Gender Care

GenderCare

UK SPECIALISTS IN GENDER THERAPY

 
CORONAVIRUS
Please note that many of the services offered by GenderCare clinicians have changed as a result of the COVID-19 pandemic. If in doubt, please check with the relevant clinician(s) and check the GenderCare Facebook page
(regularly updated by Dr Lorimer):
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Frequently asked questions

SERVICES
TIMESCALES
COSTS
WHO WE SEE
MAKING AN APPOINTMENT
APPOINTMENTS
STARTING HORMONES
GETTING HORMONES
SURGERY
GENDER RECOGNITION CERTIFICATE
MIXING PRIVATE AND NHS
CONTACTING US
GIVING FEEDBACK
FURTHER INFORMATION


SERVICES
What services do you offer?
The services we offer are listed here: https://gendercare.co.uk/index.shtml.

Where do I start?
This page should help you: https://gendercare.co.uk/how-to-use-gendercare.shtml

How do I use GenderCare?
This page should help you: https://gendercare.co.uk/how-to-use-gendercare.shtml

How do I choose a clinician?
This page should help you: https://gendercare.co.uk/how-to-use-gendercare.shtml

Can you assess me by telephone, Skype or email?
In response to the COVID-19 pandemic, the General Medical Council has acknowledged that clinicians "may need to depart from established procedures" and advised consideration of "whether treatment can be delayed, or provided differently (eg remotely)". Accordingly, GenderCare clinicians are, at least during the pandemic period, practising remote rather than face-to-face assessment using encrypted video service Zoom or similar platforms.

For further details, check with the individual practitioner.

Can you provide counselling via telephone, Skype or email?
See above.

Can you provide face-to-face counselling?
Yes, outside of the pandemic period, we provide face-to-face counselling. Details are here:
https://gendercare.co.uk/how-to-use-gendercare.shtml

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TIMESCALES
What are the waiting times for GenderCare?
It varies but tends to be months rather than weeks. Email to ask your preferred clinician, their contact details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml

If you're able to make appointments at short notice, let your clinician know: people drop out at the last minute and we frequently offer those appointment slots a day or two in advance. Please check your email regularly and get back to us promptly!

If you have a particular deadline to be seen, let us know.

How long after the appointment before my letter arrives?
It varies between clinicians but, usually, it's around 2-3 weeks.

Sometimes, if blood results have to be discussed or if it's a holiday or busy period when one or more clinicians are absent, it can take longer for a letter to go out.

How long before I'm started on hormones?
It depends on your particular situation and clinician but, as a general rule, you need to undergo two assessments, one with a general/psych and one with a medical/endo clinician – for example, one appointment with Dr Lorimer and one with Dr Seal.

If in doubt, email and ask your preferred clinician, their details are here:http://gendercare.co.uk/how-to-use-gendercare.shtml.

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COSTS
How much does it cost to get started on hormones?
Costs are here: https://gendercare.co.uk/fees.shtml. As a rule of thumb, you should budget for two appointments, for example, one general/psych appointment with Dr Lorimer, Richards, Lenihan or Dundas (£250-£300, depending on the clinician) and one medical/endo (£250-£300, depending on the clinician) i.e. up to £600 in total.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

How much does it cost to see you after starting hormones?
It depends on your individual situation but, until you are under NHS services that can assume responsibility for your ongoing care, you should meet at least annually and preferably twice per year with either your general/psych clinician or your medical/endo clinician.

Where the main focus is medical (for example, reviewing hormones) it's sensible for you to see the medical/endo clinician. Where the focus is wider (for example, discussion of the social aspects of transition) or relates specifically to assessing surgical eligibility (for example, as part of referral for chest or genital surgery), it's appropriate to see the general/psych clinician.

Usually, your clinician will advise who you should see next. If in doubt, email and ask:
https://gendercare.co.uk/how-to-use-gendercare.shtml.

Fees for review appointments vary by clinician. Details are here: http://gendercare.co.uk/fees.shtml

Many people use GenderCare while on the waiting list for NHS gender services. Depending how soon you're likely to be seen within the NHS pathway, you might not need review appointments with any clinician.

What's the monthly cost?
There isn't a monthly fee; we charge for individual appointments with a clinician. The overall cost will vary depending on the number of appointments. In between appointments, we're happy to answer email and other queries at no extra cost.

Are there any ongoing costs?
There isn't an ongoing fee; we charge for individual appointments with a clinician. The overall cost will vary depending on the number of appointments. In between appointments, we're happy to answer email and other queries at no extra cost.

Are there any hidden costs?
No. The assessment cost includes your time with the clinician, a summary sent to your GP and other relevant clinicians, passport letters and private prescriptions (if appropriate). Also included is the cost of time taken in responding to email and other queries and consulting with colleagues (in regard to blood tests, etc.).

Do you charge for private prescriptions?
No – although you'd have to pay the pharmacist the cost of the medication itself.

Can all GenderCare clinicians give me a private prescription?
No. Only the medical clinicians – Drs Seal and Coxon (and, less frequently, Drs Lorimer, Bhatia and Sahota) – can prescribe directly.

How do I pay?
Cash, cheque, bank transfer and PayPal – more or less anything except card payment. We can supply bank or PayPal details on request. Processes vary between clinicians but as a general rule, payment should be made in advance of or at the appointment itself.

Will my medical insurance pay?
Some types of medical insurance may pay for gender dysphoria related assessment and treatment. Most of the clinicians don't deal with third parties, though, so you would have to pay them yourself and then claim the cost back from your medical insurer. We're happy to send you an invoice to help with this.

Can I pay in instalments?
In some cases yes, but you would have to have completed payment by the day of your appointment, for example, you could pay in advance by several bank transfers but you'd have to have paid the complete cost by the day of the appointment itself.

Are there discounts for students or those on benefits?
At present, no, we don't offer discounted rates. This may change in the future.

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WHO WE SEE
I'm a teenager. Will you see me?
We will see ages 18-and-older.

I'm the parent of a teenager. Will you see my child?
We will see ages 18-and-older.

Please note that we require a direct communication, usually written, from the prospective patient themselves before we can offer an appointment date. Once we've taken them on as a patient, confidentiality issues apply: we communicate directly with them and need their written permission to discuss details of their medical care with you.

I'm the parent of a patient. Can I discuss them with you?
Generally speaking, family members (and partners and friends) are welcome to attend appointments with the consent of the patient themselves.

In accepting other information – for example, by letter or email – from a family member, clinicians have to be mindful of the General Medical Council's guidelines on good practice for doctors, specifically paragraph 66 of Confidentiality guidance: Sharing information with a patient's partner, carers, relatives or friends:

"66. If anyone close to the patient wants to discuss their concerns about the patient's health, you should make it clear to them that, while it is not a breach of confidentiality to listen to their concerns, you cannot guarantee that you will not tell the patient about the conversation. You might need to share with a patient information you have received from others, for example, if it has influenced your assessment and treatment of the patient. You should not refuse to listen to a patient's partner, carers or others on the basis of confidentiality. Their views or the information they provide might be helpful in your care of the patient. You will, though, need to consider whether your patient would consider you listening to the concerns of others about your patient's health or care to be a breach of trust, particularly if they have asked you not to listen to particular people."

The sentence in bold is important as it means we cannot guarantee third party confidentiality: it may well be necessary for us to tell the patient what you have said to us, particularly if it influences our assessment and treatment of them.

I'm the parent of a patient. Can I discuss them with you in confidence?
Generally speaking, no. While family members (and partners and friends) are welcome to attend appointments with the consent of the patient themselves, those individuals are considered third parties and clinical confidentiality cannot be extended to them.

In accepting information – for example, by letter or email – from a family member, clinicians have to be mindful of the General Medical Council's guidelines on good practice for doctors, specifically paragraph 66 of Confidentiality guidance: Sharing information with a patient's partner, carers, relatives or friends:

"66. If anyone close to the patient wants to discuss their concerns about the patient's health, you should make it clear to them that, while it is not a breach of confidentiality to listen to their concerns, you cannot guarantee that you will not tell the patient about the conversation. You might need to share with a patient information you have received from others, for example, if it has influenced your assessment and treatment of the patient. You should not refuse to listen to a patient's partner, carers or others on the basis of confidentiality. Their views or the information they provide might be helpful in your care of the patient. You will, though, need to consider whether your patient would consider you listening to the concerns of others about your patient's health or care to be a breach of trust, particularly if they have asked you not to listen to particular people."

The sentence in bold is important as it means we cannot guarantee third party confidentiality: it may well be necessary for us to tell the patient what you have said to us, particularly if it influences our assessment and treatment of them.

