is gender reassignment surgery covered by nhs scotland

Gender identity and your rights

Many acts and policies exist around gender identity. These are to protect people who identify as transgender from discrimination.

Visit the Scottish Trans Alliance website for further information

NHS Scotland Gender Reassignment Protocol

The Gender Reassignment Protocol  was issued to NHS health boards on 11 July 2012.

The Gender Reassignment Protocol contains many therapies and surgical procedures. The patient and their gender clinician should discuss these in detail. This helps to find the most appropriate treatment pathway.

The Equality Act 2010

The Equality Act, 2010  protects transgender people from discrimination and harassment. It provides protection in different areas, including in the workplace or in the provision of goods and services.

A person does not need to be under medical supervision to be protected by the Act. For example, someone assigned male at birth who decides to live as a woman, but does not consult a doctor or undergo any medical procedures, would be protected.

The Act also protects people associated with them. This includes family members, as well as others who are perceived to be transgender.

Gender Recognition Act 2004

Under the  Gender Recognition Act of 2004 , transgender people can:

• apply for and obtain a Gender Recognition Certificate  to legally change their gender
• get an updated birth certificate
• marry or form a civil partnership in their gender 
• have their gender recorded on their death certificate

To apply for a Gender Recognition Certificate you must be aged 18 or over. The application process requires you to prove that you:

• have been diagnosed with gender dysphoria
• have lived in your gender for the last 2 years
• intend to live permanently in this gender

Patient Advice and Support Service

The  Charter of Patient Rights and Responsibilities  summarises what you’re entitled to when you use NHS services or receive NHS care in Scotland. It also covers what you can do if you feel your rights have not been respected. This includes reference to the Patient Advice and Support Service.

The Patient Advice and Support Service  (PASS) is an independent service. It provides information, advice and support about NHS healthcare for patients, their carers and families. This information is free, accessible and confidential.

The service can give you information, advice and support if you want to:

• give feedback or comments about healthcare provided by NHS Scotland
• raise concerns or complaints about about healthcare provided by NHS Scotland
• helps you understand your rights and responsibilities as a patient
• works with the NHS in Scotland to improve healthcare provision

The Patient Advice and Support Service can be accessed from any  Citizens Advice Bureau in Scotland .

Support and advice

Help is available if you’re experiencing mental health issues as a result of gender dysphoria.

Switchboard LGBT+

Contact Switchboard LGBT+ on 0300 330 0630, from 10am to 10pm every day.

You can also use their webchat service through the  Switchboard LGBT+ website .

Breathing Space

You can also access support from  Breathing Space  by phoning 0800 83 85 87.

The Breathing Space phoneline is available:

• 24 hours at weekends (6pm Friday to 6am Monday)
• 6pm to 2am on weekdays (Monday to Thursday)

Phone 111 if you’re:

• in a state of despair
• need emotional support

Source: Scottish Government - Opens in new browser window

Last updated: 23 March 2023

Help us improve NHS inform

Your feedback has been received

Don’t include personal information e.g. name, location or any personal health conditions.

Home > HealthCARE > Scottish Gender Identity Services

Scottish Gender Identity Services

In Scotland, there are currently four NHS Gender Identity Clinics (GICs) – Glasgow Sandyford GIC (adults and young people), Edinburgh Chalmers GIC (adults), Aberdeen Cornhill GIC (adults), and Inverness Raigmore GIC (adults). There is also a private sector GIC for adults provided by Your-GP in Edinburgh.

Glasgow Sandyford GIC

Adult and Young Peoples Gender Identity Services, Sandyford, 6 Sandyford Place, Sauchiehall Street, Glasgow, G3 7NB

Website: https://www.sandyford.scot/sexual-health-services/gender-identity-service/

Sandyford GIC accepts GP and self-referrals for adults and young people from across all parts of Scotland. It is the only GIC for young people under 18 in Scotland.

The waiting time for a first appointment at the young peoples service is currently around four years.

The waiting time for a first appointment at the adults service is currently over five years.

Phone lines are open from 8:30am–11:30am Monday–Friday . Please call 0141 211 8137 for the adult service and 0141 211 8618 for the young person’s service during this time. (If you can’t get through to the gender service and need to speak to someone urgently try calling the Sandyford main switchboard on 0141 211 8130.)

You can email the Sandyford adult service on [email protected] and you can email the Sandyford young person’s service on [email protected]

Lothian Edinburgh Chalmers GIC

Chalmers Gender Identity Clinic, 2A Chalmers Street, Edinburgh, EH3 9ES

Website: https://www.lothiansexualhealth.scot/gender-identity-clinic/gic/

Chalmers GIC accepts GP referrals for service users aged over 17 living in NHS Lothian, NHS Borders and NHS Fife areas.

The waiting time for a first appointment is currently around two years.

