Help in a crisis during Coronavirus COVID-19 pandemic

During this COVID-19 pandemic there may be changes in the way some of our services work. Contact the service directly to check how services are being delivered and follow their advice.

Some of our services now offer video consultations. You should speak to your clinician if this is something you would like them to consider. You can find out more about video consultation here.

Visiting: Contact the ward you wish to visit in advance for guidance and instructions for a safe visit. 

If you need help in a mental health crisis during the COVID-19 pandemic outside office hours please contact our crisis team: Help in a crisis

For other medical advice and support contact your GP or visit NHS 111

Only visit your local Emergency Department for serious life-threatening conditions that need immediate medical attention including persistent severe chest pain, loss of consciousness, acute confused state, severe breathlessness, severe blood loss, serious burns or suspected stroke.

Services offered

We offer initial assessment over two appointments which are generally two to four months apart. If you want a family member or significant other to be part of your assessment, please ask at your first appointment. You are not required to bring someone with you to an assessment.

At the end of the assessment you may be discharged if we cannot assist you; you may offered further assessment; or you may be offered some form of assistance or treatment. Assistance may include psychotherapy, sex and relationship therapy, speech and language therapy, as well as recommendations for hormonal therapy, facial hair removal, or surgeries.

People who are neuro-diverse

The Centre has a long and affirmative history of assessing and treating gender incongruence in people who are neuro-diverse.

We have clinicians who are highly trained and experienced in ASC and other neuro-diversities and we take an individualistic approach to the assessment, diagnosis and treatment of this patient group.

We work closely with the other health professionals, support workers and carers involved in our patient’s lives to ensure that the right information and support is being provided with reasonable adjustments.

We use adapted information such as an ‘easy read guide to hormones’ for those patients who may find it helpful and will arrange extra time/appointments for people to ensure that they are as informed and ready as possible before undertaking treatment or surgery.

Hormone therapy

Not all trans and non-binary people wish to have hormone therapy and many live very comfortable lives without them. Nonetheless there are a significant number of trans and non-binary 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 generally recommend hormones after a person has made a formal and established gender role change.

Expectations of hormones are discussed when you are assessed. As hormone therapy causes infertility, it is really important to consider storing gametes (eggs or sperm) before taking hormones.

Psychotherapy

Many people attending our service have problems with anxiety, social phobia, depression, and self-harm. In general local services are best placed to help with these things and your GP can refer direct. Dealing with these issues will help make any transition easier.

A small minority of people have difficulties which require specialist psychotherapy with one of our psychotherapists. Some people we see have difficulties with sexual relationships and sex and so we also offer sex and relationship therapy.

Speech and language therapy / Voice assessment and voice therapy

We offer speech and language therapy for trans men, trans women, and non-binary people here at the center.

However some areas of the country also have local expertise, and your GP may be able to refer you for this directly.

Click here to view various intonation and rhythm exercises.

 

Voice assessment and voice therapy

Dr Ioanna Georgiadou, MA, RCSLT, HCPC, CCC-SLP Speech and language therapist, transgender voice specialist and Christopher Cook, Bsc Hons, MRCSLT, HCPC

 

Voice change - the beginning

The goal of voice change, and specifically of voice feminization or masculinization, may be to reflect what is heard on the outside or the individual’s voice identity with the person’s inside identity. Beginning the process of voice change can be very exciting and at the same time it can be frightening for many people. In our work as speech and language therapists, our clients often report feeling nervous about the different challenges they may face as they attempt to change their voice. Feminizing or masculinizing your voice is an exciting process and we hope that the information on this website will help in understanding some basic principles of voice change.

 

One-to-one voice therapy at our clinic – session structure

We generally offer 5 one-to-one voice sessions that are designed to help with voice change in a step-by-step process. Depending on your ability, we individualize each session to fit your needs.

 

Voice - what is it?

Our voice (or voice identity) sounds like our own because of several different factors combined: some of these may be pitch, resonance, intonation, rhythm, intensity, rate, and articulation. The next few paragraphs define these factors.

Pitch: How high or low we can move our voice. It is the perceptual correlate of the frequency of vocal fold vibration (measured in Hertz/Hz).

Voice pitch - Nottingham Transgender Service

Resonance: The voice quality (how rich a voice may sound). Generally, masculine voices are perceived to resonate mostly from the chest area, whereas feminine voices are perceived to resonate mostly from the head area.

