Frequently asked questions
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.
Does coming to The Nottingham Centre for Transgender Health cost anything?
No, the centre is an NHS clinic.
Can you give me a Gender Recognition Certificate (GRC)?
No. Although, if appropriate, we can write a report which you can submit to the Gender Recognition Panel. For more information please see our page on Gender Recognition Panel Reports.
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 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.
How long is the waiting list?
The waiting time varies, but generally the waiting time for a first appointment is around eighteen months.
How long will the process take?
This will vary from person to person. The assessment period is usually around six months. If you wish to have genital surgery you must live in your preferred gender role 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. This is dated from the start of full-time gender role transition, with associated paperwork.
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, and there are too many issues for you to consider in a short time.
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.
When can I be considered for bilateral mastectomy (‘top surgery')?
Bilateral mastectomy is usually considered after you have been formally established in role and on your hormonal regimen 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) 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 - for example many surgeons will not operate on people who smoke. This can be discussed with your surgeon.
Do you undertake private surgery?
The surgeons we work with are in another NHS Trust for their NHS work. They also 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 hope 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 that the cost of the surgery as they NHS will not fund any revision necessary to that surgery if things go wrong.
My psychologist, psychiatrist, or GP won't refer me to The Nottingham Centre for Transgender Health. What do I do?
We recommend that you ask for a second opinion as transsexualism (gender incongruence) and gender dysphoria (previously called gender identity disorder) are internationally recognised medical conditions which patients are entitled to seek treatment for.
I can't get funding. What do I do?
Much of trans healthcare is nationally commissioned, however some is not, so in the first instance it is important to ask your GP where the block in funding is coming from. Some things such as facial feminisation surgery (FFS) may not be funded, but if you believe that the treatment you are seeking should be funded you should speak to your GP.
If the funding is delayed by the GP consortia it may be that they have limited budgets so some may defer funding until the next financial year. If the consortia refuse funding outright, or you feel they are delaying unnecessarily, you can make a complaint to them or failing that, contact the Health Service Ombudsman.
Why do I have to do the Real Life Experience (RLE)?
The RLE is the period of time when a person lives 100% of the time in their preferred gender.
People have fewer regrets after hormones and surgery if they have had experience living full time in their preferred gender. In addition, there are some people who, having been very clear that they wanted surgery at the outset, decide even as late as 18 months that they do not want these interventions.
Sadly, there are some people who have de-transitioned and then regretted changes made in the course of their transition (often in the private sector) and we seek to avoid this whenever possible.
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 diversity of sexualities other people can be.
My treatment has stopped progressing. What do I do?
Treatment can fail to progress for many different reasons. Quite often these are to do with people feeling that they cannot change their role 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 are registered disabled we may be able to reimburse reasonable travel costs. You should download the travel claim form for more information.