Do I have to dress/act a certain way?
No. Everyone is different. Dress and act as you feel most comfortable. This is a safe space and anything that people generally wear in public is fine.
Does it cost anything?
No. As an NHS clinic we are free to patients at the point of use. Some of our clinicians do private work outside of the GIC.
What about gender recognition certificates?
Reports for gender recognition certificates are not funded by the NHS and are produced privately. To get one, ask your clinician or reception for an information sheet on gender recognition certificates, then write, with payment, to the individual clinician you would like to produce the report for you.
Can’t I just go private?
Yes. There are many private clinics and clinicians around the world. In general each clinic follows their own guidelines and procedures, and these may differ from what is provided by us. Generally speaking, we do not deal with the private sector on an ongoing basis, as we are an NHS clinic.
If you are referred to the GIC and have had or continue to have treatment within the private sector, you will need to make a choice. After two appointments you will need to commit to treatment within the NHS or the private sector, but not both at the same time.
I’ve heard that you ‘test’ people, for example making them angry/sad to see how they’ll respond – is this true?
No. There are many myths and rumours circulated about us. Some things are 20 years out of date, some may be even older, and some, like this, are simply untrue.
How long will the process take?
There is a two year real life experience (RLE) of living in the reassigned gender role at the GIC for people who want to have genital reconstruction surgery (GRS). This is dated from the start of full-time gender role transition after which they can be assessed for referral for GRS. The RLE includes at least a year in some form of agreed occupational activities.
Will I get hormones on the first visit?
Generally we will not endorse hormone treatment on the first visit. This is because we need to find out more about you than just one visit will allow and we have a two stage assessment with two different GIC clincians.
Patients who are more complex, for a number of reasons, are likely to require three or some times more assessment appointments. Complexity may be due to the patient’s social circumstances or history, such as forensic history, or someone who is presenting in an unusual way.
Similarly complexity may also be due to religious beliefs or background, highly segregated living circumstances (for example prisoners), or unusual occupational status, for example.
Some people come to us with problems that will not be helped by hormones and surgery and obviously it is important that such people do not undergo treatment that will harm them, especially if it will harm them irreversibly, as many or our treatments have the capacity to do if administered incorrectly.
National and international guidelines also advise against prescribing hormones without having evaluated the patient situation thoroughly, and that that can’t be done in a short time. You will also have the reassurance that you have been assessed by two experienced clinicians who are now familiar with your background and will be able to manage your care and any subsequent referrals requiring more than one opinion.
Also there are some medical conditions that are seen in the gender clinic and these cannot be diagnosed if you already taking hormones when you arrive. Part of the assessment given to all new patients is a blood test to make sure that they hormone levels are normal before we start treatment.
When can I be considered for chest revision surgery?
Chest revision surgery for born female people (trans men) can be considered after one year in their reassigned gender role, it is usually best to come to the GIC to discuss the options and your individual care pathway as others’ experiences may be different to your own. The process may depend also on how long you want it to take, what you are looking for in coming to the GIC and what interventions your PCT is willing to fund.
Do I need to have a certain level of fitness to have surgery?
Yes. In order for us to recommend you for surgery your body mass index (BMI) needs to be less than or equal to 30. You can work out your BMI here. The current guideline for waist measurements is less than or equal to 37 inches. There may also be other physical conditions that would affect whether or not you would be eligible for surgery. These could be discussed with the relevant surgeons.
Do you take private referrals for surgery?
The surgeons with whom we work do undertake private work but this is managed seperately. For more information see their websites.
Are private referrals accepted for NHS surgery?
No. Referrals for NHS surgery need to come via the NHS. If you are seeing a private gender specialist and are hoping for an NHS referral for surgery you should discuss this further with them. Patients sometimes find the private route for gender reassignment can take longer than the NHS if they are unable to afford private gender reassignment surgery and have to be referred to the NHS late in their treatment. As a general rule, they will still need to be referred, seen and assessed by two GIC consultants prior to any NHS surgical referral.
Do you make referrals for private surgery?
Yes, you are welcome to ask a private surgeon to perform surgery using a referral from us that you have obtained free at the point of provision as an NHS service. In such cases, we often cannot advise on the qualifications of the surgeon, only as to your suitability for surgery. Any provision of NHS funds for private surgery would be at the discretion of your local primary care trust.
Some PCT’s may be reluctant to fund revision surgery for surgery that has originally been funded privately. We understand that the PCT’s view is often that the original surgeon who conducted the surgery should make any revisions or corrections as necessary.
I have a diagnosed mental health problem – will that stop me having surgery?
Not necessarily. We do require that your mental health problems are reasonably well managed and have been under control for some time before referral, but having a mental health problem such as (but not limited to) depression, schizophrenia or bipolar disorder does not exclude you from receiving treatment, including surgery.
My psychiatrist or GP won’t refer me to the GIC. What do I do?
You are entitled to ask for a second opinion and should do so as transsexualism and gender identity disorder (GID) are internationally recognised medical conditions.
I can’t get funding. What do I do?
Many PCTs have limited budgets so some may defer funding, perhaps until the next financial year. If they refuse funding outright, or you feel they are delaying unnecessarily, you can make a complaint to them or contact the Health Services Ombudsman.
How long is the waiting list?
The waiting list varies depending on several factors, including the overall number of referrals received and the current funding situation at both government and local level.
Generally, the waiting list for a first appointment is approximately 12 months, (see how long the wait is for surgery below) although there may be further waiting for other visits, a second opinion, funding, surgery, endocrinology, speech therapy etc. We work as fast and efficiently as we can, but we have limited resources and as we are a national service there may be waiting involved.
In addition, many patients miss their appointments without contacting us, often leading to them being discharged from our service as empty appointments could have been given to other patients.
Why do I have to do the real life experience (RLE)?
The RLE, sometimes called the real life test is the period of time when a person lives 100% in their preferred gender. This means that they are known to their friends and family as well as at work (paid or voluntary) or at their place of study or daily occupation as their preferred gender.
The literature and our own clinical experience, as well as the national and international guidelines are very clear that people have fewer regrets after surgery and hormones if they have had experience living all the time in their preferred gender. Consequently before referring for surgery we do ask people to have completed the RLE.
Occasionally people who are certain that they want hormonal and surgical treatment at the outset of their gender reassignment treatment at the GIC do revert back to their initial gender role even as late as 18 months into the RLE. There are examples of people who have “detransitioned” then regretted changes made in the course of transition.
Do I have to be attracted to people of a gender that is the ‘opposite’ to my own preferred gender?
No. We recognise that our patients can be any of the diversity of sexualities other people can be. These could be bisexual, heterosexual, gay, lesbian, queer, asexual etc
My treatment has stalled. What do I do?
Treatment sometimes fails to progress for a variety of reasons. Often it is because people feel that their life circumstances mean they cannot do some of the things that our guidelines, and the international guidelines, require them to do in order to receive desired medical interventions.
In the first instance you should discuss this with your clinician. It may be that there has been a communication error and the problem can be ironed out. It may be that you simply require more time or help to progress, and this is of course absolutely acceptable.
It may also be that you need to make some space to really consider what exactly your own, personal requirements are; every person who comes to the GIC is encouraged to reflect on this. Your clinician may advise further opinion assessments with other clinicians within the clinic.
In some cases, where decisions are being considered taking into account exceptional circumstances, a “panel meeting” may be arranged in which you will meet with the whole GIC team to take stock of your circumstances and discuss possible ways forward.
Can I claim travel expenses?
In exceptional circumstances, we will reimburse reasonable travel costs. You should download the travel claim form for more information.