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Gender care pathways

Gender care pathways will be different depending on your age. If you are under 18 you will be part of children and adolescent services and if you are 18 and above you will be part of adult services.

If you are currently 17 it is recommended that you pursue adult services as it may not be time effective to access children and adolescent services in order then to be transferred to adult services

Undergoing Medical Intervention

No one can tell you whether or not you should undergo hormone therapy or surgery. It's a decision you have to make by yourself, although you can do this with the support of a gender specialist, counsellor or mentor, as well as your family members, partners, friends and anyone else you trust and who knows you well. It’s also good to talk to other trans people who have made decisions that are right for them.

Some people know straight away what they want to do medically as part of their transition. Other people may take a process of months or years to make decisions. For many trans people transition is a slowly evolving process of decision-making. For others, they may have a set plan from the beginning as to what they want.

However you feel about it it's important to remember that there is no rush. You should make decisions at your own pace. You shouldn’t feel pressurised by others or put yourself under pressure. Sometimes you can feel like you just want to get there and think to yourself ‘If only it was this time next year’. But transitioning isn't a race. You should take the time to make sure whatever decisions you make, you're doing it for yourself. Making sure you're on the right path for you is one of the most important things you can do. It is always your own personal transition.

Beginning any kind of medical intervention can feel like a daunting task. While it may seem like a long journey to undergo, being well informed before and during your treatment can make the whole process a lot less stressful. Your gender specialist team will be the main professional people responsible for ensuring that you have the most up to date, accurate information that will empower you to make decisions.

You don't need to think that you have it all worked out either. If, for instance, you're not sure about surgery but definitely want hormones, then that is completely valid and should be respected by the staff who are supporting you.

Seeing your GP

As part of your transition or as you start questioning your gender identity you may wish to share your thoughts and feelings with your GP.

If you don't know who your GP is or you're not registered with a GP, you can find out where your nearest doctors surgery is on the NHS website. Having a GP that you get on with is always a good thing whether it’s a trans related thing or about something non-trans related. Building a good relationship with your GP may be really important and useful to you.

It is understandable that seeing your GP for the first time in regards to trans stuff can be a nerve wracking experience. Here are a couple of tips to help you feel less scared:

Getting referred to a gender identity service

You and your GP may decide that you should have counselling or be referred to CAMHS, CMHT or to the Gender Identity Development Service or a Gender Identity Clinic to explore these feelings further.

Occasionally GPs are not aware of the referral pathways for accessing gender identity services. This list of adult GICs has information about the referral process for each clinic.

If you are over 17 it may help at this point that you know which GIC you would like to be referred to. It does not matter where you live, you can request to go to any GIC across the country. Part of your decision may be about the different waiting times.

Resources for health practitioners

NHS Choices website – Trans Health Section

NHS Choices website - Gender Dysphoria

Trans: A practical guide for the NHS, DoH (Department of Health), 2008.
Aimed at people working within the NHS to enable them to understand the basics of trans issues and how to treat trans people fairly.

Gender dysphoria services: a guide for General Practitioners and other healthcare staff

NHS UK, April 2013 Explaining to GPs how to work with trans people and refer them on appropriately. Contains useful information on the roles of different health professionals.

Yorkshire and Humber Protocol- Providing Hospital Services To Trans Patients Yorkshire and Humber NHS, 2012.
An example of a protocol setting out practical considerations relating to trans people in hospital.

Interim Gender Dysphoria Protocol and Service Guideline 2013/14 NHS England, 2013.
Treatments, treatment criteria, and a useful process / access flowchart (p6)

Good practice guidelines for the assessment and treatment of adults with gender dysphoria
Royal College of Psychiatrists, October 2013

Standards of Care for the Health of Transsexual, Transgender, and Gender- Nonconforming People, Version 7 WPATH (World Professional Association for Transgender Health), 2012.
The full international protocol for the treatment of trans people

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