Telephone: 0131 536 1570 , phone lines open 1pm-4pm Monday-Friday .

Chalmers GIC does not accept emails from patients. It will respond to emails from GPs.

Grampian Aberdeen Cornhill GIC

Grampian Gender Identity Clinic, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH

No Website.

Grampian GIC accepts GP referrals for service users aged over 18 living in the NHS Grampian area only.

Telephone:  01224 557651

You can email Grampian GIC on [email protected]

Highland Inverness Raigmore GIC

Highlands Gender Identity Clinic, Zone 14, Clinic 1 Raigmore Hospital Old Perth Road, Inverness IV2 3UJ

Website: http://www.highlandsexualhealth.co.uk/services/gender-identity

Highlands GIC accepts GP referrals for service users aged over 18 living in the NHS Highland area only.

Telephone: 01463 888300

Private Sector: Your-GP GIC

Your-GP is currently the only private sector GIC located in Scotland. Website: https://your-gp.com/gp-services/all-gp-services/gender-clinic/

National Gender Identity Clinical Network for Scotland

The National Gender Identity Clinical Network for Scotland (NGICNS) aims to work with gender identity clinics, gender reassignment surgical providers, primary care, patient and third sector representation to achieve timely, coordinated, service provision and equitable access to planned gender identity clinical services across Scotland.

On its website, you can find lots of useful information about hormones, surgeries and other medical services provided under the NHS Scotland Gender Reassignment Protocol.

NGICNS website

Join our eNewsletter

30 Bernard Street Edinburgh EH6 6PR

+44 (0)131 467 6039 [email protected]

• Accessibility
• Code of Conduct for our Events

Scottish Trans is part of the Equality Network

Scottish Trans is the Equality Network project to improve gender identity and gender reassignment equality, rights and inclusion in Scotland. The Equality Network is a leading Scottish lesbian, gay, bisexual, transgender and intersex (LGBTI) equality and human rights charity.

The Equality Network is a registered Scottish charity: SC037852, and a company limited by guarantee: SC220213.

We are grateful for funding from the Scottish Government

• © 2024 Scottish Trans

• Beatson West of Scotland Cancer Centre
• Gartnavel Royal Hospital
• Princess Royal Maternity
• Inverclyde Community Maternity Unit
• Inverclyde Royal Hospital – Mental Health Unit
• Institute Of Institute Of Neurological Sciences And Spinal Unit
• Queen Elizabeth Maternity Unit
• Royal Alexandra Community Maternity Unit
• Royal Alexandra Hospital – Mental Health Wards
• Schiehallion
• National Child Psychiatry Inpatient Unit
• Stobhill Hospital – Mental Health Wards
• Vale of Leven Community Maternity Unit
• New Victoria Hospital
• West Glasgow Ambulatory Care Hospital
• Health Centres and Clinics
• Maternity Hospitals And Units
• Child Development Centres
• Day Hospitals
• Learning Disability Services
• Mental Health Hospitals, Resource Centres and Primary Care Teams
• Catering Contacts
• Eating and Drinking At Home
• Food advice for visitors
• Food in Hospitals news
• Frequently asked questions and facts about our food services
• Improving the quality of our meals
• Ordering your meals and menu information
• How We Prepare Our Meals
• Improving your mealtime experience
• Patient Information leaflets
• Visiting Information in other languages
• Charitable Donations
• Data Protection & Privacy
• Access to Records
• Hospitals And Other Facilities
• Return of NHS equipment
• Treatment and Services
• Transport, Travel and Parking – Information for Patients and Visitors
• Services A to Z
• COVID-19 – what to do if you have symptoms
• Self Care and NHS Inform
• Optometrist (eyes)
• Mental Health
• Virtual Accident & Emergency (A&E)
• Accident & Emergency
• Minor Injuries Unit
• When to call 999
• Sexual Health (Sandyford)
• Alcohol and Drug Recovery Services
• Glasgow and Partners Emergency Social Work Services
• The new National Redirection Policy
• Vaccinations
• Current engagement opportunities
• Current strategy Projects
• How We Got Here
• Care Home Collaborative
• COVID-19 – General advice and guidance
• COVID-19 Testing
• Give and Go
• Information for pregnant women and their families
• Early Years
• Equalities in Health
• Group A streptococcus (GAS) – Strep A Guidance
• Heads Up – Mental Health Support
• Hospital Building Smoke-Free Perimeter
• Infection Prevention and Control
• Person Centred Health and Care
• Planning for Care
• Public Health
• Starting your NHS Career
• HR Support & Advice Unit
• Equality, Diversity and Inclusion
• Induction Portal
• Learning, Education and Training
• LGBTQ+ Staff Forum
• Occupational Health
• Once for Scotland Workforce Policies
• Organisational Development (OD) and your OD Team
• Pay and Conditions of Service
• Policies and Staff Governance
• The Recruitment Service
• Safety, Health and Wellbeing
• Self help for staff
• Staff Experience
• Cycling And Walking
• Staff Parking at NHSGGC
• Staff Shuttle Bus
• Public Transport
• Celebrating Success
• Allied Health Professionals (AHPs) – Professionals Section
• All about money – Information for managers
• Food and fluid myths in hospital
• National Hydration Campaign
• Laboratory Medicine
• Library Network 
• Medical Education for NHSGGC
• Practice Education
• #19326 (no title)
• Public Involvement Staff Resources
• Research and Innovation
• New Smoke-free Perimeter – Information for Staff
• Active Staff
• All About Money
• Food, Fluid and Nutrition
• Stop Smoking Support – Quit your way
• Support and Information Services
• Volunteering
• Work Experience
• Data Protection and Privacy
• Data Protection Impact Assessments
• Meet the Press Team
• Meet the Board
• Become a Board member
• Agendas, Papers & Minutes
• Interim Board Meeting Agendas, Papers & Minutes
• Contact the Board
• Annual reports and reviews
• Finances, Publications and Reports
• Sustainability
• Greater Glasgow & Clyde Healthcare Charity
• Feedback, Comments, Complaints and Concerns Reports
• Engagement and Consultations
• Involvement Groups and Networks
• Freedom Of Information
• Useful Contacts
• Keep up to date – help shape the future

