Gender dysphoria - Treatment - NHS

It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The ... Skiptomaincontent Home HealthAtoZ Genderdysphoria BacktoGenderdysphoria Treatment - Genderdysphoria Contents Overview Signs Howtogethelpandsupport Treatment Treatmentforgenderdysphoriaaimstohelppeoplelivethewaytheywantto,intheirpreferredgenderidentityorasnon-binary.Whatthismeanswillvaryfrompersontoperson,andisdifferentforchildren,youngpeopleandadults.Waitingtimesforreferralandtreatmentarecurrentlylong. TreatmentforchildrenandyoungpeopleIfyourchildisunder18andmayhavegenderdysphoria,they'llusuallybereferredtotheGenderIdentityDevelopmentService(GIDS)attheTavistockandPortmanNHSFoundationTrust.GIDShas2mainclinicsinLondonandLeeds.YourchildorteenagerwillbeseenbyamultidisciplinaryteamatGIDSincludinga:clinicalpsychologistchildpsychotherapistchildandadolescentpsychiatristfamilytherapistsocialworkerTheteamwillcarryoutadetailedassessment,usuallyover3to6appointmentsoveraperiodofseveralmonths.Dependingontheresultsoftheassessment,optionsforchildrenandteenagersinclude:familytherapyindividualchildpsychotherapyparentalsupportorcounsellinggroupworkforyoungpeopleandtheirparentsregularreviewstomonitorgenderidentitydevelopmentreferraltoalocalChildrenandYoungPeople'sMentalHealthService(CYPMHS)formoreseriousemotionalissuesareferraltoaspecialisthormone(endocrine)clinicforhormoneblockersforchildrenwhomeetstrictcriteria(atpuberty)Mosttreatmentsofferedatthisstagearepsychologicalratherthanmedical.Thisisbecauseinmanycasesgendervariantbehaviourorfeelingsdisappearaschildrenreachpuberty.HormonetherapyinchildrenandyoungpeopleSomeyoungpeoplewithlastingsignsofgenderdysphoriawhomeetstrictcriteriamaybereferredtoahormonespecialist(consultantendocrinologist)toseeiftheycantakehormoneblockersastheyreachpuberty.Thisisinadditiontopsychologicalsupport.GIDSneedstoapplytotheCourtforpermissiontostartpubertyblockersforchildrenandyoungpeopleundertheageof16.Thisisbecausearecentcourtrulingstatesthatit'sdoubtfulchildrenandyoungpeopleundertheageof16areabletogiveinformedconsentforthistreatment.TheCourtwillbeaskedtoconsiderineachcasewhetherhormonetreatmentisinthebestinterestsoftheyoungperson.Differentarrangementsapplyforyoungpeopleaged16and17,asthelawpresumestheyareabletogiveinformedconsent.Inthesecases,anapplicationtothecourtwillonlybenecessaryifthereisanydoubtabouttheyoungperson'scapacitytogiveconsentordisagreementaboutthebestinterestsoftheyoungperson.Pubertyblockersandcross-sexhormonesPubertyblockers(gonadotrophin-releasinghormoneanalogues)pausethephysicalchangesofpuberty,suchasbreastdevelopmentorfacialhair.Littleisknownaboutthelong-termsideeffectsofhormoneorpubertyblockersinchildrenwithgenderdysphoria.AlthoughGIDSadvisesthisisaphysicallyreversibletreatmentifstopped,itisnotknownwhatthepsychologicaleffectsmaybe.It'salsonotknownwhetherhormoneblockersaffectthedevelopmentoftheteenagebrainorchildren'sbones.Sideeffectsmayalsoincludehotflushes,fatigueandmoodalterations.Fromtheageof16,teenagerswho'vebeenonhormoneblockersforatleast12monthsmaybegivencross-sexhormones,alsoknownasgender-affirminghormones.Thesehormonescausesomeirreversiblechanges,suchas:breastdevelopment(causedbytakingoestrogen)breakingordeepeningofthevoice(causedbytakingtestosterone)Long-termcross-sexhormonetreatmentmaycausetemporaryorevenpermanentinfertility.However,ascross-sexhormonesaffectpeopledifferently,theyshouldnotbeconsideredareliableformofcontraception.Thereissomeuncertaintyabouttherisksoflong-termcross-sexhormonetreatment. TransitiontoadultgenderidentityservicesYoungpeopleaged17oroldermaybeseeninanadultgenderidentityclinicorbereferredtoonefromGIDS.Bythisage,ateenagerandtheclinicteammaybemoreconfidentaboutconfirmingadiagnosisofgenderdysphoria.Ifdesired,stepscanbetakentomorepermanenttreatmentsthatfitwiththechosengenderidentityorasnon-binary. TreatmentforadultsAdultswhothinktheymayhavegenderdysphoriashouldbereferredtoagenderdysphoriaclinic(GDC).FindanNHSgenderdysphoriaclinicinEngland.GDCshaveamultidisciplinaryteamofhealthcareprofessionals,whoofferongoingassessments,treatments,supportandadvice,including:psychologicalsupport,suchascounsellingcross-sexhormonetherapyspeechandlanguagetherapy(voicetherapy)tohelpyousoundmoretypicalofyourgenderidentityForsomepeople,supportandadvicefromtheclinicarealltheyneedtofeelcomfortablewiththeirgenderidentity.Otherswillneedmoreextensivetreatment.HormonetherapyforadultsTheaimofhormonetherapyistomakeyoumorecomfortablewithyourself,bothintermsofphysicalappearanceandhowyoufeel.Thehormonesusuallyneedtobetakenfortherestofyourlife,evenifyouhavegendersurgery.It'simportanttorememberthathormonetherapyisonlyoneofthetreatmentsforgenderdysphoria.Othersincludevoicetherapyandpsychologicalsupport.Thedecisiontohavehormonetherapywillbetakenafteradiscussionbetweenyouandyourclinicteam.Ingeneral,peoplewantingmasculinisationusuallytaketestosteroneandpeopleafterfeminisationusuallytakeoestrogen.Bothusuallyhavetheadditionaleffectofsuppressingthereleaseof"unwanted"hormonesfromthetestesorovaries.Whateverhormonetherapyisused,itcantakeseveralmonthsforhormonetherapytobeeffective,whichcanbefrustrating.It'salsoimportanttorememberwhatitcannotchange,suchasyourheightorhowwideornarrowyourshouldersare.Theeffectivenessofhormonetherapyisalsolimitedbyfactorsuniquetotheindividual(suchasgeneticfactors)thatcannotbeovercomesimplybyadjustingthedose.RisksofhormonetherapyThereissomeuncertaintyabouttherisksoflong-termcross-sexhormonetreatment.TheclinicwilldiscussthesewithyouandtheimportanceofregularmonitoringbloodtestswithyourGP.Themostcommonrisksorsideeffectsinclude:bloodclotsgallstonesweightgainacnedyslipidaemia(abnormallevelsoffatintheblood)elevatedliverenzymespolycythaemia(highconcentrationofredbloodcells)hairlossorbalding(androgenicalopecia)Thereareotherrisksifyou'retakinghormonesboughtovertheinternetorfromunregulatedsources.It'sstronglyrecommendedyouavoidthese.Long-termcross-sexhormonetreatmentmayalsolead,eventually,toinfertility,eveniftreatmentisstopped.TheGPcanhelpyouwithadviceaboutgametestorage.Thisistheharvestingandstoringofeggsorspermforyourfutureuse.GametestorageissometimesavailableontheNHS.Itcannotbeprovidedbythegenderdysphoriaclinic.ReadmoreaboutfertilitypreservationontheHFEAwebsite. SurgeryforadultsSomepeoplemaydecidetohavesurgerytopermanentlyalterbodypartsassociatedwiththeirbiologicalsex.Basedontherecommendationsofdoctorsatthegenderdysphoriaclinic,youwillbereferredtoasurgeonoutsidetheclinicwhoisanexpertinthistypeofsurgery.Inadditiontoyouhavingsociallytransitionedtoyourpreferredgenderidentityforatleastayearbeforeareferralismadeforgendersurgery,itisalsoadvisableto:notsmokeloseweightifyouareoverweight(BMIof25orover)havetakencross-sexhormonesforsomesurgicalproceduresIt'salsoimportantthatanylong-termconditions,suchasdiabetesorhighbloodpressurearewellcontrolled.SurgeryfortransmenCommonchestproceduresfortransmen(trans-masculinepeople)include:removalofbothbreasts(bilateralmastectomy)andassociatedchestreconstructionnipplerepositioningdermalimplantandtattooGendersurgeryfortransmenincludes:constructionofapenis(phalloplastyormetoidioplasty)constructionofascrotum(scrotoplasty)andtesticularimplantsapenileimplantRemovalofthewomb(hysterectomy)andtheovariesandfallopiantubes(salpingo-oophorectomy)mayalsobeconsidered.SurgeryfortranswomenGendersurgeryfortranswomenincludes:removalofthetestes(orchidectomy)removalofthepenis(penectomy)constructionofavagina(vaginoplasty)constructionofavulva(vulvoplasty)constructionofaclitoris(clitoroplasty)Breastimplantsfortranswomen(trans-femininepeople)arenotroutinelyavailableontheNHS.FacialfeminisationsurgeryandhairtransplantsarenotroutinelyavailableontheNHS.Aswithallsurgicalprocedurestherecanbecomplications.Yoursurgeonshoulddiscusstherisksandlimitationsofsurgerywithyoubeforeyouconsenttotheprocedure. LifeaftertransitionWhetheryou'vehadhormonetherapyaloneorcombinedwithsurgery,theaimisthatyounolongerhavegenderdysphoriaandfeelateasewithyouridentity.Yourhealthneedsarethesameasanyoneelse'swithafewexceptions:you'llneedlifelongmonitoringofyourhormonelevelsbyyourGPyou'llstillneedcontraceptionifyouaresexuallyactiveandhavenotyethadanygendersurgeryyou'llneedtoletyouropticiananddentistknowifyou'reonhormonetherapyasthismayaffectyourtreatmentyoumaynotbecalledforscreeningtestsasyou'vechangedyournameonmedicalrecords–askyourGPtonotifyyouforcervicalandbreastscreeningifyou'reatransmanwithacervixorbreasttissuetrans-femininepeoplewithbreasttissue(andregisteredwithaGPasfemale)areroutinelyinvitedforbreastscreeningfromtheagesof50upto71Findoutmoreaboutscreeningfortransandnon-binarypeopleonGOV.UK. NHSguidelinesforgenderdysphoriaNHSEnglandhaspublishedwhatareknownasservicespecificationsthatdescribehowclinicalandmedicalcareisofferedtopeoplewithgenderdysphoria:Non-surgicalinterventionsforadultsSurgicalinterventionsforadultsServicesforchildrenandyoungpeople(PDF,1.15MB)Amendmentstoservicesforchildrenandyoungpeople(PDF,16KB) ReviewofgenderidentityservicesNHSEnglandhascommissionedanindependentreviewofgenderidentityservicesforchildrenandyoungpeople.Thereviewwilladviseonanychangesneededtotheservicespecificationsforchildrenandyoungpeoplein2021. Pagelastreviewed:28May2020 Nextreviewdue:28May2023 Previous : Howtogethelpandsupport