Intonation: The upward and downward movement of the voice or the inflection of the voice. Generally feminine voices are perceived to have more inflections than masculine voices.  

Volume: The loudness or intensity of our voice. It is the perceptual correlate of amplitude (measured in decibels, dB). Generally, masculine voices are perceived to be louder than feminine voices.

Rhythm: The patterning of syllables in speech. Rhythm is measured in terms of vowel duration. Generally, a more legato rhythm (smooth and connected with longer vowels) may be more stereotypical for feminine voices, whereas a more staccato rhythm (choppy with shorter vowels) may be more stereotypical of masculine voices.

Articulation: The shaping of sounds by the tongue, lip, jaw, soft/hard palate, teeth and alveolar ridge to produce speech. Generally, feminine voices are perceived to be clearer in terms of articulation and more precise.

Vocal health – keeping your voice at its best

Vocal health refers to voice related behaviours that are beneficial for any voice user. Vocal health recommendations include modifications in lifestyle or behaviours that are summarized below:

  • Increase water intake. The vocal folds function best when they are hydrated adequately. 
  • Decrease caffeine and alcohol consumption (these tend to try the vocal folds).
  • Reduce/eliminate smoking.
  • Avoid vocal behaviours such as shouting, loud speaking or screaming. These behaviours irritate the vocal folds.
  • Assess acoustic properties of a room and modify as needed (e.g., use amplification).
  • Incorporate voice rest in daily schedule and reduce talk time when possible.

Facial hair removal

We provide recommendations for facial hair removal therapy which is carried out by private providers and funded by the NHS.

Surgery

Some trans and non-binary 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 by private providers who are contracted to carry out NHS work.

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

 

Surgeries for people assigned female at birth

Removal of breasts or chest reconstructive surgery (‘top surgery') is generally carried out by the following surgeons: Mr Kneeshaw at Castle Hill Hospital, Hull; Miss Dabritz at North Manchester General Hospital; Mr Ross, Mr Andrew Mellington and Mr Charles Nduka at Nuffield Health Brighton Hospital; Mr Fitton and Mr Morris at Nuffield Health Plymouth Hospital; Miss Milroy at St George’s University Hospitals NHS Foundation Trust; Mr Caddy at Hallamshire Hospital; and Miss Rose at St Thomas’ Hospital. Other providers may also be available however, we are sorry that we are no longer able to refer to Mr Yelland.

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. Phalloplasty or metoidioplasty is generally carried out at St Peter's Andrology Centre London.

 

Surgeries for people assigned male at birth

Genital surgeries such as penectomy, orchidectomy, vaginoplasty or cosmesis, and clitoroplasty are usually carried out through Imperial College Healthcare NHS Trust London, Nuffield Health Brighton Hospital, and Parkside Hospital London.

Breast augmentation (after a minimum of two years on hormones), thyroid chondroplasty and cricothyroid approximation, and facial feminization surgery are generally not funded on the NHS.

Passports

We provide letters to support the people we see to change their gender on their passport. Please ensure that you have sent us a copy of your change of name document and other updated ID, and please make the request at your appointment or by email at not-tr.gender-services@nhs.net.

Gender Recognition Certificate reports

We provide reports for people we have seen for applications for a Gender Recognition Certificate (GRC). Please allow up to three months for the completion of a report. Please make the request at your appointment or by email at not-tr.gender-services@nhs.net.

Support groups

The Centre currently offers several support and information groups for our patients.  

Trans men

We are establishing a group for trans men, which will be a general support group and facilitated by a trans man with extensive support and counselling skills as well as a clinician from the service.

If you are interested in being part of this group or putting forward topics for discussion, please email not-tr.gender-services@nhs.net with Support Group in the subject heading

Trans women

We have an ongoing group for women who have had genital affirming surgery and would like further support. The group is facilitated by 2 clinicians with experience in group work.

We have a group for women who are considering genital affirming surgery and would like more information or support. Women can attend for as many or as few sessions as they need. The group is facilitated by a volunteer who has had genital affirming surgery and a clinician.

The Trans women groups have a maximum of 10 people in them, they take place at the Centre monthly on Wednesday evenings and they can be accessed by emailing the centre or via your clinician.

You can find a useful list of nationwide trans support groups on Tranzwiki.

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