I'm the parent of a patient. I understand that you can't guarantee confidentiality to me but why won't you return my emails/telephone calls?
The fact that someone is attending (or will attend) a gender service is itself confidential information: even acknowledging that we recognise a patient's name would be considered a breach of confidentiality.

Duty to protect confidential information extends to administrators, who may be unable to acknowledge your emails/telephone calls.

I'm an OAP. Will you see me?
Yes, depending on your physical fitness, we have no upper age limit.

I am a non-UK citizen. Will you see me?
It depends on your objective. Our standard way of working is to make recommendations to a general practitioner (GP), who then prescribes. If you're not registered with a UK GP, then the options are more limited.

I'm being treated by another gender practitioner. Will you see me?
It depends on the situation but, generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment. This is partly because we prefer to do our own assessments and blood tests first and, if you're already on hormones, this may no longer be possible.

I'm being treated by another gender practitioner. Will you see me to take over my hormone care?
It depends on the situation but, generally speaking, we prefer not to take over your endocrine care if another gender practitioner has already started you on hormone treatment and is managing your care. This is partly because we prefer to do our own assessments and blood tests first and, if you're already on hormones, this may no longer be possible.

I'm being treated by another gender practitioner. Will you see me to provide a surgery assessment?
It depends on the situation but, generally speaking, we prefer not to carry out surgery assessments if another gender practitioner has started you on hormone treatment and is managing your care. Our assessment process may be very different from that of the other gender practitioner.

I'm being treated by another gender practitioner, who has given me one opinion for surgery. Will you see me to provide the other?
It depends on the situation but, generally speaking, we prefer not to carry out surgery assessments in this situation as our assessment process may be very different from that of the other gender practitioner.

I'm being treated by another gender practitioner but am unhappy with their care. Will you see me?
Generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment and is managing your care. Any doctor who starts you on hormones has an ongoing duty of care to you, meaning they're responsible for following you up and addressing any problems caused by those hormones. If they're unable or unwilling to do that themselves, ask them to refer you to a specialist who can.

If you’re unhappy with any doctor’s care, you can make a complaint through their complaints system or, more formally, to the GMC. You can do that online, here: http://www.gmc-uk.org/concerns/23339.asp.

I'm already paying for private prescriptions from another doctor but want to receive my hormones from the NHS. Can you arrange this?
Generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment and is managing your care. Ask the doctor who is issuing the private prescriptions to talk to your GP about receiving hormones within the NHS.

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MAKING AN APPOINTMENT
How do I make an appointment?

Decide which clinician you want to see (if unsure, see here: https://gendercare.co.uk/how-to-use-gendercare.shtml) check their individual page then contact them via their individual email address. Different clinicians may have slightly different processes for gathering information.

Can someone else make an appointment on my behalf?
It's not unusual for parents, partners of friends to contact us, but we also need a statement from the person actually wanting to see us.

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APPOINTMENTS
I want to start hormones. Do I have to see two clinicians?
If you seek hormones, yes, you would need to plan and budget for at least one general/psych and one medical/endo appointment. In most situations, Dr Seal and Dr Coxon would want to see a general/psych assessment from another GenderCare clinician before making a hormone recommendation. Drs Seal and Coxon tend to have longer waiting times so it is advisable to contact them as soon as you have confirmed the general/psych appointment.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I want to have chest surgery. Do I have to see two clinicians?
Generally speaking, yes, you would need to plan and budget for at least two appointments. This is particularly true for those whose situation is atypical or less well-trodden – for example, those with a non-binary gender identity, those seeking chest surgery before or in the absence of testosterone or those with a significant history of physical or mental health issues.

I want to have genital surgery. Do I have to see two clinicians?
Under international (WPATH) and national (RCPsych CR181) guidelines, yes, you would need to plan and budget for at least two appointments. Individual situations vary but, generally speaking, we prefer not to carry out second surgery assessments where the first has been carried out by a gender practitioner outside GenderCare as our assessment process may be very different from that of the other gender practitioner.

Can I see both clinicians on the same day?
Yes, you can – the original idea of GenderCare was that you could have a general/psych and a medical/endo appointment on the same day or, at least, without too long a gap between. It can be tricky to arrange in practice, given different clinicians' locations, schedules and waiting times.

