Getting referred to a gender clinic

To get gender-related medical treatment, you normally need to be referred to a specialist service, which is called a gender clinic. This works just like being referred for any other kind of medical treatment.

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.

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

Private gender services let you refer yourself, and their website will normally tell you how. Getting a referral typically involves sending them an email or filling in a form on their website.

Some NHS gender services also let you refer yourself. You can do this by downloading a form from their website, filling it out, and emailing it to them. You can find out which NHS services allow self-referral on our NHS Gender Clinics page. You don’t have to refer yourself if you’d prefer your GP make your referral for you.

If you’d like to be referred to an NHS gender service which doesn’t allow self-referral, or you’d like the GP to make the referral for you, read on.

Some people have medical insurance plans as part of their job which cover parts of medical transition. Not all medical insurance plans will cover medical transition, and many will not cover all of the diagnosis and treatment process. If you think you might be covered by your medical insurance plan, you can speak to your insurer directly to check whether you are eligible and what they will pay for. You don’t need to tell your employer you are doing this. If you are covered, the first step is to speak to your insurer to ask them to arrange a referral for you. Your insurer will have details on their website of how to arrange an initial appointment with one of their GPs to discuss this.

You don’t have to make an appointment with your GP if:

  • you’re self-referring: some NHS gender clinics will allow you to ‘self-refer’ – that means fill in a form from their website to join their waiting list, without having to speak to your GP and ask them to do it. Only some NHS gender clinics let you do this – you can find details of which ones let you self-refer on our Gender Clinics list. Your GP will normally be able to see that a referral has been made.
  • you’re using a private service: private services all allow you to use their services without needing a referral from your NHS GP.

While many people do decide to self-refer to a gender service, asking your GP to make the referral for you can be helpful to:

  • Keep your GP involved in the process: Your GP will be heavily involved in the treatment process, regardless of whether you make a self-referral. You’ll normally need to work with your GP in future in order to get blood tests, prescriptions, or injections, and your private or NHS gender clinic will write them letters asking them to do things for you. Talking to your GP early can be useful to gather information about whether they will help support you later on when you’re seen by the gender clinic.
  • Get help with getting a referral: the GP could fill in the referral form for you by asking you questions. Remember, patients in England are entitled to ask to be referred to an NHS gender clinic of their choice.
  • Ask for anything else you need: you might also want to ask for referrals to other services or to update your details. 

Even if you self-refer and/or are using a private service, you’ll still need to be registered with an NHS GP first. If you’re not registered with a GP yet, there is information on how to do this on the NHS England website and the NHS Scotland website. In Wales, you can use the NHS 111 Wales website to find a local GP surgery and use the instructions on the GP surgery website.

The rest of this page explains what to expect from talking to your GP about getting referred to a gender clinic.

Some GPs are very used to trans patients and will know exactly what to do, but others  may have less knowledge or training, and might not know how to make the referral.

In the UK, GPs don’t normally prescribe you hormones until after you’ve been seen by a specialist gender clinic. Occasionally, GPs will write a trans person a bridging prescription (a prescription while you are waiting to be seen by a specialist) but this is rare.

You can book the appointment in the same way as any other GP appointment. If you’ve not booked a GP appointment before, there’s information about how to make an appointment on the NHS website.

You’ll normally be asked to give a reason why you are asking for an appointment. If you’re arranging an appointment by phone call or in person, this might be a question you’re asked by reception staff. 

If you’re comfortable, explaining in advance that you’re looking for a referral to a gender service may help make sure you’ve got a long enough appointment and that they’ve got the forms ready for you.

If you don’t feel comfortable with saying this, you could state it’s to discuss your ‘mental health’.

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 on the ACAS website.

Research what your GP is meant to do

Your GP may not have made a referral to an NHS gender clinic before, and not know where you can be referred to or how to do it. Take information on how to make a referral with you. You can find a list of NHS gender clinics and instructions for GPs on making a referral on our website. 

