In the first instance contact your GP in order to get the referral process underway.

Under 18s: Please note the GIDS service is undergoing a period of significant change and the information below is based on the previous systems. Please click here to read their Interim Service Specification released June 2023

The GP will refer to the specialist Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust who will work with the whole family. It is often also beneficial (and advised by the Tavistock) for GPs to also refer to a Child and Adolescent Mental Health Service (CAMHS) to ensure you receive emotional support to look after their wellbeing. 

Over 18s: The GP will refer to the Tavistock and Portman NHS Foundation Trust: Gender Identity Clinic for Adults. To ensure you receive appropriate support to look after their emotional wellbeing, you can ask your GP for guidance on referring to local adult psychological services.

It’s vital that trans young people feel supported and are seen as individuals when they seek help. Unfortunately, not all GPs are understanding and some of our members have told us some very dismissive and discriminatory responses they received when they first came out to their doctor.

Remember you have every right to request a different GP if you are not receiving the support  you need and deserve. And you can reach out to the Free2B team for support.

Under 18s: Please click here to read their GIDS NHS Interim Service Specification released June 2023 – it includes information regarding accessing private health care.

How to pick a private doctor?

If you’ve got the money to go private, here are some things to consider when going private to get assessed, prescribed or have gender affirming surgery.

Get quotes from different transgender clinics, check out their websites, call and talk to them and get a feel for how they operate. Have a checklist of questions to ask when making enquiries by email or by phone. Get clear quotes from the clinics – what will the total cost be?

Be prepared

This is going to be a big leap from NHS healthcare and is a much higher price for prescriptions. Before having any trans healthcare you will need to first have a psychological assessment to discuss your experience and be diagnosed with gender dysphoria. There will be multiple consultation appointments with the prescribing doctor and/or surgeon. Each will be individually costed. You should always be able to get a clear estimate on what the cost range will be depending on your needs.

Ask friends

Ask trans friends who’ve had the same procedures or have taken hormones from a private prescription. Would they recommend their doctor? If you don’t know another trans person who has done this, then consider looking to join a trans support group to connect you with trans communities.

Compare

Check clinic reviews, be aware of fake reviews and look beyond the clinics own site for reviews. The site trustpilot is a good place to check – some clinics also do other services that may not be relevant to you or gender affirmation, so scroll through and find specific reviews of people who have had gender affirming support or procedures that are the same as what you want to get. Put together a short list of clinics available.

Get support

Sit with a trusted friend or family member and write up the pros and cons of the different clinics you’ve found. Write down the prices and service offered. You may find the clinic you felt most comfortable with might not be the cheapest. Talk through with your trusted friend or family member for support in making the best decision for you.

It may also be helpful to discuss your plans with your NHS GP. Sometimes your GP may be asked to liaise with the private practice.

Red flags

– Clinic offers much cheaper quotes than others

– Requiring large sums up front – you should only be paying for upcoming appointments

– Sending you hormones without a prescription, you should have a prescribing doctor you then collect your prescription from a pharmacy

– Can’t find them on any independent review sites

– Language used such as ‘breast reduction’ instead of breast removal

Under 18s: Please note the GIDS service is undergoing a period of significant change which impacts their procedures for prescribing blockers. Please click here to read their Interim Service Specification released June 2023

Hormone Blockers:

These suppress the body’s natural sex hormones:

For trans fem people – blockers will suppress the testosterone that their body would normally produce.

For trans masc people – blockers will suppress the oestrogen that their body would normally produce.

If blockers are started after puberty has taken place, they cannot ‘reverse’ all of the body’s changes. For example, once a voice has broken it cannot be restored.

N.B The NHS states that although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. For full details on hormone therapy and the impact of blockers / hormones click this link to access the NHS guide to Hormone Therapy.

Under 18s: Please note the GIDS service is undergoing a period of significant change which impacts their procedures for prescribing cross-sex hormones. Please click here to read their Interim Service Specification released June 2023

Cross-sex hormones are prescribed to individuals where appropriate to enable their body to develop in line with their gender identity.

The GP and Gender Identity Clinic will work very closely with you to ensure it is the correct path. Hormone levels are also monitored regularly to ensure the treatment is effective.

It is essential that individuals taking cross-sex hormones are carefully monitored and supported by a GP.

In trans fem people, oestrogen may cause the following effects:

• Fat may be distributed on the hips
• The size of the penis and testicles may be slightly reduced
• Some trans women find that erections and orgasm are harder to achieve

In trans masc people, testosterone may cause the following effects:

• It promotes beard and body hair growth
• Male pattern baldness may develop
• The clitoris increases slightly in size
• Libido may be heightened
• Muscle bulk increases
• The voice deepens, but not usually to the pitch of other men.
• Periods will stop, although there may be some breakthrough bleeding requiring adjustment of dosage
• Some individuals develop acne

Cross-sex hormones can be stopped at any time, though some changes to the body will remain. For example, trans masc people have successfully become pregnant by pausing their hormone treatment and allowing their (female) biological body to function. However, changes such as a deeper voice, facial and body hair will remain.

For full details on hormone therapy and the impact of blockers / hormones click this link to access the NHS guide to Hormone Therapy.

When researching surgeons you might want to talk to other trans people who have had the surgery you want and you could check positive trans influencers online, as they may share which surgeon they used. It’s important to look for people with the same body type as yourself as this impacts on the required approach to surgery.

Some of the key surgery options for trans masc people:

*Breast removal
*Hysterectomy
*Penis construction

Other plastic surgery options can be considered as with any individual wishing to alter their appearance, such as muscle enhancers.

Some of the key surgery options for trans fem​ people:

*Breast enhancement – though often trans fem people find that breasts develop naturally as a result of hormone treatment
*Vagina construction

Other plastic surgery options can be considered as with any individual wishing to alter their appearance, such as Adam’s apple reduction and facial feminisation.

There is a common misconception that all trans people will undergo ALL relevant surgery, but this is not the case.

Each person is different and unique and many trans people are comfortable with making a social transition (name change, appearance etc). Every surgery carries potential risks and so it is a big decision to make.

For example, we have worked with many trans masc people who have chosen to have breast removal surgery, but they choose not to proceed with a hysterectomy (as the hormone treatment prevents monthly periods) and many choose not to proceed with penis construction surgery.