Gender Reassignment

What is gender reassignment.

In most cases we grow up feeling a sense of comfort or acceptance with our gender but this is not true for all people. Around 1 in 11,500 people will find that as they grow up, they feel less comfortable with the gender prescribed to them at birth, and will instead, find greater comfort and connection to another gender. They may then express the need to live in this different and more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender’ or ‘trans’ people. ‘Trans’  is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth.

In the Equality Act it is known as gender reassignment*. All transsexual people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one.You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

*’Gender reassignment’ is a term of much contention and is one that Stonewall’s Trans Advisory Group feels should be reviewed.

The Equality Act 2010 says that you must not be discriminated against because you are transsexual, when your gender identity is different from the gender assigned to you when you were born. For example: • a person who was born female decides to spend the rest of his life as a man

In the Equality Act it is known as gender reassignment. All transsexual people share the common characteristic of gender reassignment.

The Equality Act says that you must not be discriminated against because: • of your gender reassignment as a transsexual. You may prefer the description transgender person or trans male or female. A wide range of people are included in the terms ‘trans’ or ‘transgender’ but you are not protected as transgender unless you propose to change your gender or have done so. For example, a group of men on a stag do who put on fancy dress as women are turned away from a restaurant. They are not transsexual so not protected from discrimination • someone thinks you are transsexual, for example because you occasionally cross-dress or are gender variant (this is known as discrimination by perception) • you are connected to a transsexual person, or someone wrongly thought to be transsexual (this is known as discrimination by association)

Intersex people (the term used to describe a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male) are not explicitly protected from discrimination by the Equality Act, but you must not be discriminated against because of your gender or perceived gender. For example: • if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination or disability discrimination

Following is a short film by the Equality & Human Rights Commission titled ‘What is gender reassignment discrimination?’.

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many Trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for Trans people include:

• Mental health problems including suicide, self harm, anxiety and depression
• Lack of primary care facilities as many GPs have no or little knowledge of Trans people’s needs
• Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for Trans women
• Lack of awareness and understanding of care providers so that Trans people are in appropriately treated in single gender out patient and in patient services.
• Inconsistent funding and access to transitioning services throughout Scotland
• Lack of social work service to support children, young people, adults and families with gender identity issues.
• Social exclusion, violence and abuse and the resulting negative impact on health and well-being

NHS Greater Glasgow and Clyde were the first NHS Board in Scotland to publish a  Gender Reassignment Policy  which sets out our commitment to ensure equality of access to services that are both appropriate and sensitive. We have the busiest trans services in Scotland at the Sandyford Initiative and provide a number of specialist services that are recognised as being amongst the best in the UK. However, there are still barriers experienced by Trans people using mainstream NHS services. It is essential that frontline NHS staff do all they can to remove the stigma of transitioning and play their part in delivering services of the highest standard to Trans people. To this end, guidance has been issued to support staff in responding to queries from Trans service users.Add info here…

Fran’s Story

Fran transitioned from male to female 10 years ago. She has spent her life experiencing bullying and harassment because of her gender identity and has been the victim of several hate crime incidents.

Fran was experiencing pain in her right thigh and attended an outpatient appointment.  When Fran entered the waiting area she gave her name and confirmed her appointment time.  The receptionist explained there wasn’t an appointment for a Fran Walker but there was one for a Mr Frank Walker.  Fran explained that she should now be referred to as Fran as she had requested all records be updated to reflect her gender reassignment.  The receptionist explained she was unable to do that until the medical records were updated.  Fran was asked to take a seat in the waiting area.  Fran was in discomfort but before taking a seat explained again it was Fran or Ms Walker, not Frank or Mr Walker.

