Transgender Health Information

Information for our transgender patients

Gender incongruence is the term used to describe the experience of having a gender different to the sex you were born with. Gender dysphoria describes the distress or discomfort associated with gender incongruence.

We want to support you as best we can if you think you may have gender dysphoria. We hope the following information is useful but please let us know if you think we may have incorrect information, or we have left out something important.

I think I might have gender dysphoria, what should I do?

If you’re generally struggling a bit and want to talk things through with someone, it’s worth contacting NHS Talking Therapies Welcome to NHS Talking Therapies | Talking Therapies ( or Mind Home – Mind

For more specific information about transgender issues, Tranzwiki has a list of more local support services Tranzwiki – – Gender Identity Research & Education Society – Tranzwiki directory ( (though bear in mind that these are more limited in Herefordshire).

If you are aged 16-25, Talk for Support run a support group, one to one sessions and advocacy in Herefordshire. Talk For Support – A safe space for LGBTQIA+ young people and their families in Herefordshire.

If you’d like to come and talk to one of the health care professionals in the surgery, please click here to complete an appointment request form: Our Appointment System (

Some people feel that they want to start living as the gender they feel they identify with. You don’t need anyone’s permission to do this! It can be difficult having conversations with family, friends and colleagues about this and this is often where the organisations above come in useful.

I know that I have gender incongruence, what should I do next?

Gender dysphoria diagnosis

A diagnosis of gender dysphoria is required for NHS therapies including hormone treatment, speech and language support, facial hair reduction, gamete (egg or sperm) storage and surgery. This diagnosis can only be made by a specialist in gender care – i.e. not your GP.

We are happy to refer you to an NHS gender specialist but please be aware that waiting times are growing at an extreme rate – current wait times are around 8 years.

There are 7 adult NHS gender clinics in England and you can be referred to any one of them.

There are also a number of other clinics in London, Manchester, Sussex and Liverpool but they are currently limited in who they can see and don’t offer a service to Herefordshire residents yet.

The NHS website has a list of them all and it may be worth you contacting them to find out how long their individual waiting lists are as they may all be different. How to find an NHS gender dysphoria clinic – NHS (

Tavistock clinic, London:

Gender Identity Clinic – GIC – The largest and oldest gender clinic in the UK. We accept referrals from all over the UK for adults (over 17 years and nine months) with issues related to gender


Gender Identity Clinic | Sheffield Health and Social Care (


Leeds and York Partnership NHS Foundation Trust -Gender Identity Service (


Northern Region Gender Dysphoria Service – CNTW038 – Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust


Gender Identity Clinic | NHFT


The Nottingham Centre for Transgender Health | Transgender (


Gender identity | DPT

Some of the clinics even have a self-referral form that you can complete and then bring to us for some basic medical information to be completed prior to referral. It’s worth checking their websites for information on this.

If you are under 18 things get more complicated as the only young person’s clinic currently in England is not accepting new referrals. It would be best to come in and talk to us about options.

Changing your name

You can change your name by deed poll – you don’t need to officially change your gender or see a gender specialist to do this.

Change your name by deed poll: How to change your name – GOV.UK (

Changing your name and gender at the surgery

You have a legal right to change your name, title and gender marker on your medical records. You don’t need a gender recognition certificate or a new birth certificate to do this.

When you ask us to change your name, title and gender, we will apply for you to have a new NHS number. We then re-register you as a new patient with your updated details. It is important to note that if you ever want to change your gender back again, you would need another new NHS number – you can’t go back to the original one.

We will transfer medical information across from your existing notes, but your original name, title and gender will NOT appear in your new notes.

If you’d like to go ahead and change your details on your medical records, we ask that you make an appointment with a GP as the first step to go through some of the points above in more detail. You request this appointment using the link here: Online Contact (

The new registration process should be completed in five working days.

If you don’t wish to change your name or gender on your medical records, but do wish to be called something specific when we contact you or call you in from the waiting room, please let us know and we will do our best to ensure this happens.

Passport and driving license changes

The Tavistock clinic has some useful information on this. Changing your passport or driving licence – Gender Identity Clinic – GIC

You don’t need a gender recognition certificate to change your name and gender on your passport but you do need a letter from a doctor to confirm that this is a permanent change of gender. Change your name or personal details on your passport: Gender change – GOV.UK (

You don’t need a certificate or a letter to change your driving license. More information here: Change the name or gender on your driving licence – GOV.UK (

Getting a gender recognition certificate (GRC)

You need to have seen a gender specialist before this can be issued. The GRC allows you to change your gender on your birth certificate, have your affirmed gender on your death certificate when you die, and either get married in your affirmed gender or have your gender changed on your existing marriage or civil partnership certificate.

