First appointments at gender services

Following the publication of the Levy Review, we anticipate that NHS England will change how medical transition is accessed in England. The information on this page represents our understanding of how people can access medical transition in December 2025. We will continue to update this page as more information becomes available about what changes NHS England plan to make. To find out more about the Levy Review, read our press release.

It can be really daunting to go to your first appointment at a specialist gender clinic. If you don’t know what to expect, it can be difficult to know how to prepare, and the whole experience seems even more scary. So you can feel confident that you’re well prepared, there’s information on this page about what’s likely to happen at your first appointment.

Content warning: Some sections of this page very briefly mention poor mental health, disordered eating, domestic violence, sexual abuse, self-harm, and suicide.

The number of appointments you’ll have depends on which gender clinic you go to and can also depend on your specific situation.

The first step is appointments to talk about your situation and what help you need. This page is about what to expect in these appointments.

At NHS gender clinics for adults, there are usually two of these appointments. Sometimes, people are asked to go to more appointments if their situation is particularly complicated.
At NHS gender clinics for under 18s, there are normally many more of these appointments – expect at least three at a minimum, and probably more.
At private gender clinics for adults, there’s usually at least one appointment about this.

Once these appointments are complete, you’ll normally be given a formal diagnosis.

Many people carry on having appointments with the gender clinic afterwards.

If you want to access hormone therapy, you’ll often be asked to go to at least one more appointment before you start hormones, where you talk about hormones in more detail. You’ll need to keep having appointments to discuss how your hormone therapy is going until your dose has stopped changing and any problems have been sorted out.
If you want to access surgery, you might be asked to go to another appointment to discuss that in more detail. This might need to be with a different professional. You’ll also need to have appointments with your surgeon before the surgery. You can read more about this process in our What Do I Need To Know About Surgery? guide.
You might also be offered further appointments with a psychologist, psychiatrist, or speech and language therapist. If you’re using an NHS gender clinic, there might be a limit on how many of these appointments you can have.

Your appointment might be in person or it might be a video call. Most gender clinics for adult patients have appointments that are about an hour long, though a few clinics will arrange 90 minute appointments or longer. If the appointment is going to be long, you could ask for a short break in the middle if you need one.

At most gender clinics, your first appointment is a conversation between you and a clinician – a doctor, nurse, psychologist, or psychiatrist.

Sometimes, there might be more than one clinician there.

At your appointment:

You can explain what you need from the gender clinic – to help you, they’ll ask you questions to find out what you’re looking for. 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 ask questions – you might want to ask questions if you want to know how something works, if you want to know what help they can offer you, or if you’re worried about something about medical transition. We’ve got a list of questions you might want to ask later on this page.
You’ll agree to plan for treatment and support – they’ll explain the next steps for what will happen at the gender clinic, and who else they will refer you to for support.

Gender clinics for adults might split this conversation across two appointments, or ask you to do it twice with two different clinicians to get a second opinion.

At services for children and young people, there are usually many more appointments and the questions are much more detailed. The current services for children and young people have been set up very recently, so we don’t know exactly what kind of questions they’re likely to ask yet.

Some NHS gender clinics take some basic measurements of your body, like your height, weight, or blood pressure, as part of the appointment.

In appointments at a gender clinic, it’s not okay for someone to:

examine your chest or genitalia: this shouldn’t happen unless this person is a surgeon assessing you for surgery on that part of your body.
try to ‘fix’ you being trans: this doesn’t work and would be conversion therapy.
treat you less well because you’re disabled, elderly, d/Deaf, Black or a Person of Colour, or because of your religion: this could be discrimination under the Equality Act 2010.

If any of these things happen, you could make a complaint. You can use the instructions on our Common healthcare issues (and what to do) page to do this.

If you are d/Deaf or you aren’t fluent in English, you should be able to request an interpreter. If you need an interpreter, read our page on Communicating About My Needs to help you think about how to ask for this.

Some clinicians will try and decide whether or not you’re ‘really trans’ in your appointments. This is becoming less and less common – most clinics now don’t do this, and instead focus on working out what help they can offer you.

Think about what you’ll say

Have a think about how you’d answer the clinician’s questions. You can find a list of questions that you might be asked in a later section of this page.

This might mean trying to remember things about your childhood. Many people find it difficult to do this and it can take some time. You might find that it’s easier for you to remember what your childhood was like if you make a timeline or history of your experience of gender.

It’s also worth thinking about what questions you might want to ask the clinician. You can find a list of ideas for questions you could ask in a later section of this page.

