Frequently Asked Questions
Here are some brief answers or links to resources that cover questions we hear a lot. If you need more clarification about a topic though, please do ask!
Jump to a section:
Social
Referrals
GICs
Testosterone
Top surgery
Lower surgery
Where can I find more about changing my name?
We have a name change FAQ here.
Gendered Intelligence also produces a helpful overview of what’s involved in changing your name. Mermaids has produced useful guidance, too.
How do I change my gender marker?
In most cases a name change document will be sufficient evidence for whoever you’re contacting to change your gender marker, and many people do this at the same time as changing their name.
For your passport, birth certificate, and your HMRC records, you need further evidence (see below).
How do I change my name and gender on my passport?
In order to change your gender on your passport you need a letter from your GP or GIC that states that your change of gender is likely to be permanent. To change your name you need to provide a deed poll and evidence that you are using that name. For more information see our post on changing your name on your passport.
How do I change my gender with HMRC (National Insurance)?
You need a Gender Recognition Certificate (GRC) in order to change your gender with HMRC. However you can change your name and title without a GRC, and they can lock down your details so that only a select view people can see your gender history.
Here’s a post on how to change your name with HMRC as a trans person.
How do I get a new birth certificate/Gender Recognition Certificate?
You cannot change your birth certificate without a GRC. To get a GRC you have to have been living in your gender for at least two years, and have evidence that you have been diagnosed with gender dysphoria.
Further information on Gender Recognition Certificates.
I’m applying for a job, do I have to tell them that I’m trans?
You don’t have to tell your employer that you’re trans, although if you have not yet changed your passport or certificates then you will have to explain your name change. You can ask to only show your documents to those who need to see them, and can stress that you do not wish for this information to be shared. An employer cannot discriminate against you for being trans and cannot disclose that you are trans to anyone else without your express permission.
Which toilets can I use?
You can use whichever toilets you feel comfortable with. This includes in the workplace and at school/university as well as in public.
Do you have any advice for coming out?
Coming out is a huge topic with a variety of perspectives to consider, so we’d recommend looking at the range of resources on coming out that are available online. Some good starting points:
We also have a ‘coming out’ tag that may be useful.
I wish to go swimming but I need to hide my chest, what can I wear?
There are special swimming binders available from Underworks, LesLoveBoat, and Danae, but most people just wear an older or looser binder with a rashguard shirt over the top. Most pools are fine with people wearing rashguards as they are specifically made for the water. Make sure that you thoroughly rinse out your binder afterwards, regardless of whether you’ve been swimming in a pool or outside, and bring a spare binder if you want to wear one to go home in.
What is a GIC?
A GIC is a Gender Identity Clinic. This is where you need to go in order to access hormones and trans surgeries on the NHS.
How do I get referred to a GIC?
You will need to be referred by your GP. The only exception is if you are living in Scotland and wish to attend the clinics in Glasgow or Inverness, which accept self-referrals. Note that it is not necessary to see a mental health team first.
I’m already seeing a mental health team; can they refer me instead?
Yes, they should be able to refer you. It’s still a good idea to keep your GP in the loop though, as they will need to provide you with prescriptions in the future if you want to go on hormones.
Do I get to choose which GIC I go to?
- England: You can go to any English GIC.
- Scotland: Everyone can go to the Sandyford in Glasgow. People who wish to go to any of the other three GICs need to live within their catchment area.
- Wales: New referrals will normally be sent to the Welsh Gender Service in Cardiff; however if you are on the waiting list for the London GIC you may still be seen there.
- Northern Ireland: There is only one adult GIC and one child/adolescent GIC in Ireland. Both are in Belfast.
Where is my closest GIC?
We have a list of NHS GICs which might be helpful to look through.
How long does it take to get seen by a GIC?
Most gender clinics have waiting lists in excess of 2 years for a first appointment as of 2020. We publish rough estimates of waiting times but these should be used for guidance only: you may find further information on individual GIC websites.
Is there anything that I need to take with me when I go to see my GP?
You don’t need to take anything with you, but it can be helpful to do so. As a minimum it’s a good idea to take the contact details of your preferred GIC to help ensure that your referral goes to the right place. It’s also a good idea to check your GIC’s website to see if they have any information about referrals as some have referral forms which need completing.
My GP is refusing to refer me to a GIC, what can I do?
The General Medical Council has ethical guidance for trans healthcare and links to other useful resources, which you can show your GP. You can also check your preferred GIC’s website as they often have information about referrals, or encourage your GP to contact your preferred GIC for more guidance.
