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Generalised Pathways

Below are two generalised pathways that many people choose. These are offered to give an impression of what might be available and to help patients to make decisions about how to use their time in the service effectively.  We are aware that not every individual would wish or need to have the treatments described here and we would seek to offer each individual a personalised treatment plan to meet their needs.
Voice and communication and psychological therapies are available to anyone at any time should they require them, and so are not included in the sample pathways.

Sample Feminising Pathway

Referral A person goes to their GP and asks that they complete the referral form and send it to NRGDS. The service will write to let the person and their GP know that a referral has been received.
First assessment If the referral is suitable the first assessment is offered. The assessor writes back to the GP and the service user and asks that the service user have blood tests at their GP surgery.
Second assessment The assessment is reviewed and supplemented, this time with a doctor in the team.
Hormone therapy At the end of the assessment process, treatment is discussed including hormone treatment, if this is relevant to the person. The doctor writes to the GP to recommend treatment, blood tests and other investigations. The service user is usually required to book any tests directly with their GP practice. Thereafter, the service user meets with their doctor or another team member at regular intervals to review hormone treatment and adjust hormones carefully. Frequently asked questions about hormones are here.
Facial hair reduction The team doctor offers a choice of hair reduction providers and, when the service user chooses one, sends a referral. The service user usually organises treatment directly with the provider.
Second opinion for genital surgery Once the criteria for referral for genital surgery have been met, the service user can be referred for a second opinion for genital surgery with a doctor outside the team. This usually requires travel to Edinburgh for a single appointment.
First surgical consultation When there are two opinions available, agreeing that the person has met the criteria for surgery, a referral is sent to the surgical provider of their choice. The service user travels to see the surgeon for an assessment appointment. Assessment will include a physical examination of the surgical site and a discussion about the surgery and after care. The surgeon sets criteria about body weight for safe and successful surgical outcomes. Some people will be required to lose weight and / or stop using nicotine to be able to have safe surgery.
Genital hair removal (if required) Some people require genital hair reduction treatment to prepare for surgery. This can take more than a year to complete. It is provided by the same process of referral for facial hair reduction.
Genital surgery Surgery and some aftercare is offered by the surgical team and then the service user travels home to recover. The surgeon will offer at least one review appointment after surgery.  Any problems with the outcomes of the surgery must be brought to the attention of the surgeon so that they can be addressed within 12 months.
Follow up The team at NRGDS will also offer at least one follow up appointment after all surgery is complete.
Discharge The service user can be discharged from the service at any time when they and the team agree that they have made use of all the desired treatments on offer or they are no longer able to make use of the service at that time.

 

Sample Masculinising Pathway

Referral A person goes to their GP and asks that they complete the referral form and send it to NRGDS. The service will write to let the person and their GP know that a referral has been received.
First assessment If the referral is suitable the first assessment is offered. The team write back to the GP and the service user. The team ask the service user to go for a blood test at their GP surgery.
Second assessment The assessment is reviewed and supplemented, this time with a doctor in the team.
Hormone therapy At the end of the assessment process, treatment is discussed including hormone treatment, if this is relevant to the person. The doctor writes to the GP to recommend treatment, blood tests and other investigations. The service user is usually required to book any tests directly with their GP practice. Thereafter, the service user meets with their doctor or another team member at regular intervals to review hormone treatment and adjust hormones carefully. Frequently asked questions about hormones are here.
Chest surgery second opinion Once the criteria for referral for chest surgery have been met, the service user can be referred for a second opinion with another member of the team. If they are taking hormones it is preferable that they do so for 6 months before the surgery.
First surgical consultation for chest surgery When there are two opinions available, agreeing that the person has met the criteria for surgery, a referral is sent to the surgical provider of their choice. The service user travels to see the surgeon for an assessment appointment. Assessment will include a physical examination of the surgical site and a discussion about the surgery and after care. The service user may also be asked for consent to take photographs before and after surgery; this is not obligatory and the person can refuse. The surgeon sets criteria about body weight for safe and successful surgical outcomes. Some people will be required to lose weight and / or stop using nicotine to be able to have safe surgery.
Chest surgery Surgery and some aftercare is offered by the surgical team and then the service user travels home to recover. The surgeon will offer at least one review appointment after surgery. Any problems with the outcomes of the surgery must be brought to the attention of the surgeon so that they can be addressed within 12 months.
Hysterectomy and Bilateral salpingo-oophorectomy (HBSO) Some service users wish to have surgery to remove internal reproductive organs. This is the womb, fallopian tubes and ovaries. Some people have this procedure as part of genital surgery. Others choose to have it separately and / or may not wish to have genital surgery. The referral process is similar to chest surgery.
Second opinion for genital surgery Once the criteria for referral for genital surgery have been met, the service user can be referred for a second opinion for genital surgery with a doctor outside the team. This usually requires travel to Edinburgh for a single appointment. There is more detail about the process of genital surgery here.
First genital surgery consultation When there are two opinions available, agreeing that the person has met the criteria for surgery, a referral is sent to the masculinising genital surgery surgical provider. The service user can usually see the surgeon for an assessment appointment locally, at an outreach clinic in Newcastle. If they would prefer to travel to London to be seen, this can be arranged. Assessment will include a physical examination of the surgical sites and a discussion about the surgery and after care. The surgeon sets criteria about body weight for safe and successful surgical outcomes. Some people will be required to lose weight and / or stop using nicotine to be able to have safe surgery.
Donor site epilation If a service user chooses phalloplasty, their surgeon might identify that they need hair removed from the part of their body to be used in the surgery. This decision would be made at the surgical consultation. It is provided by the same process of referral for facial hair reduction.
Genital surgery Surgery and some aftercare is offered by the surgical team and then the service user travels home to recover. The surgeon will review the person and the stage of the surgical process, in Newcastle or London. The process usually involves at least 3 admissions to hospital for surgery, which are arranged by the surgical team. Once all surgery is complete, the surgeon will offer at least one review appointment.
Follow up The team at NRGDS will also offer at least one follow up appointment after all surgery is complete.
Discharge The service user can be discharged from the service at any time when they and the team agree that they have made use of all the desired treatments on offer or they are no longer able to make use of the service at that time.