Gender Reassignment Care Pathway Female-to-Male

Patient visits General Practitioner GP refers to local Consultant Psychiatrist or Psychologist or to an appointed PCT Specialist Referral back to GP

Decision to refer to specialist services made. Patient offered choice of Gender Identity Clinic

Leeds Becklin Centre GIC NWSCG funding in place

Claybrook Centre GIC, London NWSCG funding in place

Other NHS GICs Funding not in place

See page 2 for Becklin Centre pathway

See page 4 for Claybrook Centre pathway

Pathway for Female-to-Male - Leeds Becklin Centre

Patient chooses referral to the Leeds Becklin Centre.

Consultant / Specialist obtains supporting letter from GP.

Consultant / Specialist makes written referral to Becklin Centre accompanied by supporting letter from GP; advises NWSCG of the referral; copy of referral letter to GP and patient.

Referral received by Leeds Becklin Centre and assessed for suitability

Referral returned to referral agency with detailed letter of explanation

Referral accepted and initial assessment date set. Patient, referrer and GP informed and sent information about the service.

Patient to continue to receive counselling and support from local services as required.

Initial assessment appointment

Patient discharged back to referrer with explanation of decision and any recommendations from the Gender Team.

Patient proceeds to exploration and formulation phase of assessment minimum 3 months duration equalling a minimum of 3 6 sessions.

Patient and Gender Team agree not to continue further. Discharge summary sent to GP with any recommendations.

Patient and Gender Team agree to continue to further treatment

Start of Real Life Experience

3 month period living in chosen gender role

Some patient require mastectomy at start of RLE - funding not in place. Patient will need to apply for funding from PCT. This surgery is available from Leicester

Referral to endocrine clinic and start of hormone therapy Referral to speech therapist

Other treatments: hysterectomy.- not funded but should be available through local secondary care contracts.

12 month hormone therapy

End of Real Life Experience. Decision to proceed to surgery. Second opinion obtained.

Surgery not desired. 6 months of hormone therapy under supervision of endocrine clinic. Discharge to GP with advice regarding continued prescribing of hormones.

Referral to surgical provider: St Peters Andrology Centre Funding in place. .

Assessment for fitness for surgery Discharge back to GP/GIC with advice on management of patient required and how & when to refer back for surgery

Gender Reassignment Surgery

Female-to-male surgery is performed as a number of separate surgical stages and can take a number of years to complete,

Continued support from Becklin Centre (3monthly appointments) whilst awaiting / completing surgery.

After each set of procedures / stage of phalloplasty: Post-operative care - From surgical provider - From local community services Surgical follow up appointments

Post surgical follow-up at GIC 6 months post completion of surgery 12 months post completion of surgery

Discharge back to GP for monitoring of ongoing hormone requirements and local counselling / support as appropriate.

Pathway for Female-to-Male Claybrook Centre, London

Patient chooses referral to the Claybrook Centre, London

Consultant / Specialist obtains supporting letter from GP.

Consultant / Specialist makes written referral to Claybrook Centre accompanied by supporting letter from GP; advises NWSCG of the referral; copy of referral letter to GP and patient.

Referral allocated to Gender Consultant Psychiatrist

Initial assessment appointment

Patient discharged back to referrer with explanation of decision and any recommendations from the Gender Team.

Second Assessment Appointment Patient to continue to receive counselling and support from local services as required.

Follow-up appointments every 3 4 months

Start of 2 Year Real Life Experience Some patient require mastectomy at start of RLE funding not in place. Patient will need to apply for funding from PCT. This surgery is available from Leicester

Endocrine opinion and start of hormone therapy

Other treatments: hysterectomy.- not funded but should be available through local secondary care contracts.

End of Real Life Experience. Decision to proceed to surgery. Second opinion obtained.

Surgery not desired. Discharge to GP with advice regarding continued prescribing of hormones.

Referral to St Peters Andrology Centre - funding in place through NWSCG

Assessment for fitness for surgery

Discharge back to GP/GIC with advice on management of patient required and how & when to refer back for surgery

Gender Reassignment Surgery

Female-to-male surgery is performed as a number of separate surgical stages and can take a number of years to complete,

After each set of procedures / stage of phalloplasty: Post-operative care - From surgical provider - From local community services Surgical follow up appointments

Post surgical follow-up at GIC

Discharge back to GP for monitoring of ongoing hormone requirements and local counselling / support as appropriate.