Medical Transition

Please note that TransActual do not offer medical advice. Any information provided on this page is a guide and you should always seek a medical opinion in relation to hormone monitoring and decisions around surgery. Please note that links to medical providers are for information on the types of surgery offered and are not an endorsement of any individual provider.

Table of Contents

Hormones

Transition related surgeries available on the NHS

Transition related surgeries not available on the NHS

Other transition related treatments or procedures

Gender Dysphoria National Referral Support Service (GDNRSS)

Further reading

Hormones

Trans women and non-binary people assigned male at birth

Estradiol – “feminising” hormone

Finasteride (optional) – used to suppress testosterone, typically taken as a tablet

GnRH agonist (if required) – used to suppress testosterone, typically given as an injection

Blood tests

Baseline blood tests

  • Full blood count
  • Liver Function Test
  • HbA1c
  • Fasting lipids
  • Prolactin
  • Lutenising hormone
  • Follicle stimulating hormone
  • Testosterone
  • Estradiol
  • Sex hormone binding globulin
  • Vitamin D
  • Prostate specific antigen (if over 40 years old)
  • Renal function (if indicated)

Regular monitoring

  • Liver function test
  • HbA1c
  • Fasting lipids
  • Prolactin
  • Estradiol
  • Testosterone


Estradiol target range

350-750 pmol/L

For more detailed information on monitoring and risk factors, read NHS Wales’ guidance on hormone monitoring.

Trans men and non-binary people assigned female at birth

Testosterone – ‘masculinising’ hormone

Medroxyprogesterone acetate (optional) – this can be used to suppress menstruation whilst waiting for testosterone treatment to achieve the same effect.

GnRH agonist (if required) – this can be used to suppress menstruation if testosterone treatment alone does not successfully achieve it.

Blood tests

Baseline blood tests

  • Full blood count
  • Liver Function Test
  • HbA1c
  • Fasting lipids
  • Prolactin
  • Lutenising hormone
  • Follicle stimulating hormone
  • Testosterone
  • Estradiol
  • Sex hormone binding globulin
  • Vitamin D
  • Renal function (if indicated)

Regular monitoring

  • Full blood count
  • Liver function test
  • Fasting lipids
  • Testosterone
  • HbA1c (Nebido)

Testosterone target ranges

  • Testosterone gel – 15-20 nmol/L
  • Sustanon – trough level 8–12 nmol/L (day of injection, before it is given), peak level 25–30 nmol/L (one week after injection)
  • Nebido – trough level 15–20 nmol/L (day before injection)

For more detailed information on monitoring and risk factors, read NHS Wales’ guidance on hormone monitoring.

From time to time there are supply issues with HRT. Read some guidance for GPs around different options.

Transition related surgeries available on the NHS

Trans men and non-binary people assigned female at birth

Mastectomy and chest reconstruction

Lower surgeries

  • Phalloplasty – can include hysterectomy, bilateral Salpingo-oophorectomy, vaginectomy, placement of penile prosthesis, placement of testicular prosthesis, glans sculpting. Read the GDNRSS booklet about phalloplasty.
  • Metoidioplasty – can include hysterectomy, bilateral Salpingo-oophorectomy, vaginectomy, placement of testicular prosthesis. Read the GDNRSS booklet about metoidioplasty.
  • Hysterectomy – a stand-alone hysterectomy is not available through transition related pathways, but can be accessed on the NHS. To do this, you need to ask your GP for a referral for a hysterectomy. Your GP will also have to request that your local Clinical Commissioning Group (CCG) funds your surgery. Remember that if they initially refuse, you have the right to appeal their decision.

Read the GDNRSS booklet about lower surgery

Trans women and non-binary people assigned male at birth

Lower surgeries

  • Penectomy – typically in conjunction with vaginoplasty
  • Bilateral Orchidectomy – often in conjunction with vaginoplasty
  • Vaginoplasty – read more about vaginoplasty in the GDNRSS booklet.
  • Clitoroplasty – typically in conjunction with vaginoplasty
  • Vulvoplasty – typically in conjunction with vaginoplasty, but can be a stand-alone procedure. Read more about vulvoplasty in the GDNRSS booklet.

Transition related surgeries not available on the NHS

Other transition related treatments or procedures

Available on the NHS

Gender Dysphoria National Referral Support Service

GDNRSS (GDNRSS) offer support services for people who have been referred for NHS transition related surgery or who are under the care of an NHS Gender Dysphoria Clinic. You can talk to them about your surgical options, preparation for surgery, waiting times and lifestyle changes (such as smoking cessation).

Read more about GDNRSS:

About GDNRSS

GDNRSS nurse led services

Further reading