While Fran was waiting for her appointment she heard a member of staff calling for a Mr Frank Walker.  Fran sat where she was, angry, frustrated and embarrassed that she was still being referred to in the wrong gender.  Eventually after a repeat call she stood and walked into the treatment room.  She was still very upset and asked why, despite explaining she wished to be called by her new name, staff insisted on calling her by her previous name.  The member of staff explained the name on her record was Frank Walker, not Fran, and until they heard otherwise, she would continue to be addressed as Frank or Mr Walker. Fran tried to remain calm and explained that if she was referred to as Frank again she would make a formal complaint.  The member of staff reiterated the position so Fran explained that staff were in breach of legislation protecting trans people. They were deliberately disclosing her previous birth gender and so could be held liable and receive a significant financial penalty under UK law. Fran stated that if it happened again she would take formal action. The equality Act protects trans people in a number of ways, one of which is to ensure previous birth gender is only disclosed to another party when necessary with appropriate controls in place and then only with the expressed permission of the trans person.

Publications

• Changing for the Better
• Changing Your CHI
• Engaging All Staff in Trans Inclusion
• Gender Reassignment Policy Review 2021
• Getting Equalities Monitoring Right
• Homophobic and Transphobic Hate Crime
• LGBT in Scotland Health Report
• Life in Scotland for LGBT Young People
• Sharing Trans Information
• Transgender Equality
• Gender Identity Research & Education Society (GIRES)
• LGBT Youth Scotland
• Press for Change
• Sandyford Initiative
• Scottish Trans Alliance

Would you like to keep up to date with local health news from us?

Gender reassignment surgeries to take place in Scotland says two year plan from SNP Government

The Scottish Government has committed to the introduction of gender reassignment surgeries taking place in Scotland in a plan that will be developed over the next two years.

• 14:47, 20 DEC 2021
• Updated 15:42, 20 DEC 2021

New plans from the Scottish Government have committed to introducing gender reassignment surgeries taking place in Scotland by 2024.

Under a new two-year plan, the SNP administration anticipates that facilities will open for specialist male-to-female surgery called a vaginoplasty and a phalloplasty for trans-identified men.

Currently, any patient wishing to undergo surgical intervention will have to visit clinics in England where a very small number of urologists are trained.

The controversial and risky procedures are seen by some to be a step in the journey of reaffirming gender identity, a highly contentious topic for those who are critical of gender ideology.

This project is part of a wider plan by the Scottish Government to implement self ID laws that will make it easier for trans-identified people to legally change their sex without medical involvement - an unpopular plan only supported by three in 10 Scots.

The NHS gender identity services: Strategic action framework 2022 – 2024 sets out a spending and implementation plan that will aim to manage the rise in demand for gender identity services.

The report states: "We recognise the importance of accessing treatments locally where appropriate, as well as building resilience in provision. We have therefore committed in this Framework to look at the potential for providing gender reassignment surgeries in Scotland. We anticipate that this would complement and be part of the current four nations NHS contract."

It also states that a National Gender Identity Healthcare Reference Group will be established to inform the Scottish Government and enact plans.

This group will have involvement from NHS Boards including National Services Scotland, National Education for Scotland, Healthcare Improvement Scotland and Public Health Scotland.

Waiting times across the board have a track record of making patients wait for months and even years to access mental health services with the pandemic only having made this worse.

Maree Todd MSP Minister for Public Health, Women’s Health and Sport said that they have gender patients who have been waiting for up to three and a half years to be seen by a specialist.

Regarding money Ms Todd said: "We plan to provide £9million over 3 years, with £2m in 2022/23, to fund new service models, address waiting times and support those waiting to access services."

There are currently four Gender Identity Clinics providing services to adults in NHS Scotland. These are based in four NHS Health Boards - NHS Grampian, NHS Greater Glasgow and Clyde, NHS Highland and NHS Lothian.

A separate service for young people, NHS Greater Glasgow and Clyde’s YoungPerson’s Service, accepts referrals from across Scotland.

For more news, follow us on Facebook and Twitter but never miss the latest top headlines and sign up to our daily newsletter here .

• Scottish Government
• Culture Wars
• Most Recent

• Skip to main content
• Accessibility help

Information

We use cookies to collect anonymous data to help us improve your site browsing experience.

Click 'Accept all cookies' to agree to all cookies that collect anonymous data. To only allow the cookies that make the site work, click 'Use essential cookies only.' Visit 'Set cookie preferences' to control specific cookies.

Your cookie preferences have been saved. You can change your cookie settings at any time.

