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Treatment Pathway

We expect that each person who is assessed in our service will come with their own story and experiences and that each person is unique. We aim to offer an assessment and treatment process that identifies and addresses those individual needs, through an open dialogue between clinicians and the service user.

We recognise that each person attending the service will want different things from treatment and that some will not want medical interventions of any kind. By listing treatments here we aim to explain what is on offer within the framework of the NHS, but there is no expectation that these treatments will be desirable or suitable for everyone. Part of your assessment will include opportunity to explore what types of treatment you feel you want and with your clinician, then a treatment plan will be agreed. This plan is reviewed and often altered throughout your time with the service.

Hormone therapy

Hormone treatment is recommended by our medical staff, where appropriate, and prescribing and administration is managed by the person’s General Practitioner (G.P.). The way that hormone treatment and hormone blocking treatments are administered depends on factors such as the person’s goals, age, physical health problems and lifestyle, such as smoking.

Hormone treatment is usually a lifelong commitment to taking medication and managing physical health. There are risks associated with taking any medication and it is important that people understand those risks and take great care of their physical health. We ask that anyone taking treatment recommended by the service commits to managing their physical health by taking any treatment as prescribed, and having regular blood tests at their G.P. practice to check that their treatment is working correctly and that they are healthy.

Each hormone treatment plan is personalised and some people may find that side effects, health concerns or unexpected consequences mean that they are no longer able, or no longer wish to take treatment. People using the service may change their minds about what they want. It is possible to stop treatment, although the person’s body may not return to the way that it was before starting treatment. It is important that any changes to prescribed treatment only happen under the guidance of a suitably qualified medical professional.

Voice and communication therapy

Voice and communication therapy offers service users the opportunity to reflect on and make changes to their voice, communication and personal presence. This is available to anyone using the service regardless of whether they are receiving hormone treatment. There is more information about voice and communication therapy here.

Psychological therapy

Psychological therapy is available to any person in the service who needs therapy, support, counselling or guidance to reduce their gender dysphoria. We recognise as a team that many of the people using the service will usually have good mental health and most will never need psychological therapy to meet their goals of wellbeing and resilience. A small number of people will need space to reflect, help to change or support to manage difficult relationships with their body, other people or the world around them. We offer a range of individual therapies, alongside psychosexual therapy for couples and individuals with sexual problems.

Referrals usually come from service users, via their doctor in the gender team, after a discussion which identifies a need for therapy. Some people are referred to the service purely to receive specialist psychological therapy for gender dysphoria. However, we do not provide generic mental health care and such needs should be met in the community in the usual way.

Treatments outside the NHS

Staff in the NRGDS can only refer the people they work with for treatments that are available within currently agreed NHS pathways. There are a variety of treatments that some people may wish to access, which are not available. For example, there is no provision under current NHS funding for gender clinics to provide access to feminising chest (breast augmentation) surgery, facial surgery or voice surgery.