Using GenderCare: Dr Lorimer

GENERAL
Everyone who embarks on a gender-related transition does so in their own (entirely valid) way. Similarly, every gender clinician has their own way of practising. Dr Lorimer's approach may or may not suit your transition. This guide is intended to help you decide whether he would be a "good fit" for your own treatment needs.

Please read through the relevant sections of the GenderCare website (https://gendercare.co.uk), including the following pages:

Fees (https://gendercare.co.uk/fees.shtml)
Frequently Asked Questions (https://gendercare.co.uk/faq.shtml)
Dr Lorimer's own page (https://gendercare.co.uk/stuart-lorimer.shtml).

Additional information can be found on the GenderCare Facebook page (updated by Dr Lorimer): https://www.facebook.com/drstuartlorimer

RECENT UPDATES (as of April 2020)
"Bridging hormones"
Dr Lorimer no longer offers the option of "bridging hormones" to new patients. He can form an opinion, make a diagnosis and recommend hormones but these cannot be started until after an appointment with an endocrine doctor (usually Dr Leighton Seal or Dr Jonny Coxon). Dr Seal and Dr Coxon have waiting lists of several months so you should consider contacting them as soon as you have a confirmed appointment date with Dr Lorimer. Their email contact details are as follows:
Dr Leighton Seal endoappt@protonmail.com
Dr Jonny Coxon jonny.coxon@protonmail.com

COVID-19 and remote assessment
In response to coronavirus, the General Medical Council (GMC) has encouraged doctors to consider "whether treatment can be delayed or provided differently (e.g. remotely)". In place of face-to-face meetings, Dr Lorimer has begun offering remote video assessment through Zoom (https://zoom.us) an encrypted version of Skype. Not everyone can be assessed remotely. The GMC has advised that it can be used in situations that are straightforward but not where someone has "complex clinical needs or is requesting higher risk treatments". In deciding who he can and cannot see in a Zoom clinic, Dr Lorimer has to err on the side of caution and may decide that your situation is too complex for him to assess remotely. If this is the case, please try not to take it personally. He may be willing to offer a face-to-face appointment when the pandemic is over. It is also important to accept that, during the period of coronavirus, GPs, surgeons and routine blood testing services are fully occupied and likely to be so for several months. Dr Lorimer can make recommendations for treatment (for example, chest surgery) but the treatment itself will have to wait until the pandemic is over.

SOCIAL TRANSITION
Living outwardly in a social role and presentation consistent with your experienced gender is enshrined in the ICD-11 HA60 definition. Dr Lorimer practises according to guidelines from the World Professional Association for Trans Health (WPATH) and the Royal College of Psychiatrists (RCPsych) but is also an NHS doctor: his approach is also guided by current practice in UK NHS gender clinics. There it is seen as fundamental that those seeking gender treatments also make progress towards living explicitly in a social gender role consistent with this.

Ways of demonstrating this include making an official name change (using sites such as https://freedeedpoll.org.uk or http://www.deedpoll.org.uk/AdviceForTransgender.html), showing Dr Lorimer documentation that includes your chosen name (for example, pay slips, student ID, etc.) or asking your employer to write a brief letter stating how long they have known you and in what name/gender pronouns.

HORMONES
Dr Lorimer can recommend hormones but these cannot be started until after an appointment with an endocrine doctor (usually Dr Seal or Dr Coxon) so you should budget for a minimum of two 60-minute appointments. Every hormone assessment is different and is tailored to your individual needs but Dr Lorimer generally requires the following:
You must be aged 18 or older
You must have capacity to make treatment decisions (and to give consent)
You must have considered (addressed or decided against) gamete storage
You must be stable in terms of current physical and psychological health
You must demonstrate social transition or a credible plan to do so
You must be agreeable to Dr Lorimer communicating with your GP

If you are in the early stages of social transition, Dr Lorimer may recommend low-dose hormones in the first instance. In order to escalate the dose, you would need to demonstrate that you have made progress with social transition.