Gender Reassignment Protocol for Scotland (GRP) update report 2022: FOI release

Information request and response under the Freedom of Information (Scotland) Act 2002

Information requested

"The April 2022 minutes of the Scottish Government's National Gender Identity Healthcare Reference Group refers to a presentation and update on the Gender Reassignment Protocol provided by Miles Mack and David Parker.

https://www.gov.scot/publications/national-gender-identity-healthcare-reference-group-minutes-april-2022-2/

Could you please provide a copy of this presentation and update and/or any reports, slides, handouts, or notes."

I enclose a copy of most of the information you requested.

While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested because exemptions under 25(1) and 38(1)(b) (personal information) of FOISA apply to that information. The reasons why these exemptions apply are explained below.

While the document you requested has been previously released by NHS Board as part of the response to a request made under FOISA (2002) and subsequently published online, for your convenience I again attach a copy of a written update report on progress to review and update the 2012 Gender Reassignment Protocol for Scotland (GRP) which was presented to the National Gender Identity Healthcare Reference Group (the Group) meeting on the 13th of April 2022 (Attachment - Document 1).

An exemption under section 38(1)(b) of FOISA (personal information) applies to some information which has been redacted from the enclosed document. This exemption applies because the information is personal data of a third party, i.e. names and contact of individuals, and disclosing it would contravene the data protection principles in Article 5(1) of the General Data Protection Regulation and in section 34(1) of the Data Protection Act 2018.

This exemption is not subject to the 'public interest test', so we are not required to consider if the public interest in disclosing the information outweighs the public interest in applying the exemption.

For clarity and avoidance of doubt, the reference to ‘a presentation on the work to date to complete a review and update of the 2012 Gender Reassignment Protocol for Scotland (GRP)’ as recorded in the April 2022 minutes of the Group refers to a verbal presentation accompanying the written update report on progress to review and update the 2012 GRP.

The minutes from the April 2022 meeting of the Group are publicly available on the Group’s Scottish Government webpage , which you refer to in your original request. Under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you.

The Scottish Government is committed to publishing all information released in response to Freedom of Information requests. View all FOI responses at http://www.gov.scot/foi-responses .

Please quote the FOI reference Central Enquiry Unit Email: [email protected] Phone: 0300 244 4000

The Scottish Government St Andrews House Regent Road Edinburgh EH1 3DG

There is a problem

Thanks for your feedback

Your feedback helps us to improve this website. Do not give any personal information because we cannot reply to you directly.

National Gender Identity Clinical Network for Scotland

The National Gender Identity Clinical Network for Scotland (NGICNS) website is here to provide you with information about trans healthcare in Scotland.

Please feel free to contact us with any queries you may have. We always welcome questions and feedback from patients, clinical staff, colleagues and others.

We will do our best to help, but the network staff cannot answer specific questions about your clinical care and may advise you to contact the appropriate Gender Identity Clinic (GIC) or signpost you to another appropriate service.

Treatment - Gender dysphoria

Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

What this means will vary from person to person, and is different for children, young people and adults. Waiting times for referral and treatment are currently long.

Treatment for children and young people

If your child may have gender dysphoria, they'll usually be referred to one of the NHS Children and Young People's Gender Services .

Your child or teenager will be seen by a multidisciplinary team including a:

• clinical psychologist
• child psychotherapist
• child and adolescent psychiatrist
• family therapist
• social worker

The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.

Depending on the results of the assessment, options for children and teenagers include:

• family therapy
• individual child psychotherapy
• parental support or counselling
• group work for young people and their parents
• regular reviews to monitor gender identity development
• referral to a local Children and Young People's Mental Health Service (CYPMHS) for more serious emotional issues

Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.

Hormone therapy in children and young people

Some young people with lasting signs of gender dysphoria who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist). This is in addition to psychological support.

Puberty blockers and gender-affirming hormones

Puberty blockers (gonadotrophin-releasing hormone analogues) are not available to children and young people for gender incongruence or gender dysphoria because there is not enough evidence of safety and clinical effectiveness.

From around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones alongside psychosocial and psychological support.

These hormones cause some irreversible changes, such as:

• breast development (caused by taking oestrogen)
• breaking or deepening of the voice (caused by taking testosterone)

Long-term gender-affirming hormone treatment may cause temporary or even permanent infertility.

However, as gender-affirming hormones affect people differently, they should not be considered a reliable form of contraception.

There is some uncertainty about the risks of long-term gender-affirming hormone treatment.

Children, young people and their families are strongly discouraged from getting puberty blockers or gender-affirming hormones from unregulated sources or online providers that are not regulated by UK regulatory bodies.

Transition to adult gender identity services

Young people aged 17 or older may be seen in an adult gender identity clinic or be referred to one from a children and young people's gender service.

By this age, a teenager and the clinic team may be more confident about confirming a diagnosis of gender dysphoria. If desired, steps can be taken to more permanent treatments that fit with the chosen gender identity or as non-binary.

