The Medical Route
The following information is relevant if you think medical assistance to transition (hormone replacement therapy (HRT), speech therapy and/or surgery) might be the right option for you. Since Gender Identity Clinics (GICs) tend to have quite long waiting times, it can be worth seeking a referral sooner rather than later. Don’t panic if you haven’t though; transition happens at a different rate for everyone and however long it takes, you will get there in the end.
The NHS: Your GP, your local CCG, and Gender Identity Clinics
Getting medical treatment as a trans person means that in all likelihood you’re going to see multiple different health professionals. The treatments available range from counselling to hormones and surgery, and different individuals will choose to have different treatment(s) depending on their personal needs.
Your first port of call is your GP. It’s often 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, for example, referral to a Gender Identity Clinic (see later).
Some 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, the best thing to do is to swap to another one (you don’t need to give a reason). Trumpington Street Medical Practice has several GPs who have been helpful about trans issues.
CUSU LGBT+ have produced some resources for Cambridge GPs as part of the Make No Assumptions campaign: these are available on the MNA website here.
Your GP may refer you to a psychiatrist for an assessment of gender dysphoria. According to the most recent guidelines this is not strictly necessary and GPs can refer directly to the GIC - however, there have been instances of the GIC refusing to accept referrals until a psychiatric assessment has been carried out. Psychiatric assessment is also used to investigate whether there are any other mental health problems that you would benefit from help with at that time.
Following your assessment, you should be referred to a Gender Identity Clinic. Gender Identity Clinics are few and far between: the Cambridge Clinical Commissioning Group (CCG) usually refers to Charing Cross (formerly West London Mental Health Trust) GIC in London.
However Charing Cross tends to have a very long waiting list for treatment and it may be worth getting your GP to refer you to one of the other six GICs in the UK. The voluntary organisation UK Trans Info has information on the waiting times for each GIC as of September 2014 along with all the most recent NHS guidance on trans healthcare.
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 Liason Service (PALS).
Not everyone opts for the NHS route. While the NHS has the huge advantage of being free, there are long waiting times for referrals (as of January 2015, up to 10 months from referral before the first appointment). If you go to a private clinic, for example Gender Care UK or Trans Health you’re more likely to have more control over your treatment and timescales, although it is obviously much more expensive.
What kind of treatment is available at GICs?
GICs can talk to you about your gender, provide advice on steps forward and form an individual care plan. This may include hormone therapy, chest reconstruction (primarily for AFAB people), genital surgeries, voice training (for AMAB people) and hair removal.
Notes on ongoing NHS procedural reform
It may be important to note that present NHS guidelines for treatment are temporary and subject to an ongoing review that could yield substantial changes.
Since 2013 NHS England has been developing a new service specification and commissioning policy for gender identity services with the stated aim of ensuring a more equitable and personalised approach for patients. Drafts of the new guidelines were published for consultation in March 2015 with the goal of implementation at some point in 2015.
It must be stressed that drafts could be subject to major change but present developments include:
Acknowledgement that gender identity services are covered by an 18 week referral-to-treatment guarantee under the NHS Constitution. NHS England are considering allocation of funding to bring waiting times for genital reconstruction surgery to within eighteen weeks by March 2017 and further funding for Gender Identity Clinics to reduce waiting times.
Specific formal recognition of non-binary genders and alteration of some physical intervention descriptions to apply to all people with gender dysphoria rather than specifically to trans men and trans women.
Inclusion of thyroid chondroplasty (also known as tracheal shave or Adam’s apple reduction) under centralised pathways, rather than leaving patients to seek it based on local Clinical Commissioning Group policies.
Inclusion of gamete storage via cryoperservation for a maximum of 10 years under centralised pathways, rather than leaving patients to seek it based on local Clinical Commissioning Group policies.
Increased provision of hair removal relative to the interim NHS guidelines. For photoepilation (IPL and laser), funding for up to two blocks of eight sessions is proposed. For electroepliation (electrolysis), funding for up to three blocks for eighty hours is proposed. An alternative combination of one eight session block of photoepilation and one eighty hour block of electroepilation is proposed.
As a result of this, awareness of developments in the near future may be helpful to trans people seeking access to better treatment options.
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 here: http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx
This page provides links to various resources, some medically related, that may be useful for trans people: http://actionfortranshealth.org.uk/resources/for-trans-people/
The most up-to-date NHS guidelines on treatment for trans people can be found here: http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf (Page 6 shows a particularly clear plan of how treatment is supposed to proceed.) Sadly as of January 2015, this interim protocol has not yet been fully implemented but will be implemented over the following years subject to the availability of funding.
Below is an NHS guide to trans healthcare for GPs:
Content Warning: this page & all links include discussions of dysphoria, medical gatekeeping, descriptions of medical procedures.