Changing your name and gender marker
To change your name, title and/or the gender marker on your medical records, you should ask your GP surgery for the form that allows you to change your details. You will normally be asked to show that you have changed your name elsewhere, but don’t need to provide a deed poll.
There is an option to choose a ‘not specified’ option if you do not wish to record your gender as male or female.
If you change the gender marker on your medical records, you will be given a new NHS number. Be aware that you will not be invited to some cancer screening procedures that are relevant to you, you’ll find more information on that below.
If your GP or surgery staff are unsure about any of this, you can signpost them to the information on the General Medical Council’s (GMC) website: https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#confidentiality-and-equality
Referral to a Gender Dysphoria Clinic
If you would like to medically transition, you should ask your GP for a referral to a Gender Dysphoria Clinic (GDC, previously called the Gender Identity Clinic or GIC). You are entitled to choose which clinic you’d like to be referred to. If you’re able to travel, it is worth checking waiting times at different clinics.
Some GDCs ask for a blood test to check your hormone levels prior to your first appointment – your GP will be able to help you with this. If this is the case, it is useful to take a printout of your blood test results to your first appointment.
You’ll find more information about GDCs and medical transition on our Gender Dysphoria Clinics page.
Shared care
If you are prescribed hormone treatment by a private service, you can ask your GP to make a shared care agreement. This may include your GP taking responsibility for prescribing hormones and arranging blood tests.
If you are referred to a GDC, the clinic will typically ask your GP to sign a shared care agreement. Then, if you are prescribed blockers and/or hormones, the GDC will write to your GP asking them to prescribe the hormones and blockers as required. The GP is then responsible for prescribing them and for organising regular blood tests. If you’re prescribed injections, a nurse at your surgery should be able to administer these.
You’ll find information from NHS England on shared care here.
Prescribing and monitoring hormones
Trans people under the care of an NHS GDC will typically have 2 appointments at the GDC before being prescribed hormones and hormone blockers. Trans women are typically prescribed oestrogen and testosterone blockers, trans men are typically prescribed testosterone (and sometimes estrogen blockers) and non-binary people are prescribed whatever is right for them. The GDC writes to a trans person’s GP asking them to prescribe the hormones and blockers as required. The GP is then responsible for prescribing them and for organising regular blood tests.
Bridging prescriptions
Under GMC guidelines, GPs are allowed to provide a “bridging prescription”. This is a prescription for hormone treatment to bridge the gap between the referral to a GDC and the trans person being seen by the GDC and, serves the purpose of harm reduction.
Read the TransActual guide to bridging prescriptions here.
Post-surgical care
A trans person’s GP surgery will often play a role in a trans person’s post-surgical care, especially following lower surgery. If you are due to have a surgical procedure, it is best to let your GP surgery know your surgery date and any details of the aftercare you might need. If you know you are going to need a dressing changed following surgery, it is helpful to have booked you appointment in advance. You can also find out whether your GP surgery will provide the dressings you will need or whether you will need them to write a prescription for you to collect from the pharmacy before attending appointments. For example, at their pre-operative appointment, someone having a phalloplasty will be given a list of dressings they will need and will be told when they will need their first dressing change from the local nurse. Your GP surgery will also be able to refer you to the District Nurse service if you need them to.
Cancer screening
If you have changed the sex marker on your medical records, it is important to note that you will not be sent invitations to make appointments for cancer screening that you may need. For example, a trans man would not receive a reminder to go for a cervical smear.
People with breasts over 50 ought to be invited for breast cancer screening every 3 years. If you are not automatically invited for this, you can request a referral for a mammogram.
Anyone over the age of 25 with a cervix should be invited for a cervical smear. People with a cervix should have a smear every 3 years between the ages of 25 and 49, then every 5 years after that. If you are not automatically invited for this, you can make an appointment at your GP surgery for a cervical smear. Some trans specific services offer cervical smears to trans people that need them, you will find details in our directory of trans inclusive organisations.
GPs have to be mindful that trans woman and some non-binary people might still have a prostate and the possibility of prostate cancer, although rare, is still a possibility. If you are concerned, you can request a prostate check from your doctor.
You’ll find more information about cancer screening for trans people here, here and here
Your rights under the Equality Act (2010)
Under the Equality Act (2010) trans people are entitled to freedom from discrimination when accessing healthcare. From the moment they begin their social transition (for example asking to be called a different names or starting to use different pronouns), trans people of any age are protected under the “gender reassignment” characteristic. There is no requirement to have obtained legal gender recognition or to have had any medical intervention. Non-binary people are protected from discrimination under the Equality Act (2010), as they are included within the “gender reassignment” characteristic.
What happens if you encounter difficulties?
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.
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. To complain you should write to the practice manager detailing the problem. If your complaint is not properly handled, you should write to NHS England, NHS Scotland or NHS Wales. There are details of how to make a complaint on the NHS website.
Support for GPs and practice staff
Where can I find more information?
Black Beetle Health: https://www.blackbeetlehealth.co.uk/
Gendered Intelligence: http://genderedintelligence.co.uk/projects/kip/health
General Medical Council: https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare
Gender Construction Kit: https://genderkit.org.uk/
GIRES: https://www.gires.org.uk/category/health/
Eve Appeal: https://eveappeal.org.uk/gynaecological-cancers/tnbiinfo/
Jo’s Trust: https://www.jostrust.org.uk/professionals/health-professionals/nurse-gp/trans-non-binary and https://www.jostrust.org.uk/information/cervical-screening/trans-non-binary
LGBT Foundation: http://lgbt.foundation/who-we-help/trans-people/resources-for-trans-people/lgbt-foundation-resources-for-trans-people
Prostate cancer UK: https://prostatecanceruk.org/prostate-information/are-you-at-risk/trans-women-and-prostate-cancer
Terrance Higgins Trust: https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people
The Clare Project: https://clareproject.org.uk/resources/
Trans Health UK: https://transhealthuk.noblogs.org/
Trans Healthcare Intel: https://www.transhealthcareintel.com/ (search for a trans inclusive GP)