Frequently asked questions

Referrals

How can I be referred to your service?

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. Unfortunately, we cannot accept self-referrals.
 

What happens after I am referred to your service?

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 if you have any questions.
 

How old do I have to be to access your service?

Our clinic assesses patients from the age of 17 years. We accept referrals for patients aged from 16 and a half years to account for our current waiting times.

Our young patients are generally seen at assessment without a parent unless there are exceptional circumstances which would make this the most appropriate course of action. Parents have a chance to be seen with the patient at some point in the assessment if the patient is in agreement.
 

Do you see people with non-binary identities?

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.
 

My psychologist, psychiatrist or GP will not refer me to The Nottingham Centre for Transgender Health. What do I do?

We recommend that you ask for a second opinion as the diagnoses we commonly work with -  ‘F64.0 Transsexualism’ and ‘Gender Dysphoria’  (previously called gender identity disorder) are internationally recognised medical conditions which people are entitled to seek treatment for.
 

Waiting list

How long is your waiting list?

There is currently an exceptional demand for appointments in our service. This is due to a large and increasing number of referrals, and the continuing care of our existing service users. We regret that the waiting time for a first appointment with us is currently in excess of two and a half years. We appreciate how challenging this is for our patients and would like to reassure you that we are doing all we can to see people as soon as possible.
 

If I move to a different clinic will I have to join a new waiting list?

If you are currently on our waiting list and have not yet been seen for your first appointment, we can write to the new clinic, sharing your initial referral information and explaining the time you have spent on our waiting list. We would need your consent to do this. It is the new clinic's decision whether they take your waiting time to date into consideration, and they may request a new referral from your GP or health professional.

If you have started to receive care in our service and wish to move to a different clinic, we would write to them and share your medical notes - again with your consent. This is known as a transfer of care. You would not join that clinic's main waiting list, but the wait for your next appointment would be determined by the new clinic.
 

If I am transferred to Nottingham’s clinic and waiting list, will you take into account previous waiting time on another clinic’s list?

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.
 

Are you able to offer advice about hormone treatment while I am on the waiting list?

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 GP’s decision as to whether they prescribe or do blood monitoring. If your GP wishes to seek advice from us they may write to us to do so.
 

Receiving care

How do I inform the service of a change to my name?

Please send a copy of your change of name document (any form of deed poll or statutory declaration) to the clinic so that this can be updated.
 

How can I give consent for someone to speak to the service on my behalf?

Please provide written consent to allow another person to speak to us on your behalf over phone and email. We do not have a specific form, but this can be in the form of a letter.
 

Will I need to have a physical examination?

You do not need to have a physical examination prior to being referred to our clinic. We advise an examination by your GP for blood pressure, pulse and BMI prior to hormone treatment and surgery referrals. We do not perform physical examinations in the clinic except for blood pressure and BMI which might be done in our endocrinology clinic. Occasionally, an endocrinologist might suggest further examination if there is a clinical indication. You do, of course, have a right to refuse and to have a chaperone.
 

Do you offer funding for gamete storage?

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.
 

Is surgery funded on the NHS?

Yes. Chest reconstructive surgery and genital reconstruction surgery (GRS or SRS) is necessary for many trans 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.
 

How long will the process take?

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. This must include at least one year in some form of occupation appropriate to your ability level. 
 

Will I get hormones on the first visit?

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.
 

When can I be considered for chest reconstructive surgery (‘top surgery')?

Chest reconstructive surgery is usually considered after you have been living in your preferred gender and taking hormones for a minimum of six months.
 

Do I need to have a certain level of fitness or weight to have surgery?

Yes. 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 be less than or equal to 102 centimetres (40 inches). There may be other conditions which may affect your fitness for surgery and many surgeons will not operate on people who smoke. This can be discussed with your surgeon.
 

My treatment has stopped progressing. What do I do?

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.
 

Can I claim travel expenses?

If you receive benefits we may be able to pay you back for reasonable travel costs. You should download the travel claim form for more information. Please retain all receipts when making a claim as you will not be paid without them.
 

Private care

Can I go private?

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.
 

Do you undertake private surgery?

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.
 

Are private referrals accepted for NHS surgery?

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.
 

Do you make referrals for private surgery?

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.
 

General enquiries

Does being transgender or non-binary mean I’m mentally ill?

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.
 

Does being trans or non-binary mean I won’t be able to get a job?

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. 
 

Does being trans or non-binary mean it will be difficult to find a partner?

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.
 

What causes trans or non-binary feelings?

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.
 

Can being trans or non-binary be cured?

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.
 

Is there a ‘right’ way to be trans or non-binary?

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.
 

Where can I get clothes/wigs/binders/packers/electrolysis?

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.
 

Do I have to dress or act in a certain way?

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.
 

Do I have to make a social gender role transition?

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.
 

Do I have to be attracted to people of a gender that is the ‘opposite' to my own preferred gender?

No. People coming to The Nottingham Centre for Transgender Health can be any of the sexualities which other people can be.