Gender Care

GenderCare

UK SPECIALISTS IN GENDER THERAPY

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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: http://gendercare.co.uk/index.html.

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

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

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

Can you assess me by telephone, Skype or email?
Most of the clinicians prefer to carry out assessments in person so you'll almost certainly have to travel for a face-to-face appointment. All first assessments with Dr Lorimer are face-to-face but, after that, he's sometimes prepared to carry out review assessments by telephone (the cost is the same: £150). At the current time, none of the clinicians do assessments via Skype or email. That may change in the future.

Can you provide counselling via telephone, Skype or email?
Dr Christina Richards provides counselling by Skype and face-to-face in Nottingham. Her details are here: http://gendercare.co.uk/christina_richards.html.

Can you provide face-to-face counselling?
Yes, Drs Richards, Lenihan and Dundas all provide face-to-face counselling. Their details are:
http://gendercare.co.uk/how-to-use-gendercare.html

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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: http://gendercare.co.uk/how-to-use-gendercare.html

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. 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. Dr Lorimer sends a draft copy of your letter by encrypted email, you get back to him to okay this and then the paper copies go out to you, your GP and any other doctor involved. Dr Seal usually dictates his letters in or just after the appointment and they're typed and sent within two weeks. Other clinicians will have different processes. Sometimes, if blood results have to be discussed or if it's a holiday period, 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. If, for example, your blood results are normal and Dr Lorimer agrees to "bridging hormones", you could be started on hormones a little over a month after your appointment with him. If your situation's more complicated or there's an abnormality in your bloods, you might need to have more tests and wait longer. Sometimes, Dr Seal or Dr Coxon might need to see you in person before starting hormones, so you'd have to wait until your medical/endo appointment.

Drs Richards, Lenihan and Dundas may have slightly different processes but work similarly with experienced medical prescribers. If in doubt, email and ask your preferred clinician, their details are here:
http://gendercare.co.uk/how-to-use-gendercare.html.

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COSTS
How much does it cost to get started on hormones?
Costs are here: http://gendercare.co.uk/fees.html. 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 with Dr Seal or Dr Coxon (£250-£300, depending on the clinician) i.e. up to £600 in total.

If your situation is straightforward, Dr Lorimer might consider "bridging hormones" after one appointment – so following just one payment of £300 – but that's on the understanding that you make and attend a later appointment with Dr Seal or Dr Coxon.

If, on the other hand, your situation is complex, your general/psych clinician might ask you to see a second general/psych clinician (in addition to the medical/endo appointment). This adds to overall cost so if we think this might be the case, we will tell you as early in the process as possible.

Dr Richards and Dr Lenihan may have slightly different costs and processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

How much does it cost to see you after starting hormones?
It depends on your individual situation but you should plan for a shorter review appointment with Dr Seal or Dr Coxon 6 months after starting hormones, to review dose, etc. Review appointments cost £140 or £170, depending on the clinician.

There is more variation with psych/general review appointments, depending on the clinician. If in doubt, email and ask, clinicians' details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

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 a 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 medics/surgeons, passport letters and private prescriptions (if required). 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. Drs Lorimer, Seal and Coxon are able to prescribe.

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?
Although we have some training with children and adolescents, GenderCare is an adult service, so we see ages 18 and upward. There have, in the past, been occasional exceptions to this – for example, when we've seen slightly younger teenagers who've already been assessed by child & adolescent specialists at the Tavistock & Portman NHS GIDS service – but our current rule is 18-and-older.

I'm the parent of a teenager. Will you see my child?
We will see ages 18 and upward. There have, in the past, been occasional exceptions – for example, when we've seen slightly younger teenagers who've already been assessed by child & adolescent specialists at the Tavistock & Portman NHS gender service – but our current rule is 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 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."

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 what the treatment is and how it's to be dispensed. We do have non-UK patients, but 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. If you have a doctor in your own country, who is willing to prescribe on our recommendation, then that can work.

Drs Lorimer, Seal and Coxon can provide private prescriptions themselves but generally prefer not to do this in the very long term.

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 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. 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. 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: http://gendercare.co.uk/how-to-use-gendercare.html) then contact them via their individual email address. It’s helpful to include the following information:

1 What name do you prefer to be known by (when we meet you and/or in written reports)?
Have you made an official name change, for example, via www.freedeedpoll.org.uk?
2 How old are you?
3 Have you used other gender services, private or NHS?
4 Are you living, day to day, as you'd like to live, gender-wise? If not, what needs to change?
5 What do you do during the day (work, study, social activity)?
6 Are those close to you (family, friends, partners, colleagues) aware of your gender circumstances? Do they support your plans?
7 Have you had any treatment for physical or mental health conditions? Are you on any medication?
8 What's your objective in approaching GenderCare – what would you like from us?

