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Formal diagnosis

What is formal diagnosis?

Receiving a formal medical diagnosis from a specialist. This can often be necessary to access treatments related to gender and funding for them.

What does formal diagnosis do?

  • Medical documents

    Generally required for surgery; may help get hormones and funding for other treatments

  • ID documents

    Required to get a Gender Recognition Certificate, but other documents can be updated without one

Why might I want a diagnosis?

Getting a formal medical diagnosis may help you access treatment, especially surgery. It may also help you update some legal documents, and acquire a gender recognition certificate.

Before getting a diagnosis, it’s worth considering carefully whether you need one. It can be tempting to look for a diagnosis as validation, but it can also be pathologising — making you feel like your identity is a “disease” — and may be unnecessary, depending on what your needs are. Remember that lacking a diagnosis does not make your identity as a trans person any less valid.

Here are some reasons you might want a diagnosis:

  • To access treatment

    A diagnosis is usually required to receive gender-related surgeries, and may help you get hormone treatment and NHS funding for hair removal or speech therapy.

    You may be able to get your GP to prescribe hormones without getting a diagnosis: see Accessing HRT without a diagnosis for more information.

  • To get a Gender Recognition Certificate, or update the gender on your passport

    Applying for a GRC requires providing a medical report detailing treatments you’ve had. Updating the gender marker on your passport requires either a GRC or a letter from a medical professional.

    In both cases your GP may be willing to write a letter for you without a formal diagnosis.

  • For emotional reasons

    You might find that obtaining a diagnosis provides you with a sense of validation or closure. It could be a powerful acknowledgement that what you’ve been feeling is, from a medical perspective, real.

    However, you should keep in mind that the lack of a diagnosis does not imply that you aren’t “really” trans.

Why might I not want a diagnosis?

  • You find it pathologising

    A diagnosis is essentially a declaration that you have a disease or disorder. You might not like the idea that your identity is a disease.

    The newer diagnosis of “gender dysphoria” is better for this, as the implied disease is not trans identity itself but the discomfort that comes from the mismatch between identity, body, and how society treats you. However, this diagnosis might still be too pathologising for you, and there is no guarantee that your clinician would use this term rather than the older “transsexualism” or “gender identity disorder”.

  • You want to avoid “gatekeeping”

    “Gatekeeping” is when doctors decide whether trans people should have access to treatment, rather than allowing them to decide for themselves. This practice has a long history in UK gender clinics, especially NHS ones, though some clinics are moving away from it in recent years.

    Fears of gatekeeping might make it harder for you to trust your doctor, or make you worried that being totally honest might make it harder to get treatment 1, p.39.

  • You don’t need any of the treatments that require it

    If you don’t want surgery or hormones, there might be no point in getting a diagnosis. Furthermore, if you only need hormones, there might be a way to access them without a diagnosis.

How do I get a diagnosis?

In the UK, diagnoses for trans people are normally made by specialists. The exact diagnosis given in the UK can vary, but common diagnoses include:

  • gender dysphoria
  • transsexualism
  • gender incongruence
  • gender identity disorder

These are all broadly synonymous from a medical perspective, though you may prefer a diagnosis of “dysphoria” as it is less pathologising and does not imply a binary identity. Any of these diagnoses should be as good as any other for accessing treatment.

Your GP should be able to refer you to one of the NHS gender services who will be able to diagnose you. If they are unsure, you can direct them to the advice for GPs published by the General Medical Council, or the resources on our Information for clinicians page.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

If you wish, you can pay to use private specialist gender services. You may find this is quicker than using the NHS services, but it may cost £200 per hour or more for your appointments.

You can find details of both the NHS and private gender services on our Specialist UK gender clinics page.

How do I get by without a diagnosis?

If you don’t need medical treatments or a GRC, and don’t need the gender on your passport updated, you may be fine without a diagnosis. The Equality Act (2010) protects you from discrimination on the basis of “gender reassignment”, which will still apply to you even if you only pursue non-medical aspects of transition such as clothes, cosmetics, and pronouns. If you are presenting as your gender identity, you should not be excluded from any spaces or services that are specific to that gender, with some very limited exceptions.

Getting the gender on your passport updated will require a letter from a doctor stating that you intend to live in the new gender permanently. Your GP might be willing to write this for you without a formal diagnosis.

Under some circumstances, your GP may be willing to prescribe hormones without a diagnosis; hormone treatments are well-documented, easy to monitor for safety and cost the NHS relatively little. However, it is very unlikely that you will be able to access surgery without a diagnosis. See Accessing HRT without a diagnosis for more information.

References

  1. 1.
    Vincent, Ben (2018) Transgender Health, Jessica Kingsley Publishers. Link

Errors and omissions

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