Normally, your GP will want you to have a formal diagnosis before they are willing to prescribe. However, there are some circumstances under which your GP may be willing to prescribe without a diagnosis.
Unfortunately, there is not much consistency between different sources of guidance, with different organisations giving different criteria under which a GP should prescribe. This page is intended to help you understand what the different published guidance says, so that you can be fully informed when discussing this with your GP.
Vincent 1, p.148 lists the following circumstances when it could be appropriate for your GP to prescribe hormones without referring to a GIC, or before you’ve been seen by the GIC you’ve been referred to:
When you’ve already been seen by a GIC
If you’ve already been seen by a GIC, there’s little point in sending you back to one for another diagnosis. GMC guidelines state that “Once the patient has been discharged by a GIC or experienced gender specialist, the prescribing and monitoring of hormone therapy can be carried out in primary care without further specialist input.” 2.
When you’ve changed GP practice, and your previous practice was prescribing
There are various health risks associated with stopping hormones, so if you’ve already been prescribed then your GP should continue prescribing without requiring an assessment 3, p.28. They may want to take a blood test, and this is usually a good idea.
When you need a bridging prescription — a temporary prescription while you wait to be seen by a specialist
Waiting lists for NHS services are notoriously long, and you might be able to convince your GP that it’s unreasonable to expect you to wait that long for hormones 3, p.25. However, current GMC guidance is for GPs to only prescribe bridging prescriptions when a patient is already self-medicating, or is likely to start self-medicating, and is at risk of self-harm or suicide 4. You can find more information about bridging prescriptions on the TransActual website.
When you’re already self-medicating, as part of a harm-reduction strategy
Unmonitored hormone therapy carries a number of risks. If you’re already taking hormones you got from another source, your GP should strongly consider providing a bridging prescription and monitoring blood tests 3, p.21. You may have to convince them that without safe access to medication you will be at a greater risk of self-harm or suicide 4.
It’s very likely that your GP will still want to refer you to a GIC even if they do prescribe.
Regardless of where you get your hormones, regular blood tests are essential to make sure that your hormone levels are safe and there are no problems. If your GP is unable or unwilling to give you blood tests at the practice, you should ask them to refer you to a local endocrinologist who can do the tests for them.
When talking to your GP, the following references may be useful:
The NHS England service specification 5, p.30 states:
Endocrine and other pharmacological interventions may be recommended by a registered medical practitioner in the specialist multi-disciplinary team where they are essential for the purpose of harm reduction, and where they are in the individual’s best interest for reducing gender dysphoria, when assisting the individual in achieving gender expression congruent with their identity and consistent with their treatment goals.
The NGICNS Explanatory Notes to the Scottish gender protocol 6, p.5 states:
Some service users may already be on hormonal treatment prior to referral, either through previous prescription or self medication. It is appropriate to continue this treatment following engagement with the GIC whilst Assessment One is undertaken. Appropriate prescribing guidelines and monitoring requirements are detailed in Endocrine Management of Adult Transgender Service users (NGICNS) and all service users should be made aware of this guidance and prescribing and monitoring of treatment brought in line with this guidance.
Many GPs might be hesitant to prescribe hormones due to an unfamiliarity with the standard treatments for trans people. However, they will be familiar with the same medications used for other purposes, such as treating hypogonadism, hormone-sensitive cancers, or menopausal symptoms; the GMC 2 notes that
Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes.
A number of gender clinics have published prescribing guidelines that your GP may find useful; you can find a list of these in the Hormones section on genderarchive.org.uk.
- 1.Vincent, Ben (2018) Transgender Health, Jessica Kingsley Publishers. Link
- 2.General Medical Council (2020) “Trans healthcare: Prescribing.” Link (Accessed 19th October 2020)
- 3.Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
- 4.General Medical Council (2020) “Trans healthcare: Mental Health and Bridging Prescriptions.” Link (Accessed 19th October 2020)
- 5.NHS England (2019) Service specification: Gender Identity Services for Adults (Non-Surgical Interventions), NHS England. Link
- 6.National Gender Identity Clinic Network Scotland (2012) Explanatory Notes v1.0: To be read in conjunction with the Gender Reassignment Protocol CEL 26 (2012), NHS Scotland. Link
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