First appointments at gender services

It can be really daunting to go to your first appointment at a specialist gender service. Not knowing what to expect can make it difficult to know how to prepare, and make the whole experience seem even more scary.

On this page, there’s information about who you’re likely to be seen by and what you’re likely to be asked at a first appointment, so you can feel confident that you’re well prepared.

How many appointments will I have?

The number of assessment appointments varies:

• NHS adult services: two or more appointments
• Private adult services: one or more appointments
• Under 18s services: at least three appointments and normally more

What happens in the appointment?

At most services, your first appointment is a conversation between you and a clinician. This clinician might be a doctor, nurse, psychologist, or psychiatrist. Sometimes, there might be more than one clinician there. You will normally be asked a number of questions. Don’t worry if you don’t have all the answers to these questions yet: it’s completely fine to still be thinking about some of them. You can also ask questions of your own. The appointment could be via video call, or in person at the gender service. Normally, the appointment will last around an hour.

In appointments at a gender service, you shouldn’t need to have someone examine your chest or genitalia, unless this person is a surgeon assessing you for surgery on that part of your body. Unfortunately, this might still happen. If you’re asked to let someone examine your body and you don’t feel comfortable with this, you can refuse or make a complaint, but it might delay your treatment or cause other problems.

What can I do before my appointment?

Think about whether it would be helpful to have someone with you in the appointment, or to travel to the appointment with you. Do you find it difficult to explain things clearly? Do you find it hard to say no to things that make you feel uncomfortable? Would having someone else there make you feel more comfortable?

If you’ve made a name change by deed poll or name change by statutory declaration already, make sure you have this handy in case it is needed.

If you’ve already been given a formal diagnosis by another service, find out when this was made. You should have an appointment letter or email that tells you this.

If you’ve already started on hormone therapy, find out when this happened. You should have an appointment letter or email that tells you this.

You’ll be asked a number of questions about yourself in the appointment. We’ve listed common questions below. You might want to think about them beforehand so that you feel confident to answer them in your appointment.

You might also want to think about what questions you want to ask. Do you have questions about how hormones, surgery, fertility preservation, or speech and language therapy work? Do you want to know what will happen next? Many people find it can be helpful to write a list of questions to keep with them in the appointment so they don’t forget anything.

What questions will I be asked?

In general, you will be asked about three main things in an assessment appointment: your past, your current situation, and your future plans.

Common questions about your past include:

• When did you start feeling like something was wrong?
• During childhood, did you experiment with or use clothes, makeup, hair associated with a different gender? Did you cut your hair short or grow it long in a way that would normally be associated with a different gender?
• What was it like for you going through puberty?
• Have you had sexual relationships in the past? How have you found this?

Common questions about your current situation include:

• What things cause you to experience gender dysphoria now?
• Have you made public changes relating to your gender yet, such as using a new name, updating your ID documents, or dressing differently? Has this helped you?
• Are your family, partner, children, work, and social circles aware and supportive? Have you experienced any issues in any of these areas?
• What is your sexual orientation?
• Are you in any sexual or romantic relationships? Are they aware of how you feel about your gender?
• Do you have any physical or mental health conditions?
• Do you smoke, drink, or use other drugs?

Common questions about your future plans include:

• Do you have plans to change anything publicly about your gender in the future?
• Have you spoken to friends, family members, housemates, etc. about any of these plans?
• Do you want to access hormone therapy? How do you think this might help you?
• Are you seeking fertility preservation prior to hormone therapy?
• Do you want to access surgery? How do you think this will help you?
• Are you aware that getting genital surgery is irreversible?
• If you smoke, do you plan to quit?

Private services

You may be asked some additional questions in a consultation with a private service:

• Have you spoken to your GP about shared care and are they supportive?
• Have you requested a referral to the NHS gender system as well?

What happens next?

After your appointment, you should receive a letter which has been sent to you and your GP. This should summarise what happened in your appointment and explain what will happen next.

After a first appointment with an NHS service, you will normally need to be seen for at least one more appointment before you are given a formal diagnosis or hormones.

After a first appointment with a private service, people are often given a formal diagnosis, but will also need an a private endocrinologist appointment before they can access hormones.

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 legal services.