How do I know if my GIC has got my referral?
GICs will usually send out confirmation of receipt but it may take several months. You can contact your GIC a few weeks after your referral is sent to confirm it has been received.
What happens at my first GIC appointment?
The first appointment will be focussed on getting to know you. They’ll ask you some basic questions about yourself, what you’re hoping to get from the GIC, whether you’ve taken any steps to transition yet, and about your history. They might also ask you about your living situation, and whether or not you’re in work or education.
Do I have to take anything to my first GIC appointment?
GIC websites may have guidance on what to take to your first appointment, so check their website if in doubt. In general, it can be useful to take:
- Your appointment letter.
- Your name change document if you have one - even if you were referred in the right name.
- Evidence that you have changed your name, e.g. ID or documentation from your school or workplace in the correct name (you may not be asked for this but it helps to be prepared!)
- Any documentation from private gender clinics you’ve already seen
- Anything your GIC has sent you to complete before the first appointment.
Do I have to have changed my name by the first appointment?
No, it’s perfectly fine not to have changed your name by the first appointment. However, many GICs will use name change as evidence of social transition/intent to transition and may expect you to have changed your name before the end of your assessment period with them.
How soon will I get hormones/be referred for surgery?
It depends on the GIC but most clinics will have an assessment period lasting 2-4 appointments - typically this takes at least 6-12 months but may be longer. The process should be explained to you at the first appointment - if it isn’t, you can ask. GICs may also have general information about this on their websites.
Are there any private alternatives to GICs?
There are private gender clinics based in London and Edinburgh.
Information on private clinics.
I’ve already gone privately, what happens when I see an NHS GIC?
NHS GICs will still want to complete their own assessments if you have been seen privately. Once this is completed (after 1-4 appointments in most cases), the NHS clinic will take over your care, for example responsibility for monitoring your blood tests, and discuss your next steps with you.
I’m already on a bridging prescription/self medicating, what happens when I see an NHS GIC?
Your GIC will still want to carry out an assessment. Once this is completed they will take over responsibility for monitoring your blood tests and discuss your next steps with you. They will not ask you to stop testosterone unless there are significant health complications.
Can I get testosterone on the NHS?
Yes, testosterone is available on the NHS, normally through a GIC. If you are in England and normally pay for your prescriptions then you will have to pay the standard prescription fee.
How soon will I get testosterone?
You will not normally be approved for testosterone after the first appointment: you will need to complete the GIC’s assessment process, which is typically 2-4 appointments (at least 6-12 months).
What might delay, or prevent me from, getting testosterone?
Very little will prevent you from getting testosterone at all - in most cases there will just be delays if your mental or physical health needs are very complex as the GIC may feel additional assessment or discussion with your other consultants is needed. N.B. mental health conditions and conditions such as autism are quite common among trans people and GICs will be used to seeing these. They are not normally an issue provided you’re getting support if needed.
If you haven’t yet changed your name/been able to demonstrate some degree of social transition (e.g. coming out to friends and family) they may want to see evidence of this.
Your pre-testosterone blood tests may occasionally show up things that they need to investigate further. These are rarely serious issues - common things that need further investigation are high testosterone levels (may indicate Polycystic ovary syndrome, PCOS) or high prolactin levels (often not an issue but may need repeat blood tests). These may delay but will not generally prevent you starting testosterone.
What are the different types of testosterone?
The different types are explained in this post.
Do I get to choose which type of testosterone I use?
Yes, you will normally get given a choice. Some things may influence what GICs offer, though. For instance, nebido normally isn’t recommended to begin with due to the length of time it stays in the body, sustanon won’t be offered if you have a peanut allergy, and if you have mental health problems, the GIC may recommend gel over injections at first, as the fluctuations in hormone levels caused by e.g. sustanon can be associated with worsening mood swings.
You don’t have to stay on one form of testosterone forever - you can change at a later date if you want or need to.
Does one type of testosterone work faster than others?
No, they all work at the same speed. Once your hormone levels are in the right range the speed at which your changes happen is dependent on your genetics.
Will my GIC give me the prescription?
No, GICs do not issue prescriptions. They will write to your GP and you should also receive a copy of the letter. Once the letter arrives you should make an appointment with your GP - take the letter with you just in case they don’t have theirs - and ask for them to prescribe on the GIC’s recommendation.
Is there any way of getting testosterone without going to a GIC?