If you wanted to see Dr Seal, for example, his clinics are generally booked up far ahead so you should arrange that appointment (you can contact his secretary on endoappt@protonmail.com) as soon as you have confirmed a date with the general/psych clinician. Contact details for all clinicians can be found here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Where are you based?
Details of all clinicians' clinic locations, including maps and directions, are here: https://gendercare.co.uk/location.shtml.

What should I wear to my appointment?
Wear whatever you feel comfortable wearing.

What should I bring to my appointment?
Your address
Your GP's address
Telephone contact details for your clinician (in case of delays)
Relevant letters relating to past or current treatment
Your name change document (if you've changed your name)
A list of current medication
Proof of age (passport, driving license)
A supportive partner, friend or relative, if you wish
Payment (if you haven't already paid in advance)

In addition, occupational paperwork – payslips, email printouts, student matriculation cards, etc – helps us establish that you are living and functioning as yourself. This is particularly relevant for surgery assessments.

What pre-hormone blood tests do I need for my appointment?
Ideally, bloods are fasting 9am samples (blood is taken around 9 in the morning, before you've eaten) but this isn't always absolutely necessary.

FtM/AFAB/NB Transmasculine:
Serum lipids, liver function, prolactin, glucose or HbA1c, oestradiol, testosterone, LH, FSH, SHBG, full blood count and vitamin D (to assess bone health).

If possible, these bloods should be taken between days two and eight of the menstrual cycle – i.e. 2 to 8 days after a period starts.

If menses are too irregular to estimate the 2 to 8 days interval, carry out the bloods in any case.

If menses are absent (and there is no clear reason, such as contraception) then bloods should be carried out in any case. In unexplained amenorrhoea, this should be discussed as part of medical/endo review.

MtF/AMAB/NB Transfeminine:
Serum lipids, liver function, prolactin, glucose or HbA1c, oestradiol, testosterone, LH, FSH, SHBG, PSA (if aged 40 or over), vitamin D (to assess bone health) – and, in those who have been taking the diuretic Spironolactone, creatinine and electrolytes.

I haven't had all of the blood tests. Should I still attend my appointment?
Yes, do still come to your appointment. Some labs won't do all the bloods, but they're not all essential. You can discuss it with the clinician.

I haven't had any of the blood tests. Should I still attend my appointment?
Yes, do still come to your appointment. You can email the blood results later.

What happens if I'm late?
We will generally do our best to fit you in nonetheless but can't guarantee this. If you're very late, we may be unable to see you that day.

What happens if I miss the appointment?
We generally trust people to attend their appointments. If you don't turn up or cancel on the day itself or at very short notice, we may ask for up to half of the cost of the missed appointment before offering another one.

What happens at the appointment?
The clinician asks questions about your background, current situation and future plans; they want to know how best they can help you. The general/psych appointment is more general and diagnostic while the medical/endo appointment focuses more on your physical health. The overall aim is to try to get you closer to what you want to achieve.

Counselling appointments are more to create a structured space in which you can explore your current thoughts, feelings and situation.

Will I have to undress?
The general/psych assessments are entirely interview-based; they don't examine you at all. The medical/endo assessments are more medical, and they might have to examine you if there's something unusual in your blood results or if they think there might be abnormal development of your chest (very rare) or external genitalia (about 20% of people). If they need to examine you, Dr Seal and Dr Coxon will do so with a female chaperone present.

If there's no clear "baseline" blood test (for example, if you began taking hormones before a full set of bloods was carried out), it's more likely that Dr Seal or Dr Coxon will need to do a physical examination.

What happens if I don't agree to be examined?
It depends on your individual situation and Dr Seal's or Dr Coxon's specific reasons for needing to examine you. They only ask to do an examination when it's absolutely necessary, when you feel comfortable consenting and when there's a female chaperone present.

What do I have to do after the appointment?
Wait for your assessment letter to arrive.

Different clinicians may have slightly different processes for drafting their assessment reports. If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

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STARTING HORMONES
How many times will I need to see you to get started on hormones?
It depends on your situation but you should plan for two appointments. For example, you might need one with Dr Lorimer and one with Dr Seal.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

How many times will I need to see you after starting hormones?
It depends on your individual situation but, until you are under NHS services that can assume responsibility for your ongoing care, you should meet at least annually and preferably twice per year with either your general/psych clinician or your medical/endo clinician.

Where the main focus is medical (for example, reviewing hormones) it's sensible for you to see the medical/endo clinician. Where the focus is wider (for example, discussion of the social aspects of transition) or relates specifically to assessing surgical eligibility (for example, as part of referral for chest or genital surgery), it's appropriate to see the general/psych clinician.

