6 January 2020
Gender Identity Services for Adults (Surgical Interventions): Service Specification December 2020
Gender Identity Services for Adults (Non-Surgical Interventions): Service Specification December 2020
Gender dysphoria
The term used to describe a discrepancy between birth-assigned sex and gender identity is gender incongruence; this term is preferable to the formerly-used terms of gender identity disorder and transsexualism. Gender incongruence is frequently, but not universally, accompanied by the symptom of gender dysphoria.
The current version of the International Statistical Classification of Diseases and Related Health Problems identifies ‘transsexualism’ (ICD 10 code F64) as “a disorder characterized by a strong and persistent cross-gender identification (such as stating a desire to be the other sex or frequently passing as the other sex) coupled with persistent discomfort with his or her sex (manifested in adults, for example, as a preoccupation with altering primary and secondary sex characteristics through hormonal manipulation or surgery)”
Care Pathway
The NHS pathway of care may be summarised as:
- Referral to a specialist Gender Dysphoria Clinic (self-referral; or by primary, secondary or tertiary care)
- Assessment for gender dysphoria, and diagnosis
- Individuals who meet the criteria for diagnosis of gender dysphoria related to gender incongruence are accepted on to the NHS care pathway and an individualised treatment plan is agreed
- Therapeutic interventions delivered by the specialist Gender Dysphoria Clinic; and / or referral for interventions with other providers
- Ongoing review and monitoring during and after interventions
- Conclusion of contact: discharge to primary care
New Referrals
Self-referrals may be made by individuals themselves, provided the individual is registered with a General Practitioner (GP). Referrals may also be made by GPs, other medically qualified professionals, and other professionals regulated by the Health and Care Professions Council
Preservation of Gametes
Where the patient meets the thresholds defined by the Cryopreservation of sperm, oocytes and embryos in patients whose treatment poses a risk to their fertility (hyperlink to policy) Clinical Threshold Policy, referrals for preservation of gametes should be sent to Bourn Hall. The referral letter should be accompanied by a recent letter from the provider of the gender dysphoria service, and sent by email to: bournhall.referral@nhs.net.
Requests for transfers of care from the Gender Identity Development Service for Children and Young People
A request for transfer of care may be made by the designated Gender Identity Development Service for children and young people to a designated Gender Dysphoria Clinic before the young person’s 17th birthday. This may be appropriate where joint working between the two services, including joint consultations with the young person, within a “lead-in” period is beneficial to ensure a timely and effective eventual transfer once the young person has reached 17 years.
Service for over 18 year olds
There are 7 gender specialist clinics for adults in NHS England and referrals can be made to these clinics to explore with the patient the options available to them.
Services for children and under 18s
Children and young people experiencing gender dysphoria will access treatment and support via the gender reassignment protocol. Each patient will be considered on an individual basis by their gender identity clinic.
At present specialist gender identity development services for children and young people under 18 are available through the Gender Identity Development Service at The Tavistock and Portman NHS Foundation Trust, London, and their satellite clinics in Exeter and Leeds. Children and young people should contact their GP in the first instance and thereafter may be referred to the Gender Identity Development Service at The Tavistock and Portman NHS Foundation Trust, London.
Other professionals in Health, Social Services and Education departments as well as young people and their families can contact the Service directly to discuss a possible referral. Further information can be found at https://gic.nhs.uk/.
Teenagers who are 17 years of age or older may be seen in Adult Gender Clinic. They are entitled to consent to their own treatment and follow the standard adult protocol, and this consent cannot be overruled by their parents.
Additional contact details:
Gender Identity Development Service
The Tavistock and Portman NHS Foundation Trust
120 Belsize Lane
London
NW3 5BA
Telephone: 020 8938 2030/1
Email: gids@tavi-port.nhs.uk
Website: NHS official page and http://gids.nhs.uk/
The Gender Identity Development Service at The Tavistock and Portman NHS Foundation Trust is part of the NHS Camden Child and Adolescent Mental Health Service (CAMHS) which offers help to children and adolescents from birth until their 19th birthday, their families and carers as well as offering advice and consultation to other professionals working with children, adolescents and their families.
Further information on assessment and treatment of children and young people under 16 with gender dysphoria can also be found in the WPATH Standards of Care, 7th version (page 10, http://www.wpath.org).
Referral form is available for health professionals.
For more information please visit http://gids.nhs.uk/referrals