Frequently asked questions
Frequently asked questions
We're sure you have a lot of questions about the service. Below find the answers to some that are often asked.
In this section
Referrals
| People who wish to see us should request a referral from their GP or other health professional. If a patient is referred by another NHS health professional, their GP needs to be informed and support the referral. You can also self-refer using the same form a GP would use. You can find this here. |
| We recommend that you ask for a second opinion. It is a GP's duty to refer you on request with no conditions and no delays. If your current GP is not willing to do this then ask to see another GP in your surgery. |
| After you are referred to the service, you and your GP or referring healthcare professional will receive a letter from us acknowledging the referral. This could take several weeks after your referral has been sent. You will next hear from us when you are at the top of the waiting list and we are able to invite you to make your first appointment. We appreciate that this can seem like a long time without any contact from the service, so we would encourage you to make use of our telephone support and information service in the meantime should you have any questions. |
| Whilst we are an adult service we will take referrals for young people who have had their 17th birthday and the waiting time is the same for any adult being referred. |
| Yes. We see many people who identify as non-binary. We assess for hormones and surgery in broadly the same way as we do for binary trans people. |
| You can choose to see your clinician either online or in-person, whichever is best for you. There may be times when a clinician needs to see you face-to-face, but if there is an access issue with this, get in touch with us via the main phone number, which can be found here. |
Waiting list
| There continues to be an exceptional demand for appointments in our service. This is due to a large increasing number of referrals, and the continuing care being provided to people once they are seen by the service. The wait at the moment is between two and three years. This is of course a long time to wait, however our commissioned services from Gendered Intelligence and our Waiting Well events and resources are there to support you at this time. Information about our current waiting times for a first appointment can be found on our waiting list update. |
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Yes, you can if you have a diagnosis and a treatment plan from one of the NHS England commissioned Gender Identity Clinics or from a Gender Service Pilot to a GIC, this is called a Transfer of Care. Patients can also be transferred from the London Gender Identity Development Service who have a diagnosis and a treatment plan from the age of 17. Unfortunately, NHS England Gender Identity Clinic’s do not accept waiting list transfers, except for young people who are already on the GIDs waiting list or those people moving from the Welsh or Scottish Gender Clinics as they are moving to live in England. As a clinic we would only be able to accept you as a new referral or a transfer of care once you have received a diagnosis from one of the other NHS England Gender Clinics. If you are being seen by us and have had a first and second assessment and want to transfer to another GIC, then please contact us and we will speak with your clinician. |
| We accept a waiting list transfer from the GIDS waiting list from the age of 17 years old and we take into account the time the time you have been waiting and you will follow the adult pathway. |
| In these circumstances you are a transfer of care and you will be seen within our clinic will see you within 3 months of your 18 birthday. A Lead Clinician will review your history, treatment thus far and previous care plan and then agree a future treatment plan with you whilst attending our clinic. |
| To be able to access NHS funded treatment, our commissioners service specification requires that a NHS Funded Clinic undertakes a specialised assessment, which for the majority of people will be two core assessment appointments, although a small number of people may need more. We can only accept a diagnosis and transfer of care from another NHS England Gender Identity Clinic, GIDs or NHS Gender Service Pilot, therefore a private diagnosis cannot be taken into account. |
| This would be considered on an individual case by case basis and would depend on circumstances and current waiting times in Nottingham. We are likely to take some time into consideration if you have moved into the area and attending another clinic would be difficult for you. |
| We regret that we are unable to correspond about prescribing hormones and are unable to prescribe or recommend hormones for patients on our waiting list who we have not yet seen. If you are self-prescribing, it is your GPs decision whether or not to provide blood monitoring. If your GP wishes to seek advice from us, they are more than welcome to. |
Receiving care
| We are aware that many trans people are also autistic. This will not be something that will prevent or delay your care. Our clinicians want to meet the whole person so there is no need to withhold information about your autism. All of our clinicians have experience of autistic patients. We have also tried to make our waiting room and building as autism friendly as possible. |
| Yes, you can. Treatment paths are catered for individual needs and the clinic will treat you the same as any other patient if you are non-binary. We are a gender-affirming clinic and welcome any patient, whatever their gender expressions, pronouns, or label they use. |
| Unfortunately, gamete storage is not funded through gender services. Some patients have been successful in getting this funded locally through their GP and Clinical Commissioning Group (CCG) but this varies from area to area. You will be given the opportunity to discuss this further with your clinician at an appropriate time if relevant. |
| Yes. Chest reconstructive surgery and genital reconstruction surgery (GRS or SRS) is necessary for many trans men or non-binary people to live their lives; and for some denial of access to treatment can be life-threatening. However, for a nationalised healthcare system such as the NHS it is important that only people who would benefit from surgery are given it. This is one of the reasons, aside from the great number of ethical considerations, that we have a process of diagnosis and evaluation. |
| This will vary from person to person. The assessment period is usually around four to six months. If you wish to have genital surgery you must live in your preferred gender for more than a year with the expected period to surgery being in the region of two years. |
| You won't get hormones on the first visit. We need to find out more about you than just one visit will allow. Some people have difficulties which will not be helped by hormones or surgery. It is very important that these people do not have irreversible interventions which they will later regret. National and international guidelines also advise against prescribing hormones without having considered the presenting difficulty thoroughly, which is something that can't be done in a short time. Because of the health risks hormones will not usually be prescribed to people who smoke or who are very overweight. |