Usually, your clinician will advise who you should see next. If in doubt, email and ask: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Fees for review appointments vary by clinician. Details are here: http://gendercare.co.uk/fees.shtml

Many people use GenderCare while on the waiting list for NHS gender services. Depending how soon you're likely to be seen within the NHS pathway, you might not need review appointments with any clinician.

What are "bridging hormones"?
In the past, some medical/psych clinicians would, in certain situations, start you on hormones before your appointment with the medical/endo clinician. This was sometimes referred to as "bridging".

We no longer offer this service.

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GETTING HORMONES
Do I have to be living full time to get hormones?
Not necessarily but we do prefer it.

Do I have to have changed my name to get hormones?
Not necessarily but we do prefer it. All the clinicians are interested in how you interact with the world currently and what your transition plans are for the longer term. We recognise that, for some people, name change isn't possible or isn't directly relevant.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I have mental health problems. Will that stop me getting hormones?
Not necessarily – although the type and severity of those problems may mean your overall situation is too complex to be managed in the private sector. As a general rule, clinicians will want things to be as stable as possible and may need to communicate with your mental health specialists about this. Your mental health might be relevant to the type of hormones recommended, for example, if you're prone to intense mood fluctuation and are seeking testosterone, a gel might suit you better than an injection. It's important that you provide us with as much detail as possible on any mental health diagnoses and treatment (including medication, hospital admissions, etc).

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I have physical health problems. Will that stop me getting hormones?
Usually no – although the number, type and severity of those problems may mean your overall situation is too complex to be managed in the private sector. As a general rule, there are very few medical conditions that are an absolute no-no for starting hormones. In some cases, clinician might need to communicate with your medical specialists. Your physical health might be relevant to the type of hormones recommended, for example, if you've previously had a stroke or a heart attack and are seeking oestrogen, a gel might suit you better than oral tablets.

It's important that you provide us with as much detail as possible on any physical health diagnoses and treatment (including medication, surgery, hospital admissions, etc).

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Some of my blood results are abnormal. Will that stop me getting hormones?
Probably not – there are very few medical conditions that are an absolute no-no for starting hormones – but starting hormones might be postponed if Dr Seal or Dr Coxon think you need to repeat the blood tests first or to have other investigations to check out the abnormality.

I'm a smoker. Will that stop me getting hormones?
Smoking is an issue with oestrogens and also with testosterone, and you're likely to be delayed in starting hormones if you haven't stopped smoking by the time of your appointment, ideally three months before any hormones. Vapes and electronic cigarettes are okay in this context.

After you okay me for starting hormones, where do I get them?
We prefer to work with your GP on a "shared care" basis where we're responsible for making a hormone recommendation and your GP issues the actual prescription, administers the hormones and carries out blood tests and other monitoring on our instruction. Most GPs are happy to work in this way but some – maybe 5% – are not. It's a good idea to discuss it with your GP and/or the manager of the GP practice beforehand.

What do I have to do after the assessment letter arrives?
The assessment letter usually contains instructions for your GP – for example, arranging blood tests or prescribing hormones – but you may need to prompt them to follow those instructions. Make a GP appointment and bring your copy of the assessment letter along to show them.

If you okay me for starting hormones, does my GP have to prescribe them for me?
The bottom line is: no, your GP can refuse to prescribe you hormones. NHS GPs aren't obliged to prescribe on the recommendation of private sector specialists; they usually do, as a sort of favour, but they can't be forced to prescribe if they don't want to. It's a good idea to discuss it with your GP and/or the manager of the GP practice beforehand.

My GP says hormones aren't licensed for gender transition. Is that true?
Only one hormone is licensed for gender transition, Sustanon, as "supportive therapy for female-to-male transsexuals" (see here: http://www.medicines.org.uk/emc/medicine/28840). Doctors actually prescribe a lot of medication "off-license" – for example, the combined contraceptive pill isn't licensed for suppressing heavy menstrual periods but GPs often use it for that purpose.

My GP will prescribe but wants you to write the first prescription. Can you do that?
Yes. This happens from time to time; GPs are often happier continuing a prescription that another doctor has started. If this is your GP's position, then the medical/endo clinician can write the first prescription.

My GP will prescribe but wants you to give the first injection. Can you do that?
Yes – but you would have to discuss this with your medical/endo clinician, Dr Seal or Dr Coxon.