Treatment for adults

Adults who think they may have gender dysphoria should be referred to a gender dysphoria clinic (GDC).

Find an NHS gender dysphoria clinic in England .

GDCs have a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including:

• psychological support, such as counselling
• cross-sex hormone therapy
• speech and language therapy (voice therapy) to help you sound more typical of your gender identity

For some people, support and advice from the clinic are all they need to feel comfortable with their gender identity. Others will need more extensive treatment.

Hormone therapy for adults

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery.

It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team.

In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen.

Both usually have the additional effect of suppressing the release of "unwanted" hormones from the testes or ovaries.

Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating.

It's also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.

The effectiveness of hormone therapy is also limited by factors unique to the individual (such as genetic factors) that cannot be overcome simply by adjusting the dose.

Find out how to save money on prescriptions for hormone therapy medicines with a prescription prepayment certificate .

Risks of hormone therapy

There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP.

The most common risks or side effects include:

• blood clots
• weight gain
• dyslipidaemia (abnormal levels of fat in the blood)
• elevated liver enzymes
• polycythaemia (high concentration of red blood cells)
• hair loss or balding (androgenic alopecia)

There are other risks if you're taking hormones bought over the internet or from unregulated sources. It's strongly recommended you avoid these.

Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.

Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic.

Read more about fertility preservation on the HFEA website.

Surgery for adults

Some people may decide to have surgery to permanently alter body parts associated with their biological sex.

Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery.

In addition to you having socially transitioned to your preferred gender identity for at least a year before a referral is made for gender surgery, it is also advisable to:

• lose weight if you are overweight (BMI of 25 or over)
• have taken cross-sex hormones for some surgical procedures

It's also important that any long-term conditions, such as diabetes or high blood pressure, are well controlled.

Surgery for trans men

Common chest procedures for trans men (trans-masculine people) include:

• removal of both breasts (bilateral mastectomy) and associated chest reconstruction
• nipple repositioning
• dermal implant and tattoo

Gender surgery for trans men includes:

• construction of a penis (phalloplasty or metoidioplasty)
• construction of a scrotum (scrotoplasty) and testicular implants
• a penile implant

Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.

Surgery for trans women

Gender surgery for trans women includes:

• removal of the testes (orchidectomy)
• removal of the penis (penectomy)
• construction of a vagina (vaginoplasty)
• construction of a vulva (vulvoplasty)
• construction of a clitoris (clitoroplasty)

Breast implants for trans women (trans-feminine people) are not routinely available on the NHS.

Facial feminisation surgery and hair transplants are not routinely available on the NHS.

As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.

Life after transition

Whether you've had hormone therapy alone or combined with surgery, the aim is that you no longer have gender dysphoria and feel at ease with your identity.

Your health needs are the same as anyone else's with a few exceptions:

• you'll need lifelong monitoring of your hormone levels by your GP
• you'll still need contraception if you are sexually active and have not yet had any gender surgery
• you'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment
• you may not be called for screening tests as you've changed your name on medical records – ask your GP to notify you for cervical and breast screening if you're a trans man with a cervix or breast tissue
• trans-feminine people with breast tissue (and registered with a GP as female) are routinely invited for breast screening from the ages of 50 up to 71

Find out more about screening for trans and non-binary people on GOV.UK.

NHS guidelines for gender dysphoria

NHS England has published what are known as service specifications that describe how clinical and medical care is offered to people with gender dysphoria:

• Non-surgical interventions for adults
• Surgical interventions for adults
• Interim service specification for specialist gender incongruence services for children and young people

Review of gender identity services

NHS England has commissioned an independent review of gender identity services for children and young people. The review will advise on any changes needed to the service specifications for children and young people.

Page last reviewed: 28 May 2020 Next review due: 28 May 2023

Watch CBS News

Scotland halts prescription of puberty blocking hormones for minors as gender identity service faces scrutiny

By Haley Ott

April 18, 2024 / 8:41 AM EDT / CBS News

London — The only gender identity clinic in Scotland has paused prescribing puberty blockers to new patients under 18 years old, mirroring action taken by England's health authorities after a landmark review  found young people had been let down by "remarkably weak" evidence backing medical interventions in gender care . 

The report, commissioned by Britain's National Health Service, also found that the "toxicity" of the debate around gender identity meant physicians were operating in fear.

Dr. Hillary Cass, who led the review that produced the 388-page report published earlier this month, said "we don't have good evidence" that puberty blockers are safe to use to prevent changes that come during puberty.

• Supreme Court allows Idaho to enforce ban on gender-affirming care for most minors  

"It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood, and that's been a particular problem, that we haven't had the follow-up into adulthood to know what the results of this are," Cass told CBS News partner BBC News.

