This page contains information for healthcare professionals on how to make a referral to a gender clinic (specialist gender services, sometimes referred to as ‘gender dysphoria clinics’ or GDCs).
Patients and families can read more about how to access gender specialist services:
- patients aged 17 and over: on our Accessing Medical Transition page
- patients aged under 17: on the National Referral Support Service website
Gender clinics for young people
These services are for young people under the age of 18 only. For adults, see the section Gender clinics for adults.
Referrals to these services must be made by CAMHS or a paediatrician and cannot be made by GPs directly.
If a patient has already reached their 17th birthday, it may be simpler to refer them directly to an NHS adult gender clinic as most will accept these referrals – see the section Gender clinics for adults for more information.
You can find more information about the referral process for children and young people on this page:
Information for Referrers and Professionals – National CYP Gender Referral Support Service
If a young person or their family asks for a referral for support around gender, a referral to CAMHS or a paediatrician should be made.
Young people and their families may be unaware of the restrictions on treatments and the length of the wait to be seen. Young people and their families may benefit from accessing support services while they wait. Helpful organisations to signpost young people and families to include:
- FFLAG run support groups and offer online resources
- The Proud Trust – Home of LGBT+ Youth run an online directory parents can use to search for local youth groups
- GIRES TranzWiki is a directory of gender identity support organisations across the UK
If a young person on the wait list reaches the age of 18 while on this wait list, they will be transferred to an NHS adult gender clinic.
Gender clinics for adults
Referrals can normally be made to these services from age 17. Patients will not be seen before their 18th birthday. For younger people, see the section Gender clinics for young people.
When to make a referral
There is no reason not to make a referral if a patient requests it.
As wait times for specialist services are often very long, unnecessary delays to referral (for example, to see if the gender incongruence desists spontaneously before making a referral) are likely to damage the patient’s trust and cause distress.
Referral should be made for patients regardless of:
- changeable or uncertain sense of gender
- mental health diagnoses
- autism spectrum conditions or ADHD
- high BMI / obesity
- immigration status
- chronic health conditions
- disability
- learning disorders or disabilities
- tobacco or narcotic use
Most NHS adult gender clinic will accept referrals for patients who have reached their 17th birthday. You can find details of exact referral criteria on the websites of the specific NHS gender clinics. If a patient is not yet eligible for a referral to an NHS adult gender clinic, see the previous section, Gender clinics for young people.
Referral appointments
The following are appropriate to ask during an appointment if you are making a referral to a gender clinic:
- questions required by the referral form for the service
- whether the patient would prefer you to use a different name or pronouns when referring to them
- whether the patient would like to update their name, gender, or title on their NHS records
- whether there is anything else you can do which might make them feel more comfortable
In an appointment to discuss referral to a gender clinic, it is not appropriate to:
- attempt differential diagnosis
- undertake a physical examination of the patient
- suggest a referral to mental health services be made prior to referral to gender services
Where to refer
In England, ask the patient for their choice of the services listed on the list of NHS gender clinics. The services have significantly varying wait times (these are listed on the service web sites), and often offer video appointments, so patients may prefer not to be referred to the geographically closest service.
In Northern Ireland: refer to the Brackenburn Adult Gender Identity Service.
In Scotland: check the NGICNS website for a list of gender clinics and their catchment areas.
In Wales: refer to the Welsh Gender Service at St David’s Hospital, Cardiff.
In some specific ICBs and health boards, there are locally commissioned services which patients can access.
After making a referral
Once you’ve made a referral, there’s some important things you can do next to help your patient.
Tell the patient to expect confirmation that their referral has been received by the gender clinic, and that if they don’t receive any confirmation, they can contact the gender clinic themselves to check that the referral has been received and accepted. Some patients may also be able to check whether their referral has been accepted using the NHS app.
Explain that they are likely to be in a long queue to be seen by the gender clinic, as the NHS gender clinics are currently significantly over capacity. Your patients can look at the website of their chosen gender clinic to find out how long patients that are currently being seen have been waiting. Typical waits for first appointments are at least two years, and for many services are five years or more. Patients may also find it useful to know that they will not normally be prescribed hormones on their first appointment with a gender clinic.
Consider offering a bridging prescription if you feel comfortable to do this. You can find more details about how to prescribe for trans people, and how to decide whether a bridging prescription is appropriate, on our Treatment protocols and service specifications page.
Explain they can use private services while waiting to be seen by the NHS and that this will not have a detrimental effect on their NHS treatment. There are a range of private services in the UK which offer support for exploring gender identity and managing gender dysphoria, and your patient can find a list of different services available on our Private Care page.
Signpost to other services the patient might wish to use while waiting for specialist NHS support. In some ICBs and health boards, patients are able to access services on the NHS like bridging prescription clinics, speech and language therapy services or fertility preservation before they have been seen by a specialist NHS gender service.
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