Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary. What this means will vary from person to person, and is different for children, young people and adults. Waiting times for referral and treatment are currently long.

Treatment for children and young people If your child is under 18 and may have gender dysphoria, they'll usually be referred to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust. GIDS has 2 main clinics in London and Leeds. Your child or teenager will be seen by a multidisciplinary team at GIDS including a: clinical psychologist

child psychotherapist

child and adolescent psychiatrist

family therapist

social worker The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months. Depending on the results of the assessment, options for children and teenagers include: family therapy

individual child psychotherapy

parental support or counselling

group work for young people and their parents

regular reviews to monitor gender identity development

referral to a local Children and Young People's Mental Health Service (CYPMHS) for more serious emotional issues

a referral to a specialist hormone (endocrine) clinic for hormone blockers for children who meet strict criteria (at puberty) Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty. Hormone therapy in children and young people Some young people with lasting signs of gender dysphoria and who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist) to see if they can take hormone blockers as they reach puberty. This is in addition to psychological support. These hormone blockers (gonadotrophin-releasing hormone analogues) pause the physical changes of puberty, such as breast development or facial hair. Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations. From the age of 16, teenagers who've been on hormone blockers for at least 12 months may be given cross-sex hormones, also known as gender-affirming hormones. These hormones cause some irreversible changes, such as: breast development (caused by taking oestrogen)

breaking or deepening of the voice (caused by taking testosterone) Long-term cross-sex hormone treatment may cause temporary or even permanent infertility. However, as cross-sex hormones affect people differently, they should not be considered a reliable form of contraception. There is some uncertainty about the risks of long-term cross-sex hormone treatment. The NHS in England is currently reviewing the evidence on the use of cross-sex hormones by the Gender Identity Development Service. Transition to adult gender identity services Young people aged 17 or older may be seen in an adult gender identity clinic or be referred to one from GIDS. By this age, a teenager and the clinic team may be more confident about confirming a diagnosis of gender dysphoria. If desired, steps can be taken to more permanent treatments that fit with the chosen gender identity or as non-binary.

Treatment for adults Adults who think they may have gender dysphoria should be referred to a gender dysphoria clinic (GDC). Find an NHS gender dysphoria clinic in England. GDCs have a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including: psychological support, such as counselling

cross-sex hormone therapy

speech and language therapy (voice therapy) to help you sound more typical of your gender identity For some people, support and advice from the clinic are all they need to feel comfortable with their gender identity. Others will need more extensive treatment. Hormone therapy for adults The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery. It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team. In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen. Both usually have the additional effect of suppressing the release of "unwanted" hormones from the testes or ovaries. Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating. It's also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are. The effectiveness of hormone therapy is also limited by factors unique to the individual (such as genetic factors) that cannot be overcome simply by adjusting the dose. Risks of hormone therapy There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP. The most common risks or side effects include: blood clots

gallstones

weight gain

acne

dyslipidaemia (abnormal levels of fat in the blood)

elevated liver enzymes

polycythaemia (high concentration of red blood cells)

hair loss or balding (androgenic alopecia) There are other risks if you're taking hormones bought over the internet or from unregulated sources. It's strongly recommended you avoid these. Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped. The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use. Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic. Read more about fertility preservation on the HFEA website.

Surgery for adults Some people may decide to have surgery to permanently alter body parts associated with their biological sex. Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery. In addition to you having socially transitioned to your preferred gender identity for at least a year before a referral is made for gender surgery, it is also advisable to: not smoke

lose weight if you are overweight (BMI of 25 or over)

have taken cross-sex hormones for some surgical procedures It's also important that any long-term conditions, such as diabetes or high blood pressure are well controlled. Surgery for trans men Common chest procedures for trans men (trans-masculine people) include: removal of both breasts (bilateral mastectomy) and associated chest reconstruction

nipple repositioning

dermal implant and tattoo Breast implants for trans women (trans-feminine people) are not routinely available on the NHS. Gender surgery for trans men includes: construction of a penis (phalloplasty or metoidioplasty)

construction of a scrotum (scrotoplasty) and testicular implants

a penile implant Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered. Surgery for trans women Gender surgery for trans women includes: removal of the testes (orchidectomy)

removal of the penis (penectomy)

construction of a vagina (vaginoplasty)

construction of a vulva (vulvoplasty)

construction of a clitoris (clitoroplasty) Facial feminisation surgery and hair transplants are not routinely available on the NHS. As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.