Occasionally a GP will be willing to prescribe testosterone while you’re waiting to see a GIC. This is known as a “bridging prescription”. Your GP may also refer you to an endocrinology department at your local hospital who may be willing to prescribe. Unfortunately both of these options are quite rare, though.
What changes will I notice first?
Changes vary for everyone. There’s a very rough guide to expected timelines here.
Can I stop ___ change from happening?
There is no way to pick and choose which changes happen, or in what order they happen. The only way you can made an educated guess is to look at others in your family, but even then it’s not an exact science.
Can I get top surgery on the NHS?
Yes, the NHS will cover top surgery if you’ve been referred by an NHS gender clinic. You will normally need to pay for travel to your surgeon and cover the costs of hotels if required. Some people on low incomes will be able to claim back the cost of their travel (but not the fees for anyone accompanying your or hotel costs).
Can I get top surgery privately?
Yes, you can get surgery privately. You can get a referral from a private or NHS gender clinic for private surgery. Prices are variable but range from around £5-9,000 (surgeons in the UK are usually towards the higher end of this estimate, and surgeons in Europe may be towards the lower end).
When will I get referred for top surgery?
Most GICs will refer you after you have been on testosterone for at least six months - a referral normally happens in the first or second appointment after you get approved for hormones.
Can I choose which surgeon I go to?
- England or Scotland: you can go to any of these surgeons.
- Northern Ireland: you will be referred to surgeons working in England. We believe you can be referred to those in the list above but have not been able to confirm - please check with the GIC if they have a list of surgeons you can go with.
- Wales: you will be referred to NHS surgeons in England, working at NHS hospitals only. We believe the list of eligible surgeons is as above with the exception of those working through Nuffield, Ramsey or Aspen Healthcare.
I don’t want to go on testosterone, can I still get top surgery?
Yes, it is possible to get top surgery without testosterone, but it may take longer as GICs are quite cautious about doing so as it goes against their usual procedure of giving more reversible treatments first. Private GICs are normally more flexible in regards to this, but it is possible to get it on the NHS.
At what age can I get top surgery?
In theory you can get top surgery at the age of 17 in England and Scotland, but in practice waiting lists for GICs and surgeons are so long that you would not be able to get a referral before the age of 18. In Wales and Northern Ireland the minimum age is 18.
If you are having surgery privately, again in theory the minimum age is 17 but you would need a referral from a private gender clinic - these will not generally see under 18s.
How long will I need off work/studies for surgery?
Most people need around 6 weeks off for recovery. It can vary by a few weeks either way dependant on what work you do, and if you have any complications.
Will I need to stay in hospital?
Most people will be required to stay in hospital for just one night. Occasionally people who travel long distances will be offered a longer stay. You will be told about this before you go in so that you can prepare.
Where can I find surgery results?
There’s a list of surgeons and some of their results in this post. You can also do your own searches on tumblr, reddit, youtube, facebook, or Transbucket.
Do you have waiting times or prices for (x) surgeon?
We list approximate waiting times for NHS surgeons here. You can also search the blog for mention of your preferred surgeon as followers may have shared their waiting times. We don’t currently keep track of waiting times or prices for private surgeons as the information is far more variable and more difficult to keep up to date. In all cases the most up-to-date information will be available from the surgeons themselves. You can also se
Which surgeon should I go to?
Honestly, only you can answer that. Everyone has different preferences, and what one person likes might not be as appealing to the next person. Look at as many results as you can, and read people’s reviews of their experience. You also need to consider travelling, although this shouldn’t necessarily be your main priority - a few hours of extra discomfort is worth a chest you’ll love for the rest of your life.
Can I get lower surgery on the NHS?
Yes, both phalloplasty and metoidioplasty are available on the NHS.
Where can I find out more about lower surgery?
GIRES have produced a guide to lower surgery which is a few years old, but very useful still. St Peter’s Andrology, who are the surgery providers in the UK, also have a guide to phalloplasty. Note that there are some NSFW images in these links!
Who are the surgeons in the UK?
All lower surgery in the UK is done by St Peter’s Andrology in London. You may have various stages with different surgeons depending on their availability, although you can request a specific one if you prefer.
The surgeons sometimes schedule consultations in Glasgow or Exeter but all surgeries will be carried out in London or Slough. If you are travelling a long way there will be customer assistance services at stations/airports if you need support travelling after surgery.
Do you know of any lower surgery blogs?
There is a list of lower surgery blogs here, though it hasn’t been updated recently - we will update if we have time! Otherwise you can search reddit, youtube etc. for people sharing their experiences.