Think about what you want

It can help speed up the process if you’ve thought carefully about what support you need before your appointment. Some people know exactly what support they want when they go to their appointment, and other people don’t know at all – it’s okay if you’re not sure yet.

Some questions that might help you think about what you want are:

What would medical transition change for you? Are there everyday life activities you find more difficult or avoid doing because of your body or how people treat you? Are there places you avoid going to, or find more difficult to go to than other people do, because of how people react to you or your gender?
Could you learn more about your options? You can read more about hormones, surgery, and other medical transition treatments in this resource, you could speak to other trans people who’ve already tried these things, or you could look for books, videos, or stories of people’s experiences.
What do you like and not like about the idea of medical transition? Are there things that you wouldn’t want to happen? What things would be important for you? What worries you? Taking a look at our Hormone Therapy page could help you think about this.
Would you regret not asking for it? Many of the options available to you have long wait lists. It’s fine to decide you’ve changed your mind later on.

Thinking about your needs

Think about what your needs are for the appointment. Read our page on Communicating About My Needs to help you think about whether you need to ask for things to make the appointment easier for you.

Remember that you can take a trusted person, like a friend, family member, or partner with you to the appointment if you feel this would help you feel more comfortable. You might be asked to speak with the clinician alone for a moment if you do this – this is to make sure you’re not experiencing domestic violence.

If you need to, you could contact the gender clinic ahead of time to explain your situation. You can find details of how to contact each gender clinic on their website. You can use our List of websites of NHS gender clinics to find the website.

Practical planning

A big practical worry many people have before attending their first appointment is what they are going to wear. You don’t have to dress a particular way to attend the appointment. Some people like to dress in a way that’s most comfortable for them at the appointment, as it’s an environment where they feel safe to wear what they would like to.

If you’re going to an in-person appointment, you’ll need to plan how to get to the appointment. If you need to, you may be able to claim travel expenses for your travel to the appointment. There is information about this on our Help With Travel Costs page. If you’re planning on claiming travel expenses, it may be helpful to contact your gender clinic in advance to make sure you’re able to use the scheme with their service and that they have the correct forms available. Some people use money from their local trans mutual aid fund or their local university hardship fund to pay their travel costs.

If you work, you might need to take time off work to be able to attend the appointment. You can read about your rights around taking time off work for medical appointments on the ACAS website.

Looking after yourself

Many people are extremely anxious and scared when they’re going to their first gender clinic appointment. After the appointment you might be exhausted or overwhelmed. Could you plan a nice, relaxing, or familiar activity for after your appointment? Could you make sure there’s someone you know well and feel comfortable around to keep you company?

There are a few things that it might be useful to take to your appointment:

Your appointment invitation letter if you have one.
If you’ve been asked to bring it by your gender clinic, your blood test results.
A list of questions you want to ask.
A list of things you want the gender clinic to know about you – this could relate to a disability or medical condition, to your access or communication needs, or to any relevant phobias (for example, a fear of needles).
Your communication passport if you would find it useful.
Your deed poll or statutory declaration if you’ve made a name change.
Previous appointment letters or emails if you’ve already been given a formal diagnosis by another gender clinic. You might want to look through these in advance to work out dates of things like when you started hormones or had surgery.
An up-to-date list of what medications you take, if that’s changed since you were originally referred to the gender clinic.
Anything that helps you concentrate or cope in an appointment, like fidget toys.

You’ll be asked lots of questions in your appointment.

Some of these questions can seem strange or unrelated to what you are there for, but there are medical or safety reasons why you’re being asked them. If you’re unsure why you’re being asked a question, you can ask them why the question is part of the assessment, and whether it is important for you to answer.

If you are asked a question about something that you find difficult to talk about, you can ask if you can give a very brief answer, or say that you don’t feel comfortable to answer the question. They may be happy for you to return to a question in a later appointment when you’re feeling more comfortable.

Common practical questions you could be asked include:

What name would you like them to call you by?
How would you like them to refer to you in any letters they write to your GP? What title, pronouns, or name should they use? How should they describe your gender identity?
Are you neurodivergent (e.g. autistic, ADHD, dyslexia, etc)? Is there anything that means you need extra support for appointments?
Is there anything else they can do to help you feel more comfortable in the appointment?

Common questions about your past include:

When did you start thinking about your gender? How have your thoughts and feelings about your gender changed over time?
When might other people have first noticed there was something different about you related to gender? During childhood, did you experiment with or use clothes, makeup, or hair in ways that would normally be 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 did your sexual relationships make you feel?
Are you a survivor of sexual abuse?
Do you have a criminal record?