SURGERIES
Chest reconstruction
Every chest surgery assessment is different and is tailored to your individual needs but Dr Lorimer generally requires the following:
You must be aged 18 or older
You must have capacity to make treatment decisions (and to give consent)
You must be stable in terms of current physical and psychological health
You must demonstrate that you are established in terms of social transition
You must be agreeable to Dr Lorimer communicating with your GP and surgeon
You should, ideally, be established on testosterone supplements

Where someone plans to undergo chest surgery before or in the absence of testosterone but all other criteria are met, Dr Lorimer may be willing to see you but stipulate that an additional supportive gender specialist assessment is needed from one of his colleagues.

Genital reconstruction
Every genital surgery assessment is different and is tailored to your individual needs but Dr Lorimer generally requires the following:
You must be aged 18 or older
You must have capacity to make treatment decisions (and to give consent)
You must have considered (addressed or decided against) gamete storage
You must be stable in terms of physical and psychological health
You must be agreeable to Dr Lorimer communicating with your GP and surgeon
You must demonstrate (through official name change, pay slips, etc.) at least 12 consecutive months of social transition
You must be established on hormones for at least 12 consecutive months
Transfeminine: you must be able to demonstrate (through blood tests) that your testosterone is suppressed to less than 3 nmol/L

Two supportive recommendations are needed for genital surgery. If the other recommendation has been provided by a clinician from a service other than GenderCare, Dr Lorimer may ask to read the relevant report before agreeing to see you.

Other gender-related surgery
Other gender surgeries (for example, facial feminising procedures) do not usually need gender specialist referral but WPATH notes that gender specialist clinicians "can play an important role in assisting clients in making a fully informed decision about the timing and implications of such procedures in the context of the social transition". In practice, some surgeons ask for an assessment of mental health, capacity and overall functioning.

Every surgery assessment is different and is tailored to your individual needs but Dr Lorimer generally requires the following:
You must be aged 18 or older
You must have capacity to make treatment decisions (and to give consent)
You must be stable in terms of physical and psychological health
You must be agreeable to Dr Lorimer communicating with your GP and surgeon
NON-BINARY
Dr Lorimer is experienced with and generally happy to treat people with non-binary gender identities. He notes, however, that because there is less evidence regarding the outcome of hormones/surgery for non-binary people, non-binary treatment needs are less likely to be considered straightforward. If you are non-binary, Dr Lorimer may decide that
a) your situation is too complex to be assessed in a remote video assessment, or
b) an additional supportive gender specialist assessment is needed from one of his colleagues.

Every assessment is different and is tailored to your individual needs but Dr Lorimer generally requires the following:
You must meet the same requirements (outlined above) as those with binary identities
Depending on your treatment objective, you must demonstrate social transition or a credible plan to do so
Dr Lorimer acknowledges that, in a broadly binary culture, non-binary social transitions may be trickier or more nuanced than their binary equivalents but progress can still be demonstrated. For example, even if you opt to keep your given name, you can make an official change by deed poll to include a neutral prefix or "balancing" middle name(s). Similarly, you can ask your employer to write a brief letter stating how long they have known you and in what name/gender pronouns.

COMMUNICATION
Email
Dr Lorimer uses secure email service ProtonMail (https://protonmail.com/) and encourages you to consider setting up a free account there (perhaps in the name you'd prefer to be called by): if both the sending and receiving email accounts are ProtonMail, then all content between those accounts is automatically encrypted. Dr Lorimer receives a large volume of email. You can help his administrators by doing the following:
Use the name by which we know you (if this is not apparent in your email address, please use your full name to sign each email)
Try to use the same email address throughout (we understand this may change when you change your name)
If you have seen Dr Lorimer previously in GenderCare, use EXISTING PATIENT in your email subject line
When we respond to you, we may alter the subject line of the email with keywords to help tag the correspondence for our own use; please don't change it back
Try not to send multiple emails

Draft report
Following your meeting with Dr Lorimer, he writes his report. This usually takes up to 3 weeks but can take longer if it is a busy or holiday period or if Dr Lorimer needs to discuss your case with other clinicians.

