... Medically
This is a set of guides on navigating healthcare in the UK.
Table of Contents
Medical Information
- Dr Powers Presentation (and Commentary and Fact Check)
- Transfem HRT Introduction by Transfeminine Science
- Transmasc HRT Introduction by Hudson’s FtM Resource Guide
- Guide by TransActual
- List of Clinics by Gender Construction Kit
- NHS Clinics by Trans Health UK
- Private Clinics by Trans Health UK
- Private Cost Comparison on r/transgenderUK
- Waiting Times on r/transgenderUK
- Guide by Gender Construction Kit
- Guide by Gender Construction Kit
- Bridging Prescription Guidelines by TransActual
- Twitter thread on abrupt discontinuation by Jack Doyle
- Transfem guide by the Terrence Higgins Trust
- Transmasc guide by the Terrence Higgins Trust
- Guide by TransActual
- NHS Top Surgery Leaflet
- Hudson’s FtM Resource Guide
- Our guide to voice training
Medical Information
This is an engaging introduction to transgender healthcare, although it is recommended to also read this commentary to make sure you understand all the nuances of what’s presented. Transfeminine Science produces thorough reviews and summaries of the medical literature – this is their introduction to transfem HRT. One of the authors also heavily contributes to Wikipedia, which, as a result, also has extremely thorough and accurate information on this topic, including dedicated pages for the side effects and pharmacology of key medications such as testosterone, estradiol, progesterone, bicalutamide, and cyproterone acetate. This is a set of guides for transmasc people, including information on transmasc HRT.
YOUR GP
This is a guide to the support available from your GP. GPs can book blood tests, refer you to a Gender Dysphoria Clinic, and provide repeat prescriptions after you have been assessed at one. Some GPs are also licensed to provide bridging prescriptions to people while they are on the waiting list to avoid the risks of self-medicating, self-harm, and suicide. Policies on things such as this and whether to work with private clinics vary widely and usually depend on the GP surgery and the county-wide Clinical Commissioning Group (CCG), although individual doctors may also be more or less trans-friendly.
Gender Dysphoria Clinics
Gender Dysphoria Clinics (GDCs, formerly called Gender Identity Clinics (GICs)) provide access to hormone replacement therapy (HRT) and referrals for surgery such as chest reconstruction surgery or sex reassignment surgery. NHS clinics may also provide counselling, voice therapy, and fund a small amount of hair removal. However, NHS waiting lists are so long (3 to 5 years as of 2022) that it is generally recommended to begin these steps yourself before this point if you want them (see our guide to social transition). For HRT, many go to private clinics, which tend to have waiting lists from 6 months to a year and cost about £400-£800 annually.
This is a list of GDCs, with more information on individual NHS clinics here and private clinics here. This is a table of up-to-date information on waiting times for all clinics, and this is a cost comparison of private clinics. Private practitioners’ attitudes on certain things can also vary widely (e.g. some will refuse to prescribe if you are overweight) so be sure to ask around and look for recommendations online before booking anything.
This is a list of GDCs, with more information on individual NHS clinics here and private clinics here. This is a table of up-to-date information on waiting times for all clinics, and this is a cost comparison of private clinics. Private practitioners’ attitudes on certain things can also vary widely (e.g. some will refuse to prescribe if you are overweight) so be sure to ask around and look for recommendations online before booking anything.
Self-medicating
Given the waiting times, increasingly many trans people are choosing to self-medicate with hormones sourced from online pharmacies. If you do this, be absolutely sure you have a thorough understanding of the effects and side-effects of any medications you take, and the considerations associated with whichever route of administration you use. This is a helpful overall guide. This guide also provides an overview of HRT for transmasculine people, with a focus on self-medicating safely. However, self-medicating is generally much harder for transmasculine people as testosterone is a controlled drug in the UK.
One common mistake among transfeminine people is taking cyproterone acetate (CPA) at the excessive doses it was traditionally prescribed despite testosterone suppression levelling out past about 10mg, and higher doses having been recently found to be linked to brain tumours. Another is taking finasteride or dutasteride, which are redundant when overall testosterone is sufficiently suppressed, and have been anecdotally associated with depression and sexual dysfunction.
Know that even if they don’t prescribe anything, you can still talk to your doctor and ask them for advice and blood tests. Another extremely valuable resource is other trans people, who tend to have a lot of experience in these things. While online pharmacies with a good reputation are generally trustworthy, you shouldn’t give away your CVV/CVC number, and shipping times can be inconsistent, so be sure to reorder well before you run out.
One common mistake among transfeminine people is taking cyproterone acetate (CPA) at the excessive doses it was traditionally prescribed despite testosterone suppression levelling out past about 10mg, and higher doses having been recently found to be linked to brain tumours. Another is taking finasteride or dutasteride, which are redundant when overall testosterone is sufficiently suppressed, and have been anecdotally associated with depression and sexual dysfunction.
Know that even if they don’t prescribe anything, you can still talk to your doctor and ask them for advice and blood tests. Another extremely valuable resource is other trans people, who tend to have a lot of experience in these things. While online pharmacies with a good reputation are generally trustworthy, you shouldn’t give away your CVV/CVC number, and shipping times can be inconsistent, so be sure to reorder well before you run out.
Referrals
After you have decided which NHS GDC you would like to be referred to, see this guide for information on what to expect when seeing your GP.
Your GP may suggest referring you to a psychiatrist instead. This procedure is unnecessary and time-consuming and, unless you want to see one, you can ask to be referred directly to a GDC. Your GP is required to follow your wishes and is qualified to make the referral, even if they’ve never done it before.
A few weeks after your GP has submitted your referral, contact the GDC 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 email the GDC straight away.
Your GP may suggest referring you to a psychiatrist instead. This procedure is unnecessary and time-consuming and, unless you want to see one, you can ask to be referred directly to a GDC. Your GP is required to follow your wishes and is qualified to make the referral, even if they’ve never done it before.
A few weeks after your GP has submitted your referral, contact the GDC 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 email the GDC straight away.
Blood Tests
Prescriptions
This is a guide to bridging prescriptions. This is a guide on what to do if your GP abruptly discontinues a prescription.
Sexual Health
See this guide on sexual health for trans women and transfeminine/non-binary people, and this guide for trans men and transmasculine/non-binary people. This is an article which explores lesser known sexual side-effects of transfem people taking HRT.
Surgery
This is an overview of the different surgeries available and not available on the NHS. This is a guide to choosing a surgeon which contains a list of NHS leaflets on what to expect and how to prepare for different surgeries, including orchidectomy, labioplasty, vaginoplasty, intestinal vaginoplasty, and transmasc top surgery. This is a set of guides for transmasc people which includes information on top surgery, hysterectomy and oophorectomy, and transmasc bottom surgery. See here for updates on the current availability of phalloplasty and metoidioplasty on the NHS.
Voice
Surgeries claiming to be able to feminise your voice rely on incorrect assumptions about what influences vocal gender perception and can cause serious damage. GDCs will often refer you to a speech and language therapist which, although not completely useless, don’t usually have the right skills or training to teach you how to change the gender presentation of your voice. A voice coach should be trans themselves and able to demonstrate what they claim to be able to teach. However, changing the gender presentation of your voice is also fully achievable on your own – see the voice section of our guide to social transition.
