How to access medical transition

Information for under 18s

NHS procedures for under 18s in England and Wales are currently being reviewed and this information may not reflect your experience. More information about referrals to youth services in England and Wales can be found on the Arden and GEM website.

1. Decide if you need medical support

Read our formal diagnosis page to decide if a medical service is right for you.

2. Choose the right service

Read our NHS gender clinics page, our Private Care page and our tips for choosing a gender service. If you can afford it, and are over 18, using both private and NHS services together can help you access hormones more quickly.

3. Get your referral

Read our how to get referred page for more information. Once you are referred you will be placed onto a waiting list. We have a page with information about waiting times. If you’d like to begin hormone therapy while you are waiting you can also ask your GP for a bridging prescription.

4. Practice self-care while you wait

If you’re referred to an NHS service and don’t have access to private care, long waiting times are typical. In the meantime, practice self-care and take non-medical actions that help alleviate your dysphoria.

There is support available, you’ll find more info on‘s Support Services and Support Groups pages – some groups are specifically aimed at those on waiting lists for transition related care.

5. Attend assessment appointments

Read our first appointments page so you know what to expect. Once the assessment is complete you may be given a formal diagnosis.

6. Approval for hormone treatment

In the UK, gender services may allow you to start hormones at this point if:

  • you are over 18
  • or you are over 15, have taken blockers for more than a year
  • and your clinical team feel you are ready to begin.

Services based outside the UK may not require you to meet these criteria.

Read our hormones page for more information about hormone replacement therapy and blood testing.

If you are using a private service you may need to book an appointment with a private endocrinologist to begin your hormone treatment. After that appointment your endocrinologist can write to your GP to request shared care.

7. Onward referrals

If you are over 18, you can ask for referrals to services such as speech therapy, surgery, and laser or electrolysis hair removal. If you have not undertaken it already, you can also ask for a gamete storage referral (ideally before hormone treatment is started).

What aspects of medical transition are available on the NHS for over 18s?

  • Hormone blockers (for over 18s)
  • Cross sex hormones
  • Facial hair removal – up to 8 sessions of laser hair removal or electrolysis
  • Gamete storage and fertility treatment – this is provided at a local level. Your GP will need to refer you and request funding from the Clinical Commissioning Group
  • Hair removal at surgical site – only if deemed necessary by the surgeon
  • Mastectomy
  • Hysterectomy
  • Metoidioplasty 
  • Orchidectomy
  • Phalloplasty
  • Speech therapy
  • Vaginoplasty
  • Vulvoplasty

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:


GDNRSS nurse led services

What do I do if something goes wrong?

Read our information about fixing common problems and making a complaint. If you would like support with a complaint, TransActual may be able to help. E-mail

Further reading

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 legal services.

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