Document type
Patient information
Hertfordshire and West Essex ICB
Output type
Clinical Pathways

Gender Dysphoria

Pathway published: January 2024.
Next review date: January 2026. 

GMC Website Links

Several areas of advice provided on the GMC site, trans healthcare ethical hub page. The advice provided on the page does not set new professional standards, nor is it intended to replace those standards. Instead, it’s advice on how our professional standards can be applied when caring for transgender and gender diverse adults, as well as signposting to external sources from a range of organisations.

In terms of concerns around competency: How to keep your professional knowledge and skills up to date, which suggests that in addition to taking part in activities to develop competence, doctors could contact specialist service providers for advice.

On prescribing on the recommendation of a specialist and establishing shared care – the GMC advice is clear that GPs taking on a shared care agreement with a specialist service, to expect the specialist service providers to remain available to provide the support and advice necessary. Where those working for a specialist service provider are unable to demonstrate that they are suitably qualified, doctors are not obliged to follow their recommendations. As Good medical practice says – doctors must only prescribe drugs if they are satisfied they serve the patient’s needs.

In this instance, the GMC would say that it would not, however, be acceptable to simply refuse to treat the patient. Instead the GMC would advise doctors to:

  1. Discuss their concerns with their patient and carefully assess their needs
  2. Seek to understand their concerns and preferences
  3. Consult more experienced colleagues or service leads and provide care in line with Good medical practice

Finally, given the long waiting times that patients face before their first appointment with a specialist service provider: supporting patients who are waiting for an appointment with the specialist service provider. It includes a section on what to do if your patient is self-medicating, as well as information on ‘bridging prescriptions’.



Cosmetic interventions for individuals with gender dysphoria

Hormone Prescribing for the Treatment of Gender Dysphoria in Primary Care

  • NHS England are currently responsible for commissioning specialist gender services
  • Once assessed by a Gender Identity Clinic, it is expected that patients can predominantly be managed in primary care with guidance from gender specialists
  • Guidance from regulatory and commissioning bodies is conflicting, please see following websites for following information; NHS England, the GMC, the BMA and medical defense organisations.

For further guidance please see;



Primary Care Assessment, Referral and Treatment of Gender Dysphoria


Before referring patients to gender services, consider whether there are any co-existing conditions, mental or physical health issues, or risk and vulnerability factors which need to be taken into account.

The GP will be required to carry out basic examinations and/or investigations, as a precursor to physical treatments that may later be recommended. This will include checking the patient's weight and blood pressure, as well as their general health and well-being or hormone treatment. Patients are entitled to refuse these examinations, although physical examination will become inevitable if gender related surgeries are considered.


No unmet mental health needs – Refer to Gender Identity Clinic

Unmet comorbid mental health needs – Refer to mental health services via SPA and Gender Identity Clinic simultaneously

Significant unmet mental health needs – Refer to mental health services via SPA

Advised by CMHT that Gender Identity Clinic referral appropriate – Refer to Gender Identity Clinic

What to include in referral to Gender Identity Clinic

  • Investigations should be guided by the specific requirements of the gender dysphoria clinic that the patients chooses to be referred to

​On 31 March 2024 the Gender Identity Development Service at Tavistock will close, and a new Children and Young People Gender Incongruence Service will be commissioned.

The new Service will initially be commissioned from two centers - Phase One Providers - with the intention of commissioning between five and six additional regional centers during the course of 24/25 and 25/26. 



Hormone Prescribing for treatment of Gender Dysphoria

For guidance please see;

  1. Gender Identity Services for adults (non-surgical interventions) (1)
  2. Gender Identity Development Services for children and adolescents (2)
  3. Trans healthcare - ethical topic - GMC (