Puberty blockers suppress the release of hormones that cause puberty. They can be prescribed to children who are questioning their gender in order to stop physical changes such as the growth of facial hair or breasts.

"The next step from here is to work with the Scottish government and academic partners to generate evidence that enables us to deliver safe care for our patients," Emilia Crighton, the director of the public health service for the Glasgow region, said in a statement. "We echo the views of Dr. Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them. We understand the distress that gender incongruence can cause and, while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the young people's gender service the psychological support that they require while we review the pathways in line with the findings."

Scottish Trans, an advocacy group, said it disagreed with the decision to pause prescriptions of puberty blockers for minors, which it said "has been taken within the context where the reality of trans people's experiences and lives is questioned almost daily in some of the media and some political circles."

"This makes us worry that the decision has been influenced by that context rather than solely through consideration of the best interests of trans children and young people," Scottish Trans said in a statement , adding that between 2011 and 2023, only 87 young Scottish people were prescribed puberty blockers.

"The exceptionally rare and cautious choice of puberty blocker prescription, made for a small number after huge waits, is being wrongly painted by some as though it was commonplace and rushed. Nothing could be further from the truth. We're saddened that this change will result in some young people being unable to access the care they need at all, or having to wait even longer for it," Scottish Trans said.

Ahead of the Cass review's publication, the NHS said in March that it would stop prescribing puberty blockers to under-18s at gender identity clinics in England. New young patients in the U.K. can still get a prescription for hormone blockers, but only as part of a clinical trial.

Cass' review called for better research into the medications and their long-term effects, as well as the characteristics of children seeking treatment.

"The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress," she wrote in the review.

She encouraged a holistic assessment of patients, taking into consideration issues that may not relate to their gender identity, including screening for conditions such as autism to address "diagnostic overshadowing" that could occur when issues of gender are brought up.

"What's unfortunately happened for these young people is that, because of the toxicity of the debate, they've often been bypassed by local services who've been really nervous about seeing them," Cass told the BBC. "So, rather than doing the things that they would do for other young people with depression or anxiety, or perhaps undiagnosed autistic spectrum disorder, they've tended to pass them straight on to the GID (Gender Identity Disorder) service."

The Cass review was commissioned following a sharp rise in referrals to gender identity services in the U.K., from around 250 a year to more than 5,000 in 2022.

• Transgender
• Mental Health
• United Kingdom

Haley Ott is the CBS News Digital international reporter, based in the CBS News London bureau.

More from CBS News

Contaminated deer meat may have caused 2 hunters' deadly brain diseases

Climate change a health risk for 70% of world's workers, UN warns

U.S. program has resettled 187,000 Ukrainian refugees with little controversy

What is the U.K. plan to send asylum seekers to Rwanda?

The Cass Review into medical care provided to children with gender dysphoria has been released. Here’s what it found

There's been a lot of discussion this week about the adequacy of medical care provided to children with gender dysphoria and whether change is needed.

It's been sparked by a landmark investigation into gender-affirming care offered via the National Health Service [NHS] in England, conducted by well-known paediatrician Hilary Cass.

The outcomes of the report are designed to reshape how publicly-funded care is provided to young people in England.

Her report, known as the Cass Review, spans hundreds of pages and calls for sweeping changes to how the NHS provides treatment to young people through its gender clinics.

In a nutshell, it recommends the service significantly limit the prescribing of medications — colloquially known as puberty blockers — for people aged under 18 and for patient care to be multi-disciplinary and centred around mental health support rather than medical interventions.

It's a recommendation the NHS England adopted last month, in anticipation of the findings.

"We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time," the NHS England wrote in March.

"NHS England recommends that access to [puberty blockers] for children and young people with gender incongruence/dysphoria should only be available as part of research."

Prior to the change, the drugs had been prescribed to patients with gender dysphoria in England. Though, according to UK media, it was estimated fewer than 100 people were on the drugs via the NHS. Those patients would be allowed to continue to take them.

The review also recommends "extreme caution" in prescribing masculinising and feminising hormones under the age of 18.

In her report, Dr Cass said she made the recommendations because of a lack of scientific evidence into the long-term use of the medications in children.

"You must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence," Dr Cass wrote, directly addressing gender dysphoric children.

"I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you."

Dr Cass' findings were based on a series of systematic reviews of the medical evidence and international treatment guidelines undertaken by University of York.

"This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint," she wrote.

As part of the work, researchers identified 23 guidelines published between 1998 and 2022 that contained recommendations about children and young people with gender dysphoria, four of those were international, three were regional and 16 were national.  

Dr Cass went on to call for both the scientific community and patients who are taking puberty blockers to come together to study their use.

As a result, questions are being asked about whether those findings should have implications in other countries, like Australia, where gender affirming care is available.

Will things change in Australia?

It's not out of the question, but there is deep resistance.