It may be useful to talk to the manager of the GP practice about whether another doctor or nurse in the practice is willing to administer your injection.

Some cities have walk-in clinics that may be able to help with administration of injections, for example CliniQ (https://cliniq.org.uk) in London and Clinic T (http://brightonsexualhealth.com/service/clinic-t/) in Brighton.

My GP refuses to prescribe. What can I do?
The bottom line is that your GP can quite reasonably refuse to prescribe you hormones. NHS GPs aren't obliged to prescribe on the recommendation of private sector specialists; they usually do, as a sort of favour, but they can't be forced to prescribe if they don't want to. It's a good idea to discuss this with your GP and/or the manager of the GP practice beforehand.

Sometimes, GPs want a "shared care agreement" before prescribing. This is a sort of written contract, laying out the responsibilities of the gender specialists, the GP and the patient. If your GP asks for a "shared care agreement", we're happy to provide one.

Sometimes, GPs agree to continue a hormone prescription if another doctor starts it off. In those situations, we're happy to give you the starting prescription.

Sometimes, GPs are unaware of recent guidelines from NHS England and the General Medical Council, encouraging them to prescribe hormones. NHS England's guidelines are here: http://shsc.nhs.uk/wp-content/uploads/2016/04/SSC1620_GD-Prescribing.pdf.

The GMC's guidelines are here: http://www.gmc-uk.org/guidance/ethical_guidance/28859.asp.

There's also a letter from the GMC, explaining the situation further: http://www.gmc-uk.org/Susan_Goldsmith_to_Chaand_Nagpaul_BMA_GP_committee.pdf_66389596.pdf.

More recently, Welsh health services issued a Health Circular, giving similar guidance to GPs in Wales: http://gov.wales/docs/dhss/publications/160927whc040en.pdf.

Sometimes, GPs just point-blank refuse to prescribe, and the best option is to try to find another GP who's more open to prescribing. It may be worthwhile approaching other doctors at the same practice, or talking to the practice manager. In extreme situations, it may be appropriate to make a formal complaint to the GMC. You can do that online, here: http://www.gmc-uk.org/concerns/23339.asp.

In some situations, the most practical option may be to register with a different GP practice altogether. Trans masculine support organisations like TMSA-UK (http://www.tmsauk.org) might be able to give word-of-mouth recommendations for trans-friendly GPs.

Some cities have walk-in clinics that may be able to help with administration of injections, for example CliniQ (https://cliniq.org.uk) in London and Clinic T (http://brightonsexualhealth.com/service/clinic-t/) in Brighton.

Can you provide a prescription, rather than me getting it from the GP?
Yes. The medical/endo clinician is able to provide private prescriptions and these can be collected from any UK pharmacist. We would have to inform your GP that we were treating you, and you'd have to attend for regular review. You'd also have to pay the cost of the medication itself – and some types of hormones are quite costly. Drs Seal and Coxon prefer not to issue private prescriptions in the longer term.

What are the differences between NHS and private prescriptions?
Any doctor can issue you with a private prescription and it can be collected from any UK pharmacy. It's different from an NHS prescription in that you have to pay the cost of the actual medication. For example, if the prescription was for three testosterone injections and those injections cost £5 each, you'd pay the pharmacist a total of £15.

Can you send me a private prescription?
Yes, Drs Seal and Coxon are able to provide private prescriptions. They would need to review you at regular intervals, though.

Do you charge for private prescriptions?
No. You'd have to pay the pharmacist the cost of the medication itself but the GenderCare clinicians don't charge you for the issuing of a private prescription.

I'm already paying for private prescriptions from another doctor. Can you take over?
It depends on the situation but, generally speaking, we prefer not to take over endocrine your care if another gender practitioner has started you on hormone treatment and is managing your care. This is partly because we prefer to do our own assessments and blood tests first and if you're already on hormones, this may no longer be possible.

I'm already paying for private prescriptions from another doctor but am unhappy with their care. Can you take over?
Generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment and is managing your care. Any doctor who starts you on hormones has an ongoing duty of care to you, meaning they're responsible for following you up and addressing any problems caused by those hormones. If they're unable or unwilling to do that themselves, ask them to refer you to a specialist who can.

If you're unhappy with any doctor's care, you can make a complaint through their complaints system or, more formally, to the GMC. You can do that online, here: http://www.gmc-uk.org/concerns/23339.asp.

