RAG rating
Document type
Clinical policy
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions

Cosmetic interventions for individuals with Gender Dysphoria or post Gender Reassignment surgery

July 2022 v1.0

NHS England funds gender identity disorder surgical services as part of specialised commissioning, with services provided by specialist gender identity surgical providers. This includes the complete gender reassignment process to completion of transition, from specialist assessment, preparation for gender reassignment procedures, surgery, and immediate associated aftercare. Further information, including service specifications for surgical and non-surgical interventions, can be found from NHS commissioning » Gender Dysphoria Clinical Programme (england.nhs.uk)

It would be expected that patients undergoing gender reassignment will have all procedures required as part of transition, and the ICB would only consider funding additional cosmetic procedures on a case-by-case basis as part of the usual individual funding process and through consideration of the respective relevant policies (e.g., cosmetic procedures).

In light of increasing requests and appeals to ICB’s for further treatment to complete phenotypic gender transition after gender reassignment surgery, a systematic literature review was conducted to answer the following question: What is appropriate cosmetic treatment following gender reassignment surgery? The rational to this question was that where a patient has had GRS they should be treated as any other individual of their (adopted) gender with regards to eligibility to interventions for aesthetic non-clinical reasons. In addition to the literature identified in the review the following statements were made with consideration of the four ethical principles of beneficence, non-maleficence, justice (equity) and autonomy.

  • A - No directly relevant evidence was found regarding the question of what cosmetic treatment might be appropriate following GRS apart from the provision of phono surgery by the London policy document1
  • B - A ‘cosmetic’ intervention might be equitably provided to a person who has had gender reassignment surgery if NOT providing the treatment undermines the person’s gender identity including their ability to function socially and be accepted as their adopted gender, rather than merely fulfilling a desire to improve one’s appearance2. Generally this will only be for characteristics outside the normal range for the persons adopted gender2 . (Statement level D, appendix)
  • C- Points a and b (above are dependent on the individuals making fully informed choices regarding the risks and implication of the procedures and the likelihood that their expectations will be realised (i.e., autonomy and non-maleficence).

IFR panels will take these points into consideration in their deliberations.


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