If you’re in England, think about which NHS gender clinic you would like to be referred to, as you’re able to choose which one you attend.

Think about what you’ll say 

Have a read through the list of questions that your GP might ask lower down this page, and think about how you might answer them. You might find it helpful to take some time to think about what your experiences of gender were like in your childhood or teenage years, as there might be questions about this subject from your GP.

Think about what questions you might have for your GP or what help you might want to ask them for. We’ve got some suggestions lower down this page, but you might have more questions of your own.

Many people are extremely anxious and scared when talking to their GP for the first time about gender. Some people find they’re unable to say what they’re there about. 

Think about what might help you with nerves. For example, writing a list of bullet points to discuss, making a letter you could hand the GP, or having someone safe with you could help.

Some people find it particularly difficult to talk in stressful situations – take a look at our Communicating about my needs page for ideas of how to handle this.

Looking after yourself

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?

You can expect to be asked lots of questions by your GP in the appointment. You might also have questions you want to ask your GP too.

If you’re being referred to a service for children and young people, your GP will normally refer you to local child and adolescent mental health services who will make the referral onwards to the gender clinic. The GP is likely to ask you questions to make the referral to mental health services, though they might be a little different from the ones on this page. You can find out more about referrals for children and young people on the National Referral Support Service website.

If you’re an adult, you shouldn’t be referred to a mental health service, and should be referred directly to the NHS gender clinic. In your referral appointment, the GP is likely to take your height and weight, and sometimes you might be asked to have a blood test or if they can take your blood pressure.

There are some things that shouldn’t happen in your GP appointment.

If you’re an adult, your GP shouldn’t suggest that you be screened by psychiatry or a mental health team before they make a referral to an NHS gender clinic – this isn’t required. 

Regardless of your age, GPs should make a referral without asking you to:

  • wait some time first – sometimes a GP will say that they won’t make a referral until you’ve waited several months to see if you’ve changed your mind, or that they won’t make a referral because it’s against their personal beliefs. Your GP is expected to make a prompt referral when you ask for it.
  • lose weight first – NHS gender clinics don’t require you to be below or above a certain weight or BMI, though some surgeons will ask for this later on.
  • come out to other people first
  • show them any of your body parts first – this isn’t relevant to the referral. Your GP is not required to perform any examination of your body, apart from measuring your height, weight, or blood pressure, before making a referral.

Your GP should make a referral regardless of whether you are:

  • non-binary
  • disabled
  • chronically ill
  • neurodivergent – for example, if you have a diagnosis of autism or ADHD
  • elderly
  • a smoker or use vapes
  • a personal with a high BMI
  • diagnosed with a mental health condition

If your GP is refusing to make a referral, you can show your GP:

If this doesn’t help, another GP at the surgery should be able to help you instead – see the What To Do If Something Goes Wrong section further down this page for more information about this.

You shouldn’t be treated less well in your appointment because you’re disabled, elderly, d/Deaf, Black or a person of colour, or because of your religion. 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.

If you’re an adult in England, your GP shouldn’t tell you that you need to be referred to a particular NHS gender clinic. You’re allowed to choose which of the seven main adult NHS gender clinics you want to be referred to, and this doesn’t need to be the closest one to you. 

Your GP will normally start the appointment by asking you what you’d like to talk about.

The clearest thing you do is to explain that you are trans or that you think you might be, and that you would like to be referred to a NHS gender clinic. If you’ve got a particular NHS gender clinic you want to be referred to, you can explain that too.

To make the referral, the GP will need to ask you the questions on the referral form. Many NHS gender clinics publish their referral form on their website, so you can check ahead of time which questions your GP is likely to ask you. We have a list of NHS gender clinics you can use to find the form for the service you want to be referred to.