I'm already paying for private prescriptions from another doctor but want to receive my hormones from the NHS. Can GenderCare arrange this?
Generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment and is managing your care. Ask the doctor who is issuing the private prescriptions to talk to your GP about receiving hormones within the NHS.

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SURGERY
Do I have to be living full time to get chest surgery?
Generally, yes. We would want you to be established in terms of living full time as yourself/masculine.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Do I have to have changed my name to get chest surgery?
Generally, yes – although we recognise that, for some people, name change isn't possible or isn't directly relevant.

I have a tight deadline for surgery. How soon can you see me?
It depends on the clinician and their schedule but if you need to be assessed within a particular window of time, ask; clinicians will generally do their best to accommodate you if they can. Email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Generally speaking, you and your surgeon should not agree a provisional surgery date until you have been assessed and referred.

I want chest surgery before testosterone. Will you see me?
It depends on the clinician but usually yes, it's increasingly common for us to see people who want to do things in that order. There are pros and cons to having chest surgery first, and we'd want to talk about those with you.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I want chest surgery but not testosterone. Will you see me?
It depends on the clinician but usually yes, it's increasingly common, especially with non-binary, for us to see people who want chest surgery without testosterone. Every situation is different and we'll assess you individually but, generally speaking, you would be asked to see more than one clinician.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Can you okay me for testosterone and chest surgery in the same appointment?
Usually, no, there isn't time to cover both in one appointment. Depending on the order in which you want to do things, the clinician might cover either testosterone or chest surgery in the first appointment and arrange a shorter review at a later date, to discuss the other.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I'm having my surgery abroad. Can you provide a referral?
Usually yes, the GenderCare clinicians are recognised as established gender specialists and have made referrals to various surgeons all around the world. With surgeons based outside the EEA, we need your explicit consent to send them your personal data.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I'm being treated by another gender practitioner. Will you see me for a surgery assessment?
It depends on the situation. Yes, usually, but the surgery assessment may not be as straightforward as if we had seen you from the outset, as the other gender practitioner might do things very differently from us.

Do I have to be living full time to get genital surgery?
Yes, under national and international guidelines, you have to have been living full time for 12 consecutive months.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Do I have to have changed my name to get genital surgery?
Under national and international guidelines, you have to have been living full time for 12 consecutive months. We recognise that, for some people, name change isn't possible or isn't directly relevant.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

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GENDER RECOGNITION CERTIFICATE
Can you provide a GRC report?
Yes, most of our clinicians are included in HM Government's list of approved gender specialists (details are here: https://formfinder.hmctsformfinder.justice.gov.uk/t493-eng.pdf). If they haven't met you before, the clinician would need to see you for a longer 60-minute assessment.

If in doubt, email and ask your preferred clinician, their details are here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

I'm already your patient. Do I need to pay for a GRC report?
Our written assessments are detailed, and the Gender Recognition Panel will often accept them as the specialist part of the application; this means you don't need a separate report and won't have to pay any extra fee. If in doubt, discuss it first with the Panel (advice available here: GRPenquiries@hmcts.gsi.gov.uk). If you do need a separate report and the clinician is able to write it based on your notes, we'll charge £50.

Do I need a GRC to change my passport?
No, all you need to get a UK passport in the correct name and gender is a letter from a doctor stating that, in their opinion, your gender identity is stable and permanent. Any doctor can write a passport letter but your GP likely won't have done it before and might charge you a fee. We don't charge for passport letters and can provide you with one after we've met you and seen your change of name document.

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MIXING PRIVATE AND NHS
I'm one of your NHS patients. Can I contact you through GenderCare?
No, GenderCare is specifically private sector. If you want to ask a clinician questions about your NHS care, you should do so through NHS channels – for example, you can contact the Tavistock and Portman gender clinic here: https://gic.nhs.uk/about-us/.

Can you refer me to an NHS gender clinic?
Not directly, no. Referrals to an NHS gender clinic have to come through an NHS pathway. In England, your GP can refer you directly (for example, to the Tavistock and Portman NHS gender clinic, using the form on the clinic website: https://gic.nhs.uk/referrals/). In Wales, there is a somewhat different system but seeing your GP is still the starting point

I'm on the waiting list for an NHS gender clinic. Can I use GenderCare?
Yes, many of our patients are waiting for a first appointment at an NHS clinic. Using GenderCare won't jeopardise your NHS care. You're not "locked into" using private care by using GenderCare. If in doubt, get in touch with your own NHS gender clinic and ask their advice.

