Treatment options

Endocrinology (hormones)

Not all trans people wish to have hormones and many live very comfortable lives without them. Nonetheless there are a significant number of trans people who do wish to take hormones in order to make physical changes to their bodies so they are more in line with their felt sense of themselves. We will only recommend hormones after a person has made a formal and established change of gender role.

The changes you may see can be discussed further at the centre.


Both trans men and trans women will become infertile if they take cross-sex hormones. It is really important to consider all of the issues around fertility before taking hormones.

This will be discussed in more detail at your appointments.


Some trans people live very comfortable lives without surgery of any kind. Some trans people only wish to have chest or other surgery. It is important that you decide if surgery is right for you.

If you do opt for surgery, and it is considered appropriate by your gender specialist clinicians, then it will be undertaken by surgeons within NHS Trusts who are not part of The Nottingham Centre for Transgender Health or private providers who are contacted to carry out NHS work.

We work closely with the staff at these surgical centres, however please bear in mind that we don't directly influence their policies and procedures. We can't control which clinicians the surgical centres will accept referrals from, any special requirements they may have, their waiting lists, or which centres will be funded to perform your surgery.


Trans male

Bilateral mastectomy and associated chest reconstruction (‘top surgery') are generally carried out by the following practitioners: Mr Yelland at Brighton Hospital; or Miss Walls at North Manchester General Hospital. Other providers may also be available. 

Genital surgery (‘bottom surgery') for trans men generally includes hysterectomy and oophorectomy, as well as phalloplasty or metoidioplasty. The hysterectomy and oophorectomy are sometimes carried out separately from the phalloplasty or metoidioplasty and at Leicester General Hospital. The creation of a penis (phalloplasty or metoidioplasty) is generally carried out at St Peter's Andrology Centre London or Leicester General Hospital.


Trans female

Breast augmentation (after a minimum of two years on hormones), thyroid chondroplasty and cricothyroid approximation are sometimes requested but may be subject to funding restrictions. Facial feminisation surgery is generally not funded on the NHS.

Trans female genital surgeries such as penectomy, orchidectomy, vaginoplasty or cosmesis, and clitoroplasty are usually carried out through Imperial College Healthcare NHS Trust, but may also be carried out by Mr Bellringer at Parkside Hospital.


Facial hair removal

Facial hair removal is carried out by private providers. For our patients, it is paid for by the NHS after they have transitioned formally - if it is agreed with your Gender Specialist Clinician. Please speak to you clinician about referral for this if it is something you feel you would need.


Speech therapy

Feminising hormones do not affect the voice, so some people choose to have speech therapy to feminise their voice. Some areas have this locally, however many do not and so patients who have formally transitioned full time may be referred to the speech group at The Nottingham Centre for Transgender Health. You will need to attend regularly to gain the most benefit. Any surgical assessments for vocal pitch will only be considered after a full course of speech therapy, as surgery without speech therapy has been found to be ineffective.

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