Common questions about your current situation include:

What things cause you to experience gender dysphoria?
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?
Do you use a binder to disguise your chest or “tuck” to hide your genitals?
Have you started hormone treatment already? Have you experienced any unwanted side effects from hormone treatment?
Have you had any gender-affirming surgery already?
Where do you live? Who do you live with?
Are your family, partner, children, work, and social circles aware and supportive?
Have you experienced other people being unsupportive or intolerant of you?
What is your sexual orientation?
Are you in any sexual or romantic relationships?
Are you sexually active? Are your sexual partner(s) aware of how you feel about your gender? Are you using contraception? Would you like to know more about your sexual health and contraception options?
Do you have any physical or mental health conditions? Do you have a family history of any inherited medical conditions?
Do you smoke, drink, or use other drugs?

Common questions about your future plans include:

What would you like to change in the future related to your gender?
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?

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

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

Many people worry about whether there are ‘right’ answers to questions they’re asked at the gender clinic. You might be concerned whether your answers could mean you are refused treatment.

As an adult, it’s your decision whether to reveal information in a medical appointment. If you are asked a direct question about something you don’t want to answer, you could choose to say ‘I don’t feel comfortable answering that’.

It’s important not to lie or give an incorrect answer – if this is discovered later, this could impact your transition further.

People usually don’t have any issues accessing treatment if they:

have accessed private care
have been self-medicating
are a survivor of sexual abuse or domestic violence
are neurodivergent
are non-binary
are disabled
are gay, bisexual, or another orientation
have been diagnosed with anxiety or depression
don’t want hormones, but do want surgery
don’t want surgery, but do want hormones

While many people worry about how these things might affect their care, clinicians see lots of people who are one or more of these things, and should not be surprised. Being open about your situation may be helpful as it may allow the clinician to support you better.

However, you might also:

have more complex mental health conditions like schizophrenia or dissociative conditions
have complex PTSD
be actively suicidal or self-harming
be intersex or have a DSD diagnosis
suspect you have an eating disorder
be in an abusive home environment or relationship

In these situations, there is a possibility that your gender clinician knowing this information might affect how you are treated. It’s your decision whether you want to talk about these things or not.

If you’re not sure whether you want to talk about something in your appointment, you might want to think about these questions:

Clinicians at gender clinics see quite a lot of people in these situations – could they offer support or suggest places that could help?
Would the gender clinic knowing about your situation help them keep you more safe?
If your gender clinic decided to take more time to discuss your situation with you before offering your surgery or hormones, would you be okay with that?
Do you feel like you can trust the clinician? Do other people who’ve used that NHS gender clinic report that they’ve been supportive?
How would you feel if your clinician said they had to tell other people (like your GP or the police) about what you’ve told them?
Could your clinician already know because it’s on your NHS medical records? Or because your GP included the information in your referral?

There are lots of things you might want to ask during your appointment. You can ask about things you’re worried about. It’s normal to have questions about things – most people going to the appointment don’t know everything about gender transition yet.

In this section we’ve given some suggestions about the things you could ask.

Questions about what support you can get

What kinds of treatment and support does the gender clinic offer?
What things would I have to organise or pay for myself?
Is there any information I can give my family or partner(s) about transition?
Could you write me an evidence letter (for a passport or GRC)?
Could you ask my GP to do something for me?
Can you give me information I can take away and read?
Could you explain to me what to expect from something I’m considering?
Can I get more support for thinking more about my gender and what I want to do?
Can I get support around stopping smoking?
Will I need to lose weight? Can I get help with that?

Questions about hormones or surgery

Will taking hormones or having surgery affect my other medical conditions?
How could I avoid things from hormones I don’t want (e.g. balding)?
How does fertility preservation work? How does it affect how fast I can get on hormones?
How long will it be before I can start hormones or have surgery?
What are the pros and cons of different forms of hormone therapy?
What happens if I decide I want to change my mind?
What happens if I want to stop hormone therapy?

Questions about the process

How long will it be before my next appointment?
Who else are you going to refer me to?
What is supposed to happen next? When is it supposed to happen? What should I do if it doesn’t happen?
Is there anything I can do to help make sure I don’t have to wait longer than I need to?
Who should I contact if I need support or information between appointments?

The appointment is your main opportunity to explain what help you’d like the gender clinic to give you.

You can ask for practical support like:

Fertility preservation
Hormones
Surgeries
Speech and language therapy
Permanent facial hair removal
Peer support
Counselling or psychotherapy

You could also ask for information about:

hormones, surgery, hair removal, voice, and fertility
contraception and stopping periods
alternative options for hair removal
local trans support groups, social groups, and social activities
local mental health support services
local services for stopping smoking or vaping
local services for healthy weight loss
support for family members and partners of someone transitioning
handling thoughts about self-harm or suicide
support for people experiencing domestic violence

If you’ve got other things you’re worried about that aren’t related to gender, like your relationship, your housing situation, or your use of substances, you could ask the gender clinic if they know of services that are friendly to trans people.

