Gender Identity Services The Nottingham Gender Clinic provides a secondary and tertiary service for people with Gender Dysphoria aged 18 years and over. Dr Brian Ferguson, Consultant Psychiatrist and Dr Bernard Ratigan, Consultant Psychotherapist originally set up this Clinic in 1997.
Contact and location details
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham NG7 6LB
Telephone: 0115 960 2820
How to find us
Service offered
This is a regionally commissioned service, which incorporates psychiatric and psychological assessment, endocrine assessment and treatment, and supportive therapy if required. We work according to our clinic protocol (see the attachment at the bottom of the page), which is largely based on the forthcoming Good Practice Guidelines for the Assessment & Treatment of Gender Dysphoria by The Royal College of Psychiatrists Intercollegiate Committee. We also follow the Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders for guidance. The service has close links with surgical services providing gender reassignment surgery.
Who is the service for
The service is for anyone who experiences distress about his or her assigned gender.
Referral information
Referrals are usually made via the GP. Referrals from local psychiatric or psychological services are also accepted, although we would like the GP of the person referred to support the referral.
Staff
The Nottingham Gender Clinic team consists of the following members:
Dr Karen Baker
Dr Baker is an adolescent psychiatrist who joined the clinic in 2008. Alongside her psychiatric training she qualified at the Tavistock Clinic in London as a psychoanalytical psychotherapist for children and adolescents.
Dr Walter Pierre Bouman - Clinical Lead
Dr Bouman is a psychiatrist-sexologist who joined the clinic in 2007, having initially trained in psychiatry and psychotherapy in the Netherlands; he received further postgraduate training in sexology at the Porterbrook Clinic in Sheffield and is an accredited member of the British Association of Sexual and Relationship Therapy (BASRT). He is also registered with the United Kingdom Council of Psychotherapy (UKCP) as a couple psychotherapist. His name is included as a registered medical practitioner on the Gender Recognition Panel. He is Deputy Editor of the Journal of Sexual and Relationship Therapy.
Dr Nick Mepham
Dr Mepham is a psychiatrist who joined the clinic in 2006. He is a recognised specialist in Gender Dysphoria and his name is included as a registered medical practitioner on the Gender Recognition Panel.
Dr Sarah Murjan
Dr Murjan is a psychiatrist who joined the clinic in 2000. She has published a study on gender clinics in the United Kingdom. She is a recognised specialist in Gender Dysphoria and her name is included as a registered medical practitioner on the Gender Recognition Panel.
Mrs Helen Gardner
Mrs Gardner has been the administrator of the Gender Clinic since 2002 and very much enjoys working here, having built up considerable expertise and knowledge in this area; she is the friendly voice on the phone and always willing to help whenever she can.
General Information
Our protocol describes the provision of assessment and treatment of people who present with Gender Dysphoria. Gender Dysphoriacould be defined as follows: "Atypical gender development may give rise to a psychological experience of oneself as male or female, that is, a 'gender identity', which is incongruent with the phenotype (the external sexual characteristics of the body). The personal experience of this incongruence is termed gender dysphoria. In its profound and persistent form, the individual affected may need medical assistance to facilitate a transition of status, to live in accordance with his or her gender identity rather than with the phenotype; this degree of Gender Dysphoria is described as transsexualism."
The International Classification of Diseases version 10 (ICD-10) diagnosis of transsexualism (F64.0) in an adult requires three criteria to be met. ¹
- The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormonal treatment;
- The transsexual identity has been present persistently for at least two years.
- The disorder is not a symptom of another mental disorder or a chromosomal abnormality.
Although the aetiology of the condition is not yet fully understood, there is current evidence that suggests that transsexualism is not a mental illness, but rather a neuro-developmental condition.
Transsexualism cannot be "cured"; instead interventions may be required to optimise mental health and facilitate transition of gender status where appropriate. The overarching treatment goal is lasting personal comfort with the gendered self in order to maximise overall psychological well being and self-fulfilment.
Legal obligations in the provision of treatment
The House of Lords confirmed that Gender Dysphoria is a bona fide medical condition and agreed that Primary Care Trusts (PCT) should make available gender reassignment services subject to funding and in accordance with the PCT's normal prioritisation process. A PCT is however allowed to accord any treatment "low priority".
The Guidelines for Health Organisations Commissioning Treatment Services for those experiencing Gender Dysphoria and Transsexualism states under the section Health Commissioner's funding obligations: " Once a diagnosis, or even a provisional diagnosis, of gender dysphoria has been made and the process of treatment is initiated, there is an obligation for funding to be provided throughout the entire process of transition and, if it is clinically appropriate, on an ongoing basis following transition. The individual must be given the necessary psychological support, hormone treatment and, where appropriate,
surgery must follow. Surgery may be delayed or withheld on clinical grounds only."
Treatment Pathway for Gender Dysphoria
Although there is no single model for treatment, the care pathway for people with Gender Dysphoria usually includes diagnostic assessment, supportive psychotherapy, the "Real Life Experience", hormonal therapy and surgical interventions. Not all people with gender Dysphoria will wish to progress through all stages of the treatment.
References
¹ World Health Organization (1990). International Classification of Diseases. Geneva, Switzerland: World Health Organization.
Links for Gender related Information and Leaflets
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