| Chest reconstructive surgery is usually considered after you have been living in your preferred gender and taking hormones for a minimum of six months. |
| Yes. Before we can refer you for surgery, your body mass index (BMI) usually needs to be less than or equal to 30. You can work out your BMI here. Your waist measurement should also be less than or equal to 102 centimetres (40 inches). The referral portal for surgery, which is managed by the NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM), will not accept patients with higher BMI than this. If your BMI is higher than 30, please be aware that we won’t be able to refer you until you lose weight. There may also be other conditions which may affect your fitness for surgery. As you prepare for your period of care with us, it’s a good idea to focus on healthy eating and regular exercise, which will help you manage your mood as well as your weight. You can find out about how the NHS supports people to lose weight and improve their fitness here. |
| Treatment can stop progressing for many different reasons. Often these are to do with people feeling that they cannot live in their preferred gender in the way the guidelines, both national and international, require. If this seems to be the case for you then please discuss it with your clinician at the next meeting. They are there to try to help move things forward as far as the guidelines allow and may be able to offer some helpful suggestions. |
| Preferably. Smoking is counter indicated for hormone treatment, and many specialist gender surgeons will also not operate on people who smoke. As you prepare for your period of care with us, it’s a good idea to reduce and if possible stop smoking. You can find out about how the NHS supports people to stop smoking here. |
| If you receive benefits we may be able to pay you back for reasonable travel costs. You should ask reception for a travel claim form for more information. Please retain all receipts when making a claim as you will not be paid without them. |
Private care
| Yes. There are many private clinicians around the world of varying quality. As we are an NHS clinic we cannot work in parallel (on the same thing at the same time) with private clinicians so you will need to decide after your initial assessment if you would like each part of your treatment to be undertaken within the NHS or privately. |
| The surgeons we work with often undertake private work, but this is managed separately from their NHS work. You would need to contact them directly about this. |
| No. Referrals for NHS surgery need to come via the NHS. If you are seeing someone privately and are hoping for surgery within the NHS, we recommend that you discuss the matter with them. |
| Yes, you are welcome to ask a private surgeon to perform surgery using a referral from us. We won't, however, be able to advise on the qualifications of the surgeon, only as to your suitability for surgery. If you are considering private surgery it is wise to have considerably more money available than the cost of the surgery, as the NHS will not fund any extra surgery if things go wrong. |
Being trans
| No. ‘F64.0 Transsexualism’ and ‘Gender Dysphoria’ are listed in medical manuals because of the distress the unresolved condition can cause. This severe distress then requires NHS funded interventions aimed at resolving a person’s conflict between their body and their sense of self. However, a person can be trans or non-binary and be doing well. If a person is doing well it may seem inappropriate for them to receive a diagnosis of (what is technically) a psychiatric disorder, however, such a diagnosis may be made so that they can receive the appropriate treatments to prevent future problems. Seeing a psychiatrist or psychologist does not in itself mean that one has a mental illness. |
| No. The vast majority of trans and non-binary people have jobs and many employers have policies in place to deal with issues that may arise. People who transition at work are also protected under employment law. Being trans or non-binary alone is not enough to seek benefits for ill health. |
| No. Just as with anyone else, many trans or non-binary people are in long term relationships, some are married, some are in a civil partnership and some have relationships with more than one partner. Often the relationships that last longest are those where a person is open about their gender status, but their partner is not with them for that reason. Every relationship is different. |
| There are so many different ways of being that there is no single 'cause'. The academic literature suggests that it may be: genes, pre-birth conditions, hormones, neurology, learning, choice, or any combination of these things. It is important to realise, however, that speculating on causes doesn’t tell you as an individual what to do. |
| Being trans or non-binary is not a problem in and of itself and so not something which could, or should, be ‘cured’. The distress that can be caused by being trans or non-binary in an occasionally misunderstanding society can be distressing, however, and the ‘cure’ for that distress will be different for different people. We do know that for many trans or non-binary people, talking therapies do not resolve their gender issues. Because of this, for some people the best course of action is for the body to be altered to fit the mind through hormones and surgery. |
| No. There are a great many ways to be trans or non-binary and, sadly, one of the most common forms of distress among trans or non-binary people is in not fitting in to some ‘ideal’ - whether it comes from the wider media or the communities themselves. It is important for people to transition to being more themselves, rather than to the person they think they are expected to be. You do not have to have hormones or surgery to be trans or non-binary, or to live a content life in your preferred gender. We also do not expect all trans people to look and act the same. You will be treated as an individual at all times. |
| As we are part of the NHS we don’t recommend any private outlets or providers unless they are being used as providers of NHS services. Support groups listed on our support pages may be able to point you in the right direction. |
| No. People have many different modes of dress which are suitable to wear in public and any of them are fine. Please dress in a way which feels most comfortable to you. |
| A social gender role transition is when a person lives 100% of the time in their preferred gender. We generally suggest this if people wish to have hormones or surgeries because evidence suggests that people have fewer regrets after hormones and surgery if they have had experience living full time in their preferred gender. If you wish to have genital surgery, guidelines say that you must live in your preferred gender for more than a year. |
| No. People coming to The Nottingham Centre for Transgender Health can be any of the sexualities which other people can be. |