Gender Services at the practice

University Health Service Southampton is a gender inclusive practice and has over 100 trans, gender fluid patients and non-binary patients.

We support all our patients. Please find details of our service below and some points to note regarding your healthcare.

Transgender Basics

For some people, their gender identity may not match the gender they were assigned at birth. These people are described as transgender. Many, though not all, transgender people feel a deep distress with their primary and/or secondary sex characteristics, their bodies as a whole, or how their gender is perceived by others. This is known as gender dysphoria. It is estimated between 1-2% of the UK population is transgender.

Gender Dysphoria

Transgender people experiencing gender dysphoria may request hormone treatment, surgery or other treatments to align their bodies with their gender identity.

What can you expect?

The GPs at University Health Service Southampton are supportive but are not specialists in Gender Medicine. We cannot initiate treatment apart from in special circumstances and require patients to see a specialist. We recommend that you see us to seek referral to an NHS Gender clinic and, or a private health care provider.

Referral to Gender Identity Services

A patient with gender dysphoria can be referred by their GP to the Gender Identity Services. There are currently numerous Gender Identity Clinics for adults in the UK, and you can choose which one you would like to be referred to.

London: Tavistock and Portman NHS Foundation Trust.
Sheffield: Sheffield Health and Social Care NHS Foundation Trust Gender Dysphoria Service.
Leeds: Leeds and York Partnership NHS Foundation Trust Gender Dysphoria Service.
Newcastle: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Northern Region Gender Dysphoria Service.
Northamptonshire: Northamptonshire Healthcare NHS Foundation Trust Gender Dysphoria Clinic.
Nottinghamshire: Nottingham Centre for Transgender Health.
Exeter: Devon Partnership NHS Trust West of England Specialist Gender Dysphoria Clinic (also known as The Laurels).

Pilot clinics have also opened in other areas like Greater Manchester, London, and Merseyside, with access initially for people already on waiting lists at other established clinics.

The waits are often quite long. The Nottingham clinic is just over 2 years.

Private clinics

For many the wait is too long so they wish to go privately. We work closely with Gendercare

Other clinics are also available, please check with the practice before engaging with them. In the past we have not been able to take on shared care with certain clinics and it is best to check with the practice before spending money.

Shared care

In the NHS, "shared care" refers to a formal arrangement where the responsibility for a patient's care is shared between a specialist (usually at a hospital) and their General Practitioner (GP). This is most common for the long-term prescribing and monitoring of medications that were initiated by a specialist.

Gender services are an area where we have established shared care. Please note that acceptance of shared care is not a given and the practice will not enter shared care with providers who operate outside the UK.

The private service must also be able to prescribe. Some UK clinics have no prescriber. We will not enter shared care agreements with them.

Fertility

Taking hormones may cause irreversible change to your fertility. Transwomen may decide to preserve sperm before taking hormones. This can be done privately or on the NHS. To be done on the NHS you need to have been assessed by an NHS clinic or an acceptable private provider. Once this has been done your GP can ask for funding for cryopreservation and storage of sperm. This currently is funded for 2 years but is likely but not guaranteed to be longer.

Bridging

Under GMC guidelines, GPs are allowed to provide a bridging prescription. For many patients their journey is best supported by specialists as this is a complex area.

A bridging prescription is a temporary prescription of hormone replacement therapy (HRT), such as oestrogen or testosterone, that a GP may issue to a patient who is on a waiting list for a GIC. The bridging prescription is intended as a "holding and harm reduction strategy" to mitigate the negative effects of the long wait, which can include:

• Exacerbated gender dysphoria and related mental health problems.
• Increased risk of suicide and self-harm.
• Self-medicating with hormones purchased from unregulated, often dangerous, online sources.

The dose is usually very low and will only be entered into rarely and when the individual is on an NHS waiting list. This option is discouraged and is at the discretion of the GP.

More details can be found here: GMC guidance: https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#mental-health-and-bridging-prescriptions

Changes to Medical Records including Name/ Gender Markers

Doctors are asked by transgender patients to change their name and/or gender on the medical record. Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so. Patients have the right to change the name and gender on the medical record irrespective of whether they intend to obtain a Gender Recognition Certificate.

Mental health

Whilst being trans is not a mental health condition, trans people are disproportionately impacted by mental health difficulties. These can be exacerbated by long NHS waiting lists and anxiety over accessing hormone treatment and surgery It is also important remember not all trans people’s mental health difficulties are related to them being trans.

Some trans patients will benefit from trans healthcare that specifically caters to trans people. At University Health Service Southampton we have 15 GPs skilled in mental health. We also have a psychologist, and 4 mental health workers and close links with student services.

Details of trans inclusive mental health services: https://www.transactual.org.uk/transorgs