None of these is a trick question; we ask them to get a better sense of how best we can help.

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. It's helpful for us to have the following information:

1 What name do you prefer to be known by (when we meet you and/or in written reports)?
Have you made an official name change, for example, via www.freedeedpoll.org.uk?
2 How old are you?
3 Have you used other gender services, private or NHS?
4 Are you living, day to day, as you'd like to live, gender-wise? If not, what needs to change?
5 What do you do during the day (work, study, social activity)?
6 Are those close to you (family, friends, partners, colleagues) aware of your gender circumstances? Do they support your plans?
7 Have you had any treatment for physical or mental health conditions? Are you on any medication?
8 What's your objective in approaching GenderCare – what would you like from us?

None of these is a trick question; we ask them to get a better sense of how best we can help.

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APPOINTMENTS
Do I have to see two clinicians?
It depends what you want but, usually, yes. For example, if you seek hormones, you would need to plan and budget for 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. Dr Lorimer is open to recommending "bridging hormones" before your medical/endo appointment but that's on the understanding that you still make and attend the later appointment with Dr Seal or Dr Coxon.

Drs Richards, Lenihan and Dundas may have slightly different assessment processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

Separately, you might see Drs Richards, Lenihan or Dundas for Psychotherapy or Counselling Psychology. You might see Ms Antoni for Speech and Language Therapy or Ms Middleton for self-injection training or other advice.

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 make that appointment first (you can contact his secretary on endoappt@protonmail.com) then contact the general/psych clinician. Contact details for all clinicians can be found here: http://gendercare.co.uk/how-to-use-gendercare.html.

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

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)

What pre-hormone blood tests do I need for my appointment?
Ideally, bloods are fasting (blood is taken first thing, before you've eaten) but this isn't absolutely necessary.

FtM/AFAB/NB Transmasculine:
LFTs, lipids, glucose, vitamin D, FBC, LH, FSH, SHBG, oestradiol, testosterone, prostate specific antigen. (Some labs won't do the last one; it's usually not essential, so don't worry too much).

MtF/AMAB/NB Transfeminine:
LFTs, lipids, glucose, vitamin D, prolactin, LH, FSH, SHBG, oestradiol, testosterone, prostate specific antigen. (Some labs won't do the last one; it's usually not essential, so don't worry too much).

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. We might also then ask for advance payment of any further appointments (some clinicians already do this as routine).

Dr Lenihan will ask you to pay for your appointment in advance. Dr Richards charges the full cost of an appointment if you cancel with less than 24 hours' notice.

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. For example, Dr Lorimer's, Richards', Lenihan's or Dundas' appointment is more general and diagnostic while Dr Seal's or Dr Coxon's will be more medical. The overall aim is to try to get you closer to what you want to achieve.

Drs Richards', Lenihan's and Dundas' Psychotherapy and Counselling Psychology appointments are more to create a structured space in which you can explore your current thoughts, feelings and situation.

Will I have to undress?
Dr Lorimer's, Dr Richards', Dr Lenihan's and Dr Dundas' assessments are entirely interview-based; they don't examine you at all. Dr Seal's and Dr Coxon's assessments are more medical, and they might have to examine you if there's something unusual in your blood results or if they thinks 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. Clinicians vary in how they produce reports: Dr Seal and Dr Coxon send theirs through the post. Dr Lorimer sends his in draft form first, as an encrypted email attachment, so check your inbox (and junk mail/spam filter) 2-3 weeks after the appointment. You need to check over Dr Lorimer's draft letter and let him know you're happy with it, and then he sends the paper version through the post.

Drs Richards, Dr Lenihan and Dr Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

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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. Dr Lorimer is open to recommending "bridging hormones" before your medical/endo appointment but that's on the understanding that you still make and attend the later appointment with Dr Seal or Dr Coxon.

Drs Richard, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

How many times will I need to see you after starting hormones?
It depends on your situation but you should plan for a shorter appointment with the medical/endo clinician perhaps 3-6 months after starting hormones, to review dose, etc. There is more variation with the shorter general/psych appointments, for example, Dr Lorimer might want to see you for general review after 6-12 months.

Drs Richards, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

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"?
The original idea with GenderCare was to start hormones after two separate assessments, one general/psych and one medical/endo – for example, one with Dr Lorimer and one with Dr Seal. As a result of lengthening time-gaps to wait for the endocrine clinic, however, we began "bridging" that gap by getting people started on hormones after seeing Dr Lorimer but before seeing Dr Seal. This option depends on having a full set of normal blood results and both doctors being in agreement.