Dr Lorimer then emails a draft version of his report to you so you can check personal details especially addresses for accuracy. The draft report is encrypted and password-protected: at the time of his appointment, he provides a unique password that must be entered to see the report. Once you have read through it, you must reply to confirm the report is accurate. Please remember that the report is an account based on the information known to Dr Lorimer at the time of your meeting; it will not include "updates" that have happened since then.

Telephone
Dr Lorimer's telephone – 07805 150909 – is specifically for contacting him, not other clinicians. It is a secondary service; it is usually better to contact him via email. His administrators generally respond outside of office hours except for on clinic days, when they are on hand to take messages from those running late or having other difficulties attending their appointment.

If contacting Dr Lorimer by telephone, you can help us by doing the following:
Leave a clear message
Include your name and return telephone number (if you wish to be called back)
Note that confidentiality guidelines mean we cannot impart information to third parties (we cannot even confirm that someone is a patient)

Dr Lorimer and his team appreciate your patience.

LINKS TO FURTHER INFORMATION
Official name change
https://freedeedpoll.org.uk (with specific advice for trans and non-binary people at
http://www.deedpoll.org.uk/AdviceForTransgender.html)

Gamete storage
https://www.hfea.gov.uk/choose-a-clinic/clinic-search/

Counselling (within GenderCare)
https://gendercare.co.uk/how-to-use-gendercare.shtml

Counselling (outside GenderCare)
http://pinktherapy.com
https://cliniq.org.uk
http://brightonsexualhealth.com/service/clinic-t/
http://www.ellismorgan.org.uk

Endocrine reading
https://www.jkp.com/uk/transgender-health-1.html

Trans-specific walk-in clinics for blood testing
https://cliniq.org.uk
http://brightonsexualhealth.com/service/clinic-t/

Support (transmasculine-specific)
http://transnetworklondon.org.uk/members/tmsa-uk/
https://ukftm.tumblr.com

Secure end-to-end encrypted email
https://protonmail.com/

Privacy policy
https://gendercare.co.uk/privacy-notice.shtml

NEXT STEPS
If, having read the above, you would still like to proceed with arranging an appointment, the next step is to send Dr Lorimer your replies to the queries below. None is a trick question; he asks them to get a better sense of whether/how I can help.

(We appreciate that you may have provided some of this information already.)

1 What name do you prefer to be known by (when we meet you and/or in written reports)? Have you made an official name change? What pronouns do you use?
2 How old are you?
3 Have you used other gender services, private or NHS?
4 Are you living, day to day, as you'd like to live, gender-wise? Have you made a social transition? If not, what are the obstacles? What needs to change?
5 What do you do during the day (work, study, volunteering, social activity)?
6 Are those close to you (family, friends, partners, colleagues) aware of your gender circumstances? Do they support your plans?
7 Have you had any treatment for physical health conditions?
8 Have you had any treatment for mental health conditions? Have you ever harmed or tried to kill yourself?
9 Are you on any medication for physical or mental health conditions (including contraception)?
10 What is your objective in seeing me?

I take all reasonable steps to ensure that your personal data, both sensitive and non-sensitive, is collected, stored and processed in accordance with the General Medical Council guidelines on confidentiality, the Gender Recognition Act, the Information Commissioner's Office guidance and the General Data Protection Regulation (GDPR). Please familiarise yourself with your data rights as outlined in the Privacy Notice on the GenderCare website: https://gendercare.co.uk/privacy-notice.shtml.

Although I maintain the highest standards of confidentiality, I have a professional obligation to disclose if a client or others are at risk. I also engage in peer consultation around client care with GenderCare colleagues, in accordance with good professional practice.

I understand and accept this (delete as appropriate in email reply) YES / NO

All paper clinic reports are sent via first class post to you and to agreed outside agencies (for example, your GP). If I need to discuss you with other GenderCare clinicians, we communicate your information between ourselves using an end-to-end encrypted email service (ProtonMail) to provide an extra layer of security.

Email communication with outside agencies (for example, surgeons, your GP or you yourself) cannot be guaranteed the same level of security after your information has left the ProtonMail network.

I understand and accept this (delete as appropriate in email reply) YES / NO
email
text
telephone

Yours sincerely


Dr Stuart Lorimer
Consultant Psychiatrist and Senior Gender Specialist

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