I'm attending an NHS gender clinic. Can I use GenderCare?
It depends on that NHS gender clinic's policies and, as a general rule, where you are in that gender clinic's care pathway. At the Tavistock and Portman gender clinic, for example, you can continue using the private sector until your second appointment; at the second appointment, you'd have to choose either NHS or private from that point on. Other gender clinics operate slightly differently. If in doubt, get in touch with your own NHS gender clinic and ask their advice.

Can I start hormones with GenderCare then get them from the NHS?
Yes, that's how we generally prefer to do it. We work with your GP on a "shared care" basis where we're responsible for making a hormone recommendation and your GP issues the actual prescription, administers the hormones and carries out blood tests and other monitoring on our instruction. Most GPs are happy to work in this way but some are not. It's a good idea to discuss it with your GP and/or the manager of the GP practice beforehand.

I'm already paying for private prescriptions from another doctor but want to receive my hormones from the NHS. Can GenderCare arrange this?
Generally speaking, we prefer not to take over your endocrine care if another gender practitioner has started you on hormone treatment and is managing your care. Ask the doctor who is issuing the private prescriptions to talk to your GP about receiving hormones within the NHS.

What's "shared care"?
It means that responsibility for your care is shared between the medical/endo clinician and your GP. Often, it might involve a "shared care agreement", a sort of written contract laying out the responsibilities of the gender specialists, the GP and the patient. If your GP asks for a "shared care agreement", we're happy to provide one.

If I go private for hormones, will I have to pay for surgery in the future?
No, it's very common for people to use the private sector for starting hormones and later seek surgery through an NHS gender clinic.

I'm having my surgery through the NHS. Can you provide a referral?
No, if your surgery is being funded in the NHS, then the referrals have to come from gender specialists in the NHS, and GenderCare is private sector. We could provide a referral but it wouldn't be accepted in terms of NHS funding.

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CONTACTING US
What's the best way for me to contact GenderCare?
Always email the clinician: if unsure which clinician to contact, this page should help: https://gendercare.co.uk/how-to-use-gendercare.shtml. The telephone is mainly for leaving messages for Dr Lorimer and conventional mail is collected by individual clinicians. Generally, we can be much more responsive by email.

What's the best way for my GP to contact GenderCare?
Always email the clinician: if unsure which clinician to contact, this page should help: https://gendercare.co.uk/how-to-use-gendercare.shtml. . Alternatively, your GP may prefer to send conventional mail to the clinician's PO Box address. It is more difficult for us to return telephone messages.

If your GP prefers to contact us using a secure nhs.net account, some clinicians can provide this.

Can we talk over the telephone?
Our clinicians are often in clinic, so it's more difficult to arrange a telephone call. We far prefer to answer queries by email, and can usually respond quicker to a short email question. Our individual email addresses can be found from here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Why haven't you returned my telephone call?
The GenderCare telephone is mainly for leaving messages for Dr Lorimer and Dr Seal and it's difficult for us to take or return telephone calls. We can be more responsive by email and our respective addresses can be found from here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

Why haven't you returned my email?
The GenderCare telephone is mainly for leaving messages Dr Lorimer and it's difficult for us to take or return telephone calls. We can be more responsive by email and our respective addresses can be found from here: https://gendercare.co.uk/how-to-use-gendercare.shtml.

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GIVING FEEDBACK
I'm not happy with GenderCare. What can I do?
If you've had a negative experience with us (and this FAQ hasn't helped), let your clinician know; we may be able to resolve the issue. If not, we're able to involve governance systems beyond the GenderCare clinicians in the handling of your complaint.

I'm very happy with GenderCare. What can I do?
If you've had a positive experience, let your clinician know; we love receiving good feedback!

I have a suggestion for improving GenderCare. What can I do?
If you can think of ways to improve our service, let your clinician know; we value all feedback.

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FURTHER INFORMATION

GenderCare page (updated by Dr Lorimer) on Facebook
https://www.facebook.com/drstuartlorimer/

UK FTM information (transmasculine only)
https://ukftm.tumblr.com

Trans Masculine Support + Advice UK (transmasculine only)
http://www.tmsauk.org

Email the clinician best able to help you!
https://gendercare.co.uk/how-to-use-gendercare.shtml.

 
   
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