(We recommend clinicians and GPs download the full guide to prescribing which can be found NCTH Network Guide to prescribing of Hormone Treatment v5 05.22.docx 80KB
The NCTH is a national service which carries out assessments to determine eligibility and readiness for hormone treatments amongst other functions. Once hormone treatment has been recommended the patient is guided through an information sheet to enable them to give informed consent. NCTH is not commissioned by NHS England to do blood monitoring, prescribe or administer hormone treatment. NCTH aims to work collaboratively with primary care teams in England to offer support and advice to GP’s and their patients.
The General Medical Council 2018 have online ethical guidance for General Practitioners for treating adult patients who are trans and non-binary. This guidance states:
“GPs must co-operate with GICs (Gender Identity Clinics) and gender specialists in the same way as they would other specialists, collaborating with them to provide effective and timely treatment for trans and non-binary people. This includes:
With regard to the prescribing of off licence medication
“Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes.”
Further information can be found at Trans healthcare - ethical topic - GMC (gmc-uk.org)
It is the NCTH’s responsibility to carry out the following:
The usual baseline blood tests are as follows:
FBC, U&E’s, LFT’s, Lipid profile, Prolactin, Oestradiol, Testosterone, SHBG, LH, FSH and Glucose. These baseline bloods should be sent to the NCTH to be reviewed.
NCTH works collaboratively with GP’s and will request GP’s to do the following:
Without safe monitoring of hormone therapy we may no longer support the prescribing of hormone therapy. We will require patients on hormone treatments to do the following:
The hormone regimens that we commonly use in the initiation phase are summarised in Table 1. Ongoing Masculinising Hormone Treatment.
Once satisfactory testosterone levels have been achieved the blood monitoring required is set out in Table 2. Once treatment is established and other treatments such as surgeries, speech and language therapy, and psychotherapy are complete, patients are discharged from NCTH.
The GMC advocates “Once the patient has been discharged by a GIC or gender specialist, the prescribing and monitoring of hormone therapy can be carried out in primary care without specialist input. From the patient’s perspective, management in primary care is far easier, and there is no specific expertise necessary to prescribe for and monitor patients on hormone therapy.”
Once patients are discharged, a re-referral to a specialist team can be made if it is felt that the patient is experiencing distress, difficulties in adjusting in relation to their gender or treatment, regret, or adverse effects of hormone treatment.