In Australia the review has been acknowledged but most doctors and institutions, and even the government, have cautioned against applying the findings here, arguing the settings are very different.

Here, puberty blockers are only subsidised for patients who have certain cancers or those experiencing early puberty. Though, patients can access them without subsidy.

Health Minister, Mark Butler, described the Cass Review as "significant" but said the clinical pathways in Australia were different to those offered in the UK.

"Clinical treatment of transgender children and adolescents is a complex and evolving area in which longer term evidence to inform treatment protocols is still developing," he said.

"Everyone, including the states and territories who are responsible for these services in Australia, will take the time to consider this review which has just been released."

In 2020, the Australian government rejected calls for a national inquiry into gender affirming care for young people, saying it was concerned it would negatively impact their wellbeing.

That followed the advice provided by the Royal Australian College of GPs, which warned such an inquiry would not increase scientific evidence but would further harm vulnerable patients.

Who is sceptical of the review's findings?

A recurring bone of contention is around the quality of existing research. Some advocates and doctors argue the data available is strong enough despite the Cass Review suggesting otherwise.

Head of the Trans Health Research group at The University of Melbourne, Associate Professor Ada Cheung, said she did not see any merit in carrying out a similar review here.

"The Cass report goes against the consensus of professional medical associations around the world, and I don't think is relevant to practice in Australia," she said.,

"It downplays the risk of denying treatment to young people with gender dysphoria and limits their options by placing restrictions on their access to care."

Associate Professor Cheung said, unlike the UK, Australia already had a coordinated multidisciplinary approach to care, where puberty blockers were provided as part of specialist hospital-based teams, as recommended by Australian guidelines.

"The way that gender affirming care is accessed and provided in Australia is substantially different to the NHS."

The Royal Children's Hospital Melbourne, which penned the guidelines, declined to comment for this story.

The head of Transcend Australia, the national body for trans, gender diverse, and non-binary young people, suggested the review excluded good research.

"Families deserve to be provided with all the available evidence about medical treatment, which the Cass Review has failed to do by excluding a significant amount of global research," Transcend Australia CEO Jeremy Wiggins said.

Dr Portia Predny, from the Australian Professional Association for Trans Health agreed, adding that applying the findings here would be "flawed" because the review specifically looked at the NHS in England.

"In Australia, our guidelines for gender affirming care for young people already prioritise holistic, individualised and person-centred care with the involvement of multidisciplinary teams of clinicians with all kinds of areas of expertise, to help and support young people to navigate their gender journey," Dr Predny said.

Who is supportive of the findings?

In the UK, the review has been widely welcomed by senior academics and the medical profession. Though, some doctors and advocates are worried that patients will be blocked from receiving the care they need.

The findings were cautiously welcomed by Ashley Grossman, an Emeritus Professor of Endocrinology with the University of Oxford.

"It may be that a small number of these children should in the long-term transition to a different sex, but routine puberty blocking treatment for this use has not yet been adequately studied, and many of these children may have other problems for which they need help," Prof Grossman said.

"More carefully run clinical trials are needed so that we can understand how and when such agents are justified and of benefit."

There is also some divide in Australia.

Dr Jillian Spencer is a child and adolescent psychiatrist who has long advocated against gender affirming medical interventions and has welcomed the review's findings.

"I think it signals a return to careful and evidence-based treatment approaches rather than treatment approaches driven by activists," she said.

She also remained critical of the services provided by specialist gender clinics here.

"There has been failure to acknowledge the risks and harms of transitioning children," she said.

Dr Spencer was stood down from clinical duties at the Queensland Children's Hospital last year and is awaiting the outcome of an investigation over a complaint from a young transgender patient.

She's contesting the action with a case to be heard by the Queensland Industrial Relations Commission.

Speaking to the ABC, Dr Spencer cited FOI documentation showing there were 172 prescriptions initiated for puberty blockers last year at Queensland's Gender Service and said she was worried by that rate.

"The lesson for Australia is that we must find a way to freely discuss health care issues regardless of their sensitivity. In this case, children have been harmed by the mainstream media and the government being unwilling to examine concerns that were repeatedly raised by health professionals and parents over many years."

The Australian Medical Association declined to comment, but provided a statement from earlier this year which said, "people who are LGBTQIASB+ thrive in health care environments where they feel safe, affirmed, respected and understood".

It also called for greater access to gender-affirming treatment.,

The ABC has also approached the RACGP for comment.

Editor’s note: This story was amended to clarify the way in which Dr Jillian Spencer’s position had been paraphrased and to note the Cass Review’s recommendation on cross-sex hormones.

• X (formerly Twitter)

Related Stories

Medical insurer drops cover for doctors who initiate hormone treatments in adolescents with gender dysphoria.

'We did all we could': Noah was desperate for gender care. He died waiting for help

• Doctors and Medical Professionals
• Medical Research