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. The letter may take several weeks to arrive – if it’s been more than a month, you may want to check the letter has been sent.

Make sure you keep your appointment letters so you can refer back to them later. These letters can be useful later:

to help you remember what’s going to be happening next
when you’re applying for a GRC, they can be useful evidence
if you want to check whether your GP is correctly following the instructions
if you want to make a complaint about how you’ve been treated, they may be useful evidence

If you’ve lost your appointment letter, and need a new copy, you can ask your GP surgery to print a copy of the letter for you. If your GP surgery isn’t willing to do this, make a request for your medical records which should contain your letters – you can find instructions on how to do this on our Common healthcare issues (and what to do) page.

After a first appointment with an NHS gender clinic, you will normally need to be seen for at least one more appointment before you are given hormones. You might see a different clinician at your next appointment. In some parts of the UK, your second appointment might be at a local service (rather than at the specialist gender clinic).

The waits between appointments can be long, and some gender clinics have asked patients to wait over a year for a second appointment. It’s important that if your contact details change during this time that you let the gender clinic know – they may need to email or phone you to make your appointment.

Private gender clinics will sometimes give you a formal diagnosis after one appointment. However, you may also need to have another appointment with a private endocrinologist before you can access hormones.

I need to rearrange my appointment

There’s lots of reasons why you might not be able to attend your appointment. If you think you’re not going to be able to make your appointment, tell your gender service as soon as possible.

NHS gender services will usually be happy to reschedule if you contact them to rearrange. They will normally be able to offer your appointment slot to someone else who is waiting for an appointment, so if you’re not going to be able to make the appointment, let the gender clinic know.

You may find it’s difficult to contact your NHS gender service. NHS gender services have a very large number of people contacting them, and sometimes don’t have enough staff to respond to all queries straight away. Expect to need to try both phone calls and email, and to phone several times, in order to get in contact. You may need to try phoning at different times of the day. If you can’t get through, or you don’t get a reply straight away, this doesn’t mean that your situation is not important to the gender clinic staff.

I missed my appointment

Lots of people miss their appointment with a gender clinic. Missing your appointment can be very upsetting, particularly if you’ve waited for a long time for it.

NHS gender services will usually be happy to reschedule if you contact them quickly to apologise.

I experienced discrimination or was treated inappropriately

There are some things that shouldn’t happen in your gender service appointments – you can read the What shouldn’t happen in my appointment? section for some examples of these things.

If something happened in your appointment that should not have happened, you can use the instructions on our Common healthcare issues (and what to do) page to make a complaint.

Some of the NHS gender clinics have created information about what to expect in your appointment:

Sussex Gender Service: What to expect at your first assessment
Nottingham Centre for Transgender Health: Your first appointment
Northern Region Gender Dysphoria Service: there’s good information on the Frequently Asked Questions page about what to expect in their assessments

You can use our list of websites of NHS gender clinics to find information from other clinics.

Community voices

“I think I’d built it up in my mind a lot because of the waiting time and thought they’d be super rude or whatever. Actually they were super nice and it was more of a case of telling them what I needed. The questioning was still very intrusive but on a similar level with other trans healthcare.”
“My partner took lots of notes in my consultations. We explained this wasn’t to trip them up, but more that I may space out and forget what is said afterwards, especially when these sessions are often emotionally exhausting.”
“I wish I’d asked them for specific timings on next steps so I could record that and follow up rather than wait and assume things were being handled when I’d actually been forgotten about.”
“I had written a list of questions and actions/outcomes that I wanted to achieve and told the clinician I had it to refer to. They were good and made sure I was happy and had asked everything on my list. I made sure I asked them at the end to confirm what the next actions/outcomes were so I went away understanding, as it’s quite a big thing and easy to get muddled up!”
“I think sometimes there is an outdated understanding in some trans communities about GICs, that clinicians don’t support non-binary people, or there are certain things that you need to hide from the GIC clinicians. I think these narratives are harmful and outdated and most GIC clinicians are well trained, and want to do their best to support trans people.”

You can find more people talking about their experiences of medical transition on our Our Voices, Our Healthcare and Nobody Teaches You How To Be A Patient pages.

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This page is based on information originally posted on genderkit.org.uk with permission.

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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.

Page last updated:

19 February 2026