Here are some questions that you might be asked:

  • What is your current gender identity and pronouns?
  • Have you previously attended a gender clinic?
  • Are you taking any hormones? Have you had any surgeries related to your gender?
  • Do you need any support to attend appointments (e.g. an interpreter, advocate, or carer)?
  • Do you have any access needs to attend appointments (e.g. wheelchair access, sensory sensitivities, etc)?
  • What medications do you currently take?
  • How would you like the gender clinic to contact you to arrange appointments?
  • When did you start thinking about your gender? 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?
  • Have you made a name change? If not, do you have a preferred name?
  • Have you updated your NHS records to a new name, title, or gender? Would you like to?
  • Have you made any public changes to your gender presentation?
  • Have people around you (friends, family, coworkers, neighbours) been supportive?
  • What support or treatments would you like from the gender clinic?

Your GP will need to list your medical conditions on the referral form, so they might ask you questions about your medical history or family medical history. These questions might include whether you have:

  • mental health conditions
  • DSD or intersex conditions
  • neurodiversity (e.g. ADHD, autism, dyslexia, etc)
  • learning disabilities or a developmental disorder
  • a history of self-harming or suicidal behaviour

You might also be asked:

  • Do you use any recreational drugs? 
  • Do you drink? 
  • Do you smoke or vape? 
  • Do you have a criminal record?
  • Where do you live? Who do you live with?
  • Are you employed? Are you in education?

If you’re being referred to a service for young people, you are likely to be asked:

  • whether your parents or guardians are happy for you to be referred
  • whether you have experienced any bullying
  • whether you have experienced any abuse

As well as your GP asking you questions, you can ask your GP questions too.

Some questions you might want to ask your GP are:

  • Could you use a different name and title for me from now on?
  • Could you update my NHS records for me to a new name, title, and sex marker?
  • Could you refer me to support for stopping smoking or vaping?
  • If I refer myself to a private service too, would you be willing to enter into a shared care agreement with the private service?
  • Would you consider bridging prescriptions while I wait to be seen by the NHS service?

Many people worry about whether there are ‘right’ answers to questions they’re asked by their GP when a referral is being made. You might be concerned whether your answers could mean you are refused treatment later when you are seen by the gender clinic. 

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 at an NHS gender service 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
  • 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 at the gender clinic, gender clinic staff 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 gender clinic 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 the gender service 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:

  • Could your GP already know? Might it already be on your NHS medical records?
  • How would you feel if your GP said they had to tell other people (like the police) about what you’ve told them?
  • Could your GP provide support or suggest places that might help?
  • 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 gender clinic? Do other people who’ve used that NHS gender clinic report that they’ve been supportive?

Most services will say on their website how long you can expect to wait and how long people who are currently being offered appointments have been waiting. You might find it helpful to write down what date your referral was made for later reference.

After you’ve been referred, most services send you a confirmation letter, letting you know you have been added to their waiting list. This usually takes a few weeks, so don’t worry if it takes a little while before you hear anything. 

However, it’s not unusual for mistakes to be made with referrals, and it’s important to make sure the referral has actually been made by your GP and accepted by the NHS gender clinic. 

To make sure the referral has been made correctly, you can:

  • look in the NHS app, if you have access to it
  • ask the reception staff at your GP surgery to confirm that the referral has been sent
  • contact the NHS gender clinic you’ve asked to be referred to by phone or email – you might want to wait 4-8 weeks before doing this so they have time to receive and process the referral.

If you have a bad experience with your GP, you can ask to see a different GP within your practice. You are also entitled to switch GP surgery without providing a reason for changing. If you are part of a local trans group, you might find it useful to ask people for their recommendations.

If a GP says that they will not make a referral for you because of your nationality, immigration status, or residency in the UK, or require you to prove these things first, show them this clear guidance from the British Medical Association.

Trans people are entitled to the same quality of care as everyone else. If you experience discrimination when accessing healthcare, or are not given proper support, you can complain. You’ll find more information about that on the Common healthcare issues (and what to do) page.

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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.

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