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What to expect when you approach your GP

Mainly concerning the United Kingdom but the same principles will apply in most western countries

I have had so many emails concerning this subject I thought it time to put a few brief notes here on approaching your local doctor and the likely reaction.This is based pretty much on my own experience but you must bear in mind that whilst GP's follow much the same code of practice there may be some variance in their individual methodology.

Breaking the news to your doctor for the first time that you think you may be a transsexual can be a somewhat harrowing experience. For most of us though the GP is the first step. There is an alternative and that is to visit a private specialist such as Dr Richard Curtis (see below). Richard will (with your consent) write to your GP in any event.

There is no easy way to broach the subject but remember doctors today have a very much better awareness of transgenderism or as the medical profession classify it "gender dysphoria". Many GP's have already dealt with patients under similar circumstances. The rules if one can call them that do vary between GP's but in the main the GP initially will ask you a number of questions. These will be about your feelings, thoughts, actions and in addition the relationship with your partner if you have one. Dependant upon your answers the next stage could be in one of two directions. Firstly he may refer you to a counsellor or psychiatrist locally. Don't expect to be immediately sent off to one of the UK's limited number of Gender clinics. Most local health trusts in the UK have a contract with the Gender clinic at Charing Cross hospital and for these notes we will assume that this is the NHS clinic concerned. However it is very possible that you will be referred to the NHS gender clinic. A local counsellor will probably not be able to help too much unless they have specific experience.

Hormones from the GP?

In response to many requests we have created An Introductory Guide for GPs and Health Professionals

Your GP will probably not know the correct hormone combos and strengths for a gender change unless he/she has had previous experience and therefore will refer you to a specialist as mentioned above. A GP will not prescribe HRT just like that for gender change and without guidance from the gender clinic. So you are not just going to pop into the local surgery, say you are a transsexual and get prescribed female or male hormones!

Charing Cross Gender Clinic and other UK NHS gender clinics do not prescribe hormones direct (unlike USA clinics) but will after initial diagnosis write to your doctor to advise what (usually synthetic estradiol) and when to prescribe but only after about one year of seeing their psychiatrists and you the patient living and working "in role". (one visit every three months) It is a very slow process and at the end of it all your GP may well refuse to prescribe as he/she has the right to do under their patient liability charter/coverage.. be warned it could be rocky road.

If you follow the NHS route then you will end up at Charing Cross. Here you will be seen by a psychiatrist (usually Prof Richard Green, Dr Barratt, Dr Montgomery or Dr Dalrymple). The first meeting will be an hour and copious notes will be made. During this session an assessment will be made. The idea of this is to determine whether you are transsexual or whether you are a crossdresser. Remember that sex for sex sake has nothing to do with changing sex. There will be some searching questions.

If you are taken on as a patient there will be interaction between the clinic and your GP even if your GP refuses to follow the clinic's advice to prescribe hormones. You can expect about three years of visiting Charing Cross before any surgery assessments are made and once approved for surgery you could wait another year or two. This will depend upon your local NHS trust finding the money to support your operation.

Hormone Regimes

I cannot offer a specific regime but I can tell you what I did. Everyone is different and no doubt you will try a number of combinations before you find one that is comfortable for you.

For me it was 6mg (3 x 2mg tabs) zumenon (estrofem - estradiol) per day. This is a valerate, a naturally extracted oestrogen as opposed to synthetic or animal. Although I tried synthetic there were some minor reactions which I did not get using natural. I also did not like the idea of premarin on principle. I also used hormone gels.

For the first year and a half I took an anti androgen (testosterone reducer)in addition (in my case androcur at 1 tab per day). If you don’t and you are taking HRT then up to 80% of the HRT effect is lost fighting the body’s naturally produced male hormone.

Assuming you start HRT then you will require a blood check every three months for liver/lipids levels plus cholesterol levels. Also watch out for any unusual swellings or cramps in the legs and stop hormones and visit your GP immediately if this occurs. (DVT can be a common reaction to HRT which thickens the blood) I also took aspirin for a while until the body became more acclimatized. This acts as a blood thinner.

Suggested Transgender Hormone Regimes

Going the private route

You may be better going the private route and if in UK see Dr Richard Curtis. Richard will make a careful assessment and if in his judgment it is considered that you would benefit from hormones then he will prescribe very quickly. This is an entirely different approach from the NHS and GP route.

The London Gender Clinic 3rd Floor, 25 Wimpole Street, London, W1G 8GL Contact: Dr Richard Curtis Tel: 020 7631 3164 Email: enquiries@transhealth.co.uk In response to many requests we have created a page called "What to expect when you approach your GP" See: Dr Richard Curtis

Costs (in UK pounds sterling)

For a regular visit to Richard expect to pay about £120. For hormones on a private prescription expect to pay at least £200 for a month plus supply of estradiol, gels etc. None of these can be funded by NHS. For SRS in the UK say with Mr Bellringer expect to pay around £12,000 including hospital facilities.

It is lower cost to purchase hormones on the internet but be very careful. We only recommend Pharmacy Network/ NPD and they have a page they administer on this site (see Pharmacy). Do not take hormones unless it is recommended by your doctor and you have regular checks.