Drs Richards, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

How do I get started on "bridging hormones"?
You should arrange the necessary blood tests through your GP, and have the results ready when you see Dr Lorimer. At the appointment, Dr Lorimer will take a copy of your blood test results and discuss them with Dr Seal or Dr Coxon. If your blood tests are normal and both doctors are in agreement that it's reasonable for you to start hormones, Dr Lorimer can start the process before your appointment with Dr Seal or Dr Coxon.

Drs Richards, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

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GETTING HORMONES
Do I have to be living full time to get hormones?
Not necessarily. All the clinicians are interested in how you interact with the world and what your plans are for the long term, but everyone's situation is different and they're generally happy to work with you on that.

Do I have to have changed my name to get hormones?
Not necessarily. All the clinicians are interested in how you interact with the world and what your plans are for the long term, but everyone's situation is different and they're happy to work with you on that. For some people, name change isn't possible or isn't relevant.

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.

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.

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.

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 Drs Lorimer, Seal or Coxon can write the first prescription.

Drs Richards, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

My GP will prescribe but wants you to give the first injection. Can you do that?
Yes, although it can take a little time to arrange. GPs are quite often happier continuing a prescription started by another doctor but it's rare for them to also refuse to administer the actual injection. If this is your GP's position, we can usually arrange for an experienced nurse to give you the first injection. It'll mean you travelling to London, though, and there's a cost for the nurse's time – for example, Ms Middleton's details are here: http://gendercare.co.uk/iffy.html.

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.

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 and Transfigurations has a directory of trans-friendly doctors: http://transfigurations.org.uk/trans-friendly-doctors/.

Can you provide a prescription, rather than me getting it from the GP?
Yes. Drs Lorimer, Seal and Coxon are all 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 Lorimer, 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 Lorimer, Seal and Coxon are able to provide private prescriptions. We'd want 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. 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. 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. 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
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: http://gendercare.co.uk/how-to-use-gendercare.html.

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: http://gendercare.co.uk/how-to-use-gendercare.html.

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. Although we can sometimes reach a decision in one appointment, in some cases – with younger adults, where there's significant mental health history or where there's a lack of supports, for example – you might be asked to see more than one clinician.

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

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 appointment (possibly by telephone, in Dr Lorimer's case) at a later date, to discuss the other.

Drs Richards, Lenihan and Dundas may have slightly different processes. If in doubt, email and ask your preferred clinician, their details are here: http://gendercare.co.uk/how-to-use-gendercare.html.

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.

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.

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

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GENDER RECOGNITION CERTIFICATE
Can you provide a GRC report?
Yes, Dr Lorimer, Dr Richards and Dr Lenihan 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: http://gendercare.co.uk/how-to-use-gendercare.html.

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 Charing Cross 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 Charing Cross NHS gender clinic, using the form on the clinic website: https://gic.nhs.uk/referrals/). In Wales, there is a more complex system of "gatekeeping" 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 Charing Cross 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 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. 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 a GenderCare 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: http://gendercare.co.uk/how-to-use-gendercare.html. The GenderCare telephone is mainly for leaving messages for Drs Lorimer and Seal, 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: http://gendercare.co.uk/how-to-use-gendercare.html. Alternatively, your GP may prefer conventional mail to the 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: http://gendercare.co.uk/how-to-use-gendercare.html.

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: http://gendercare.co.uk/how-to-use-gendercare.html.

Why haven't you returned my email?
Email is the best way to contact GenderCare but we do sometimes get snowed under. We aim to get back to you within 10 working days but it can take longer during especially busy periods or during holidays. Try not to send multiple emails; we’ll do our best to respond as soon as we can. Our respective addresses can be found from here: http://gendercare.co.uk/how-to-use-gendercare.html.

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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 GenderCare 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
How to use GenderCare
http://gendercare.co.uk/how-to-use-gendercare.html.

Dr Lorimer’s GenderCare page on Facebook
https://www.facebook.com/drstuartlorimer/

Gender Construction Kit: the UK guide to changing things linked to GenderCare
http://genderkit.org.uk

UK FTM Information
https://ukftm.tumblr.com

Trans Masculine Support + Advice UK
http://www.tmsauk.org

Transfigurations register of trans-friendly UK doctors
http://transfigurations.org.uk/trans-friendly-doctors/

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

 
   
For more information please choose a clinician and email them directly, or telephone 07805 150909
 
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