lower surgery, and to have lived fully as male for 12 months. A referral requires two doctors to be in agreement. Lower surgery usually involves more than one operation.
For MTF lower surgery, you are typically required to have lived for 12 months as a woman, and be at least 18 years old. You are also required to have confirmation from two medical professionals, a psychiatrist specialising in gender care and a doctor. For the operation, you’ll be required to stay in hospital for 7-8 days and will have a recovery time of 6-12 weeks.
There are many good resources on the web that discuss the effects of hormones and the different kinds of surgery available. You can find a discussion of these at the following address: www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx
Private Treatment
Not everyone opts for the NHS route. While the NHS has the huge advantage of being free, and you only have to pay for hormones, there are long waiting times for referrals. The average waiting time before initial assessment at Charing Cross is around 13 months, although some GICs have a waiting list of up to 2 years.
If you go to a private clinic, for example GenderCare UK, you’re more likely to have more control over your treatment and timescales, although it is much more expensive. Each appointment costs between £130-£270 depending on the type of appointment, plus charges for hormones and blood tests. However, you’ll have fewer appointments and the process will move a lot faster, and you can refer to a GIC at any point during or after private treatment. You may be able to be prescribed hormones after your first appointment, although sometimes you will need appointments with two different doctors.
You can find lots of helpful, frequently-updated information about transitioning in the UK here, including waiting times for GICs, costs for private funding, surgery results and information on changing your name, plus lots of FAQs: https://ukftm.tumblr.com
