Gender identity clinic resources

If you smoke it is very important that you stop altogether at least three months before starting hormones, although vaping is perfectly OK. If you wish to have surgery you should not have nicotine in gum, patches, e-cigarettes, or vaping devices because nicotine affects blood flow and scar healing among other things.

Smoking is a problem because the thromboembolic (clotting) risk with oestrogens, and polycythaemia (thickening of the blood) risk with androgens is raised to unacceptable levels in people who smoke. Any form of nicotine replacement, including electronic cigarettes, is safe with hormone therapy.

Find advice and support around stopping smoking

Mental health

If you have difficulties with your mental health or substance use, please speak to your GP to help you access the appropriate support. We regularly see clients with a range of mental health needs and encourage engagement with the support offered to you. Receiving treatment for your mental health is not a barrier to accessing GIC.

As we are a specialist gender service, we do not offer a crisis service and we require patients with severe and enduring mental illness to engage with their local mental health teams. 

There are a range of psychological services you may be able to via a varied referral process. 

Online mental health self-help resources: 

• www.getselfhelp.co.uk  
• www.mind.org.uk / info line 0300 123 3393
• www.thehappinesstrap.com

Wellbeing

Exploring your gender identity, addressing gender dysphoria, and transitioning can be difficult. Therefore, doing things to support your wellbeing can be helpful, for example:

• Do things you enjoy such as exercise, hobbies and community activities
• Eat a healthy diet 
• Practice mindfulness/meditation – there are free resources available such as ACT with compassion and Headspace. 

If you have any physical health concerns or conditions, please tell your GP so that you can be offered the appropriate support.

If you change your name and gender at your GP practice, you may miss invites for national health screening programmes, such as cervical smear tests. However, you can ask your GP to arrange the right screening appointments for your needs.

Please continue to access sexual health support and screening regularly, in order to care for your sexual health. You can access this support from your local sexual health services. For those in and around London, CliniQ is a specialist transgender sexual health clinic in central London that offers a wide range of sexual health and other services, such as acupuncture and counselling.

We see many different people at the clinic with different gender needs and goals. For those seeking physical treatment, we recommend making steps towards a social role change before receiving hormones or surgery as this may help to relieve gender dysphoria, and generally happens before hormones or surgeries.

Making a social role transition may include:

Telling people your gender identity

This does not necessarily mean telling people your sex assigned at birth or that you are trans or non-binary. 

• This may include friends, family, colleagues, or other people.
• This often starts with telling people you trust most who are likely to support you.

Changing your name

• You can officially change your name by Deed Poll. You should then update your name everywhere that you are registered, such as banks, GP etc.
• People sometimes first make an unofficial name change, for example, among friends or family.

Asking people to use different pronouns, titles, or other gendered language

• You can ask people to use the pronouns (e.g. he, she, they), titles (e.g. Mr, Ms, Mx), or other gendered language that fits with your gender identity.

Changing your gender expression

• This may or may not be a traditional gender role.

Being yourself in the world

• Consider studying, working or volunteering (in line with your abilities) in your new gender role.

It can be really helpful to gain support from people in your life. We recommend spending time with and talking to those you can trust, such as your friends, family, colleagues etc. Pets can be wonderful too.

It can also be helpful to meet other people whose experience is similar to yours in order to gain information and support. There are a wide range of in-person and online support groups that you can join. You can find information about trans specific support groups below:

• Tranzwiki
• Trans Unite
• Stonewall
• It Gets Better Project

GIRES (Gender Identity Research and Education Society)

Before commencing hormone treatment, it is important to consider fertility and preservation. Hormone treatment is likely to make you unable to have biologically related children. Please think about fertility preservation before starting hormone treatment. NHS funding for fertility preservation can be applied for from your local Clinical Commissioning Group (CCG) (or Integrated Care Board (ICB)) via your GP.

Find more information at Human Embryology and Fertilisation Authority.

We urge people not to self-medicate with hormones, as this can be unsafe due to lack of medical monitoring. In particular we advise against taking Spironolactone, which our Endocrinology Department advises can cause hyperkalaemia (high potassium), which can lead to irregular heart rhythms and kidney damage. Evidence suggests that Spironolactone triples the risk of an upper gastro-intestinal haemorrhage, and that patients taking Spironolactone are more likely to have insufficient breast growth. Using medical resources not regulated by NHS England can be unsafe and, as with all medical advice online, you need to discuss your individual circumstances with a doctor.

Self-medicating will not have an impact on the treatment you receive at the gender identity clinic (GIC). If you are self-medicating, please review this medication with your GP to ensure it is monitored safely as we are not able to provide advice about hormone therapy until we (or another GIC) have seen you for an appointment. If you do choose to self-medicate against medical advice, please try to minimise harm to yourself by having regular blood tests, keeping a standard weight for your height, and not smoking.

It is important to get screening blood tests done to make sure there is not a hormone issue present in your body before any of these treatments are given. Your GP will need to look at these results and liaise with local services if any abnormalities are detected. Please do not send these results to the GIC.

To stop menstruation

Your GP may wish to consider medroxyprogesterone acetate (Provera) 10mg three times a day to stop menstruation if this is causing you distress. Please note this medicine needs to be stopped before gamete storage, if you want to store gametes.

Accessing anti-androgens

On the advice of the physicians in our Endocrinology Team, your GP may wish to consider commencing Finasteride 5mg/day. This is an anti-androgen that can support with current experiences of dysphoria while you are waiting further assessment for hormone treatment. Side effects of this medication can include reduced erectile function and libido. Please discuss this with your GP. Your liver function will need to be normal. If your GP can see no contraindications to it, they may consider prescribing this to you. Please note this needs to be stopped before gamete storage if you want to store gametes. 

Removing facial hair

Your GP may wish to prescribe Vaniqa facial hair removal cream, which can help to alleviate any experiences of dysphoria with regards to facial hair. Unfortunately, some NHS regions don’t allow GPs to prescribe this.

Please discuss ALL side effects with your GP before commencing any of these treatments. We will ask you to have updated blood tests completed before your first appointment. When you receive your invitation to your first appointment, we will ask you to have these blood tests completed by your GP and sent to the clinic.

Chest surgery for transmasculine people 

UK FtM Tumblr is not officially affiliated with surgical providers but tends to have up to date information about chest surgery providers and patient reviews. TMSA-UK Facebook group is also a place people post reviews for masculinising surgeries.

For patient safety during and after surgery, we ask you to aim for a BMI of between 19 and 31. Surgery is likely to be delayed until BMI is lower than 31 and waist measurement is less than 100cm. This is because surgical risks and healing difficulties happen more often when people are overweight.