Having recently found an old copy of the "GENDER REASSIGNMENT – CHARING CROSS HOSPITAL. CLINICAL MANAGEMENT POLICY." on an old backup. I had thought of posting it here, except my copy was dated around 2000 so I thought that there must be a newer copy somewhere. Well, if there was, I couldn't find it on my computer, so I then looked online. I looked at the 'West London Mental Health Trust' website and couldn't find one there, not even through its search facility. Plenty of policies but none that I was looking for, so I then googled further.

I used this term - clinical management policy of Charing Cross GIC and found two sites that displayed a policy dated 9th September 2003, but I was on a roll and wanted the most up-to-date one available. And then I found this link 1 which showed that in March 2012 a "Freedom of Information" request was made to the West London Mental Health NHS Trust asking for a copy of the current treatment protocol 1.

After a lot of toing and froing it seems that the current state of affairs is that there are several documents that could be construed as a clinical management policy. The current protocol for NHS England is the "Interim Gender Dysphoria Protocol and Service Guideline 2013/14" which was published in October 2013 2.

Any issue not covered by the Interim Protocol is instead guided by the "CR181 Good practice guidelines for the assessment and treatment of adults with gender dysphoria" which was published at the same time October 2013. It does not override the interim protocol and the interim protocol refers to it in several places [^31712].

There is also "Gender dysphoria services: a guide for General Practitioners and other healthcare staff". This is, as the name suggests, a guide mainly aimed at GPs but also for other healthcare staff. It does not override any document, it is simply a guide which was published in May 2013 (several months before the other two documents) as can be seen from the 'last updated' date in the bottom right of this page 4.

And why are 'clinical management policies' so important? These lay out the rules for the organisation to follow, and they will therefore help you to know what your pathway should be.

A commissioning policy is a document that defines access to a particular service
for a cohort of patients. A NICE Technology Appraisal Guideline on the same topic
will replace, or be incorporated into a commissioning policy, as appropriate.

These are important documents that are developed to define national consistency.


In 2013, NHS England introduced an interim protocol for gender dysphoria. The main aim of the interim protocol is to improve funding and access provisions for service-users.

The interim protocol will remain in place until 2014/15, when a new NHS England policy will be introduced by NHS England's Gender Identity Services Clinical Reference Group (CRG).

The good practice guidelines for health practitioners also changed in 2013, to be consistent with the interim protocol.


Here we are at the end of 2015, and there is not a new policy in place, so we have the somewhat confused situation with separate policies and documents issued at different dates all trying to give one policy - and failing! Individual users of each and every Gender Identity Clinic throughout England are trying to find out what their local policy is, and the organisation that is supposed to provide the information hasn't, and there is no reason given why not! To put it bluntly, they have failed! And they have no idea when a new policy will be in place!

Which means that we're back on the s**t heap, scrabbling around, trying to learn important information which will help and guide us, our GP's can't really help - because they don't know either! And I bet my bottom dollar if we asked CX again, they will just refer us to the documents already posted here, which isn't good enough! Somehow heads need to be knocked together, but I don't know whose heads, or who should do it or when!


So to try to help you I am now hosting all of these documents here, and here are the download links -

Download - Interim Gender Dysphoria Protocol and Service Guideline 2013/14

Download - CR181 Good practice guidelines for the assessment and treatment of adults with gender dysphoria

Download - Gender dysphoria services: a guide for General Practitioners and other healthcare staff



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