Remember that you don’t need a GRC to be a recognised transgender person. Many people choose not to get one.

Apply for a Gender Recognition Certificate: Overview – GOV.UK (

Gender recognition certificate – Gender Identity Clinic – GIC

NHS screening checks

This is really important. If you change your gender with us at the surgery, you will not be routinely called for some cancer screening tests. So as a trans man, we would not call you for a cervical smear test or breast screening mammograms, but if you still have a cervix or breasts, it is really important that you have access to these tests. As a trans woman, you would be entitled to aortic abdominal aneurysm screening after the age of 65 and if you are taking oestrogen, you should have breast screening from age 50 to 70.

You need to contact us to have screening tests if you are registering as a different gender than that assigned to you at birth. Additionally, you can opt out of having screening invitations sent (for example if you are a trans woman, or a trans man who has had their cervix removed, you may not want to be sent cervical smear invitations).

There is some excellent, detailed information on screening on the Government website.

NHS population screening: information for trans and non-binary people – GOV.UK (

Or try Cancer Research UK’s page:

Trans and non-binary cancer screening | Cancer Research UK

What happens at a gender identity clinic?

Gender identity clinics are where we refer you if you wish to:

  1. Obtain a gender recognition certificate
  2. Start hormonal treatment
  3. Access some gender reassignment surgical treatments, speech therapy or NHS funded facial hair removal (body hair removal not available on NHS)

The first appointment will usually involve a detailed talk with the clinician, and then possibly some blood tests and information on what happens next. You usually won’t be prescribed hormones on your first visit.

I don’t feel I can cope with the wait for NHS gender identity clinics – what else can I do?

This is really difficult. Waits for gender identity clinic have reached record timescales and we understand how distressing this must be for people waiting for a diagnosis and treatment.

However, we would really discourage you from buying hormone treatment directly from non-specialists or from the internet. You will often have no real idea of what you are taking, and hormones and hormone blockers may potentially have some dangerous side effects.

Many people choose to self-refer to private gender identity clinics. Whilst we can’t recommend specific clinics, we can give some pointers about what to look for.

  1. Try to find a UK based clinic. Some gender clinics now operate from Europe – or other places worldwide – and are run by health care professionals who are not registered in the UK. We won’t continue to prescribe hormone treatment initiated by doctors or nurses who are not UK registered gender specialists. The clinic would also need to be Care Quality Commission (CQC) registered.
  2. A clinic run by doctors who also work for NHS gender identity clinics is more likely to give you responsible, reliable care.
  3. If the clinic suggests that your GP should be able to continue prescribing for them, we would need a Shared Care Protocol (SCP) from them, equivalent to a standard NHS one. This is a document which makes it clear what the plan is, what the doses are, what the monitoring requirements are, and who is responsible for which bit. It should be agreed by the specialist, the GP and the patient. To give you a sense of how detailed this should be, the Tavistock clinic SCP is 15 pages long.

Things to also consider while you are waiting to be seen at a GIC

  1. If you feel you’re ready, make a social gender change. This means letting your friends, family and workplace know about your gender change and starting to live in the role that suits you. The clinics like to see that you are committed to your gender identity and able to cope with the challenges of transitioning.
  • If you smoke, you need to quit. If you are wanting to start hormone therapy, the clinics will need you to have stopped smoking for at least three months before they will prescribe. This is due to the risks of heart disease and blood clots associated with smoking, which can be increased with hormone treatment. They don’t mind if you vape.
  • Try to keep physically healthy. If you’re considering surgery, your BMI will need to be below 31 for the clinic to refer you.
  • If you already have a long term condition such as diabetes, asthma, COPD or heart disease, it’s really important to get this as well controlled as possible. This means paying close attention to your lifestyle, taking any prescribed medications and attending your planned review appointments at the surgery.

I’ve been buying hormones on the black market, what should I do?

We understand that starting hormone therapy can be the main aim for many trans folk, and the waits for gender identity clinics are too long. Whilst we strongly advise against buying hormones on the black market, we don’t judge you for it.

It is really important that we try and keep you as safe as possible so we would encourage you to make an appointment to come and talk to a GP about it. We can often arrange monitoring tests and may be able to access advice from NHS gender specialists even if you’re not officially under their care.

More useful resources: