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.

The Nottinghamshire Local Medical Committee have developed this guide  Nottinghamshire LMC Transgender Guidance.pdf [pdf] 757KB

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.

Finding your voice

Voice and communication therapy is offered as part of our treatment pathway at NCTH. If you wish to align your voice and communication with your identity in ways that feel authentic to you, we can help you do this safely.  This may involve explore changes to your vocal technique, including pitch, resonance, intonation, rhythm, and volume.

Sessions may include singing to explore different vocal techniques. From our clinical experience, better understanding of pitch can help with voice modification. This technique will be discussed in our one-to-one and some group sessions. Non-verbal communication can be discussed if you wish to explore this in one-to-one or group therapy sessions.

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).

frequency

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

Surgery can be an important part of a person’s transgender pathway, however there are some trans and non-binary people who live very comfortable lives without surgery of any kind. Some people only wish to have one surgical intervention such as chest reconstruction or other surgery while other people require several different surgical interventions. It is important that you decide if surgery is right for you and this can be discussed in your appointments with clinicians here in the NCTH network before you make a final decision. Equally, you may need time to consider if surgery is right for you.

If you and your clinician decide that a referral for surgery would be appropriate for you, your referral will be handled by the NHS Gender Dysphoria National Referral Support Service (GDNRSS). The GDNRSS runs a support line to talk about aspects of your surgery if you need further advice or support.  If you do opt for surgery, and it is considered appropriate by your gender specialist clinicians, then it will be undertaken by surgeons commissioned by NHS England in line with the national service specification. In the event that you experience post-operative problems, then this should be discussed with the surgical team in the first instance, your gender clinician at the clinic or GDNRSS.

Click here for more information about the NHS Gender Dysphoria nurse-led support and information service.

 

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 Ross, Mr Andrew Mellington and Mr Charles Nduka at Nuffield Health Brighton Hospital; Mr Thangasamy Sankar at Nuffield Health Leicester Hospital; Mr Phillip Rubin at Nuffield Health Newcastle Upon Tyne Hospital; Mr Antony Fitton and Mr Robert Morris at Nuffield Health Plymouth Hospital; Mr Peter Kneeshaw, Mr Brendan Wooller, Mr Kartikae Grover and Mr Dorin Dumiru at Castle Hill Hospital; Miss Catherine Milroy and Victoria Rose at Parkside Hospital London. Other providers may also be available however, we are sorry that we are no longer able to refer to Mr Yelland.

Here is some further information about top surgery -  NCTH v6_top_surgery_leaflet.pdf [pdf] 169KB

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.

Here is some support information from the GDNRSS -  v2_gender_dysphoria_about_us_booklet.

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 NCTHGeneral@nottshc.nhs.uk

Gender Recognition Certificate reports

If you are applying for a Gender Recognition Certificate there a number of routes you can take and full details can be found at the YouGov website. The medical reports sent to the panel will need to include a gender incongruence or gender dysphoria diagnosis, hormonal and/or surgical treatment information and this can be found in the letters and reports you have already received from the clinic. If however these have been lost, we can send you copies for you to submit. If there is something within one of your documents you do not want to share with the panel, please let us know and we can redact this.

We are sorry that we are unable to complete GRC reports as a service and do note that the Gender Recognition Panel list is out of date and contains reference to clinicians who have previously worked or at here at the clinic. However, the above information should be accepted by the Gender Recognition Panel when considering your GRC request.

 

What do I need a Gender Recognition Certificate for?

A Gender Recognition Certificate (GRC) is needed for trans people to change their birth certificate and their sex marker with HMRC. Trans people also need a Gender Recognition Certificate if they want their marriage or civil partnership certificate to reflect their true identity. Having a Gender Recognition Certificate also means that trans people will have the correct sex recorded on their death certificate, preventing them from being misgendered after death. Many private pension providers and some insurance providers require trans people to have obtained a GRC before they will change the sex on a trans person’s records.

Trans men and trans women over the age of 18 are able to seek legal gender recognition in the UK. There is no legal recognition offered to trans children and young people. Non-binary people in the UK are unable to obtain legal recognition of the fact that they are non-binary.

 

Which documents can I change without a Gender Recognition Certificate?

In the UK adults can change their legal name by completing a deed poll - this can be done through the Royal Courts of Justice after signing a statutory declaration, but you can also change your name without doing this and information is available via the internet and does not have to cost anything.  Please note that some agencies may require a different form of Deed Poll. There’s more information on how to change your name on the YouGov website. Once you have a deed poll, you can change your name on all other records (including medical records, HMRC and pensions) apart from your birth certificate. It is important to note that changing your name on a document does not automatically change your sex on the document, where that is recorded.  Under 18s require parental consent.

To change the sex marker on your medical records, you should ask your GP surgery for the form that allows you to change your details. It is generally most sensible to do this at the same time as changing your title and name with the GP. You will be given a new NHS number.

Changing the sex marker on your passport requires a letter from a doctor confirming that you’re trans and that the change is likely to be permanent. Again, it is generally most sensible to do this at the same time as changing the name and photo on your passport. You can apply for a new passport online via the YouGov website.

UK driving licences are coded with a sex marker and this can be changed at the same time as changing your name and title. To do this you need to send your original deed poll along with your old licence and a D1 form. All of the forms can be found on the YouGov website.

In the UK there is currently no provision for recognising non-binary people as non-binary on any legal documentation or on medical records.

You will be able to find the forms and more information on the YouGov website.

Further information can be found on a variety of transgender and non-binary website sites such as https://www.transactual.org.uk/the-gender-recognition-act and https://genderedintelligence.co.uk/projects/kip.html.

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 NCTHGeneral@nottshc.nhs.uk 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.

 

 

Rate this page or report a problem

Rating
Rate this page or report a problem

branding footer logo