Bridging Prescriptions

What is a bridging prescription?

A bridging prescription is a temporary prescription of hormone replacement therapy (HRT), typically oestrogen or testosterone, issued by a GP to a patient who is waiting for specialist treatment at a gender clinic.

Why are bridging prescriptions necessary?

The average waiting time for a first appointment at an NHS gender clinic in England was already 296 weeks (over five and a half years) as of October 2024 (1). By the end of 2025, some patients of one NHS gender clinic had already waited more than eight years to be assessed (2). No NHS England gender clinic meets the standard of care set out by the NHS England constitution – that patients have a legal right to wait no longer than 18 weeks for treatment by a specialist service. 

Long waiting times exacerbate gender dysphoria and mental health problems, and increase risks of suicide and self-harm. In our 2022 Transition Access Survey (3), the vast majority of trans people told us that waiting for hormone therapy had affected their mental health (87%), with many also reporting impacts on their physical health (78%), personal relationships (61%) and work life (63%).  

Many trans people turn to self-medicating (buying and using unprescribed and unregulated hormone medication over the internet) because of the long wait for treatment at an NHS gender clinic. In our 2022 Transition Access Survey (3), 25% of the trans people we spoke to had self-medicated. Self-medicating has the potential to cause serious harm due to potential contamination of unregulated medications, lack of oversight and monitoring in dosage and unknown contraindications (e.g. someone may have an allergy to a particular medication they are self-medicating with and not be aware of it).

Bridging prescriptions act as a ‘holding and harm reduction strategy’, to mitigate the effects of waiting to receive care from an NHS gender clinic and the resultant risks of suicide, self-harm and self-medication. They are issued on an interim basis, to be replaced by a prescription from an NHS gender clinic.

What are the limits on bridging prescriptions?

Guidance for medical professionals on offering bridging prescriptions (4) normally suggests that bridging prescriptions should be offered only to patients who:

1. Have persistent gender dysphoria
2. Are at risk of mental health deterioration, self-harming, or suicide due to their unmet needs
3. Are likely to, or already have, started self-medication
4. Are able to give informed consent 

Some older guidance suggested that bridging prescriptions should be only for the ‘lowest acceptable dose’, which was often interpreted as meaning a dose that was too small to be effective. This specific wording is not found in more up-to-date guidance.

How likely are GPs to issue bridging prescriptions?

Although in theory all GPs can issue bridging prescriptions, most are reluctant to do so. In our 2022 Transition Access Survey (3), only 16% of UK trans people we spoke to had received a bridging prescription from their GP, and in our 2025 Trans Lives Survey, the majority of trans people told us that their GP had refused to offer a bridging prescription. As of 2025, you can expect that most GPs will not issue you bridging prescriptions.

Are there any resources I could share with my GP to support them to offer me a bridging prescription?

Your GP can find guidance on prescribing hormones written by UK experts in our Information for Healthcare Professionals web pages. This page also contains information about making a decision whether to offer a bridging prescription or not. If your GP has not offered a bridging prescription for a trans person before, it might be useful to share this guidance with them.

What else can I say to persuade my GP to offer a bridging prescription?

Your GP is allowed to refuse to offer a bridging prescription.

However, you could still point out that:

• GPs have a responsibility to the physical and mental health of their patients. Arguably, a GP who refuses to issue a bridging prescription is risking your mental and physical health by failing to provide a safe source of medication, and failing to take action to mitigate serious risks of suicide and self-harm. If you are self medicating, you may want to raise the issue of insecure or risky sources, or unknown contraindications to the medication you are taking. If you’re not currently self medicating, you could suggest that not being prescribed hormones puts you at risk of mental health issues and self medication, and also at greater risk of transphobic violence due to being more visibly trans.
• According to the NHS Constitution for England, all patients ‘have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible’ (5). The maximum legal waiting time for a ‘specialist service’ such as a NHS gender clinic in England is 18 weeks (6), a standard which no NHS England gender clinic currently comes close to meeting. It is the responsibility of all NHS England gender clinics to meet this standard, but the constitution makes it clear that when this standard is not being met, the NHS has a responsibility to ‘offer a range of suitable alternative providers’. Bridging prescriptions are the only form of such an ‘alternative provider’ generally offered by the NHS, so it is reasonable to say that GPs have a responsibility to either meet this requirement by issuing a bridging prescription, or offer an alternative source of treatment.
• The General Medical Council (GMC) has issued guidelines on decision making and consent (7). The new guidelines include the following point: ‘All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.’ This does not mean that any patient has the right to request a course of treatment and be given it. However, if a recognised treatment for a recognised medical need is available (e.g. a bridging prescription), and a patient understands the risks, benefits and side-effects of either having or not having that treatment, then the patient’s wishes should be a key deciding factor.

What can I do if my GP won’t give me a bridging prescription?

Bridging prescriptions are issued at the discretion of the individual GP, and they are not obligated to do so.

In NHS England and NHS Scotland, you have the right to ask for an appointment with a different GP if you wish to without having to give a reason for your request (8, 9), and your GP surgery is expected to try to accommodate this request. In Wales and Northern Ireland, while this right isn’t guaranteed to you in the same legal way, you can still normally ask for an appointment with a different GP.

This means that if a GP refuses to issue a bridging prescription, you can book an appointment with a different GP and try asking again. You may wish to do some research about different GPs to see if there are any who you think may be willing to help you. Some trans community organisations have created lists of GPs that they have had positive experiences with in the past, though this doesn’t guarantee that a GP will be helpful to you, or that they will be willing to offer a bridging prescription. Some of these lists are available at https://www.transhealthcareintel.com/trans-friendly-gps.

If you’re having problems with a whole GP surgery, you can also switch to a different GP surgery, without having to get permission from your current GP surgery (8, 9, 10). To change GP surgery, follow the instructions for England, Northern Ireland, Scotland, or Wales. You do not need to tell your new GP surgery why you want to leave your old GP surgery. However, if you are switching GPs specifically in order to try and obtain a bridging prescription, you may wish to ask your potential new GP if they would be open to doing this or if they have any experience treating trans patients before you switch over to them.

You can also make a complaint to your GP practice if your GP is not willing to issue a bridging prescription. However, it is worth keeping in mind that GP practices will often support the decision of a GP not to issue a bridging prescription, and you may be forced to take a complaint further. 

You can read more about seeing a different GP, switching GP surgery, and making complaints on our Common healthcare issues (and what to do) page.

References

1. NHS England, 2025: Operational and delivery review of NHS adult gender dysphoria clinics in England
2. GOV.UK, 2025: Support for adults facing staggering waits for gender services
3. TransActual: TransActual Transition Access Survey 2022
4. British Association of Gender Identity Specialists, 2025: Healthcare for Trans Adults: Practical Information for GPs
5. Department of Health and Social Care, 2023: The NHS Constitution for England
6. NHS England: Referral to Treatment
7. General Medical Council, 2020: Professional Standards: Decision Making and Consent
8. Department of Health and Social Care, 2024: NHS Choice Framework – what choices are available to you in your NHS care
9. Scottish Government, 2022: The Charter of Patient Rights and Responsibilities
10. NHS Wales: Registrations FAQ – The Practice of Health

Errors or omissions

Is there something missing from this page? Have you spotted something that isn’t correct? E-mail info@transactual.org.uk to let us know.

A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.