What does your service offer?
We offer access to information and recommendations about gender-affirming medical care for people who want to transition. We use technology to interpret your specific situation and compare it with international best practices and published research and clinical guidelines from across the world and make recommendations on which medication would be the recommended choice. We can then either signpost you to an independent prescriber to prescribe for you or you can give the recommendations to your own doctor or pharmacists to prescribe for you.
How do I sign up to your service?
You can sign up by completing our comprehensive intake form which will gather all the information that is required in order to make recommendations for you. There will be sections about you and your demographics and your medical history etc to evaluate your health. Then there will be sections on your preferences and choices. Everyone also has a session with a specialist that will be able to confirm that you understand the choices you are making and that you are making the best decisions.
How long does it take to sign up?
For most people who are secure in their gender identity and able to give informed consent, the process should only take a couple of weeks. If the medication choices you make require you to have any blood tests then obviously that will delay things. Some people opt to start with easy regimens to start with while they get their blood tests sorted. Having the consent session with the specialist should only take a week or so. If you want to take steps to preserve your fertility before you stop then start that process early so you can get that done quickly.
What are the steps that I have to take?
The information gathering stages consist of a questionnaire to fill in, and a session with a specialist. If you want to have any counseling or store your eggs or sperm then that can happen too. Once you have had any blood tests that are needed and paid your fees then that’s everything done!
What if I need some counseling?
Counseling is entirely optional and it is available for you at any stage of the process. Just head over to our Directory and choose your counselor and book your session. Remember, counseling is only there to help you and support you, never to judge you. It can help you, or your family or friends, with any struggles you may have.
What if I want to preserve my fertility?
Taking hormones can affect your fertility, especially while you take them and maybe even if you stop them later. However, many people do go on to parent biological children after stopping hormones, even temporarily. However, if you do wish to preserve your fertility and store eggs or sperm then you should do that before you start. If you want a referral letter for private storage then we can arrange that for you, or your doctor can refer you to a service local to you.
How do I know if puberty has started?
You only need to take puberty blockers once there is something to block. If you have started to develop then please let us know. You can check for the signs of puberty by seeing if your pubic hair has started to grow, or if your breasts have started to develop or your testicles and penis have started to grow.
Is it safe to take HRT?
Switching your hormones profile from one to the other is surprisingly safe. If you are switching to have an estrogen profile then you will have the same chance of developing illnesses that someone who was assigned female at brith will have and vice versa. The hormones are what we call bioidentical, so they are identical to the ones your body would have produced if you had been born with testicles or ovaries. If you have been told that you should switch off your own hormone production because eg you have had breast or prostate cancer then you need to think very carefully about the risks of taking hormones before you do. People who have a history of, or risk factors for, blood clots or heart disease will have the risk that is equivalent to their hormone profile. So switching to testosterone will increase your risk of heart attack and stroke because men have a higher risk of this because of their hormone profile. You can check if it is safe to take gender medication with your medical history by clicking HERE.
I am taking medication, will that matter?
Taking other medication can interact with your gender-affirming medication. In particular if you are taking heart tablets or blood pressure tablets then it is probably best to avoid taking spironolactone as your antiandrogen, because that can lower your blood pressure or raise your potassium levels. If you are taking medication that can upset your liver then it might be best to avoid cyproterone. However, in general, it is quite safe. You can check your medication against the commonly used gender medication HERE.
What if I smoke?
Smoking isn’t good for you, we all know that, so our advice would always be to stop smoking. However, whether you smoke or not is not related to your ability to medically transition and have gender-affirming medication. Your risk of heart attacks, blood clots, strokes and cancer will all be increased if you smoke.
What if I am overweight or obese or have a high BMI?
The most healthy way you can be is to have a healthy body weight, and this is regardless of whether you take gender-affirming medication or not. Some people actually find that their self-esteem improves with gender-affirming care and that can help you get the motivation to lose weight and exercise.
What if I have an eating disorder?
It is sad that some trans people use food restriction to try and mimic the changes associated with their natural puberty. However, to really see the benefits of gender-affirming hormones you do need to be well-nourished so you can see the effects of the muscle mass changes, or the fat redistribution. Your body needs food to develop.
What about alcohol?
Drinking alcohol to excess is bad for you, but it is not a barrier to you having gender-affirming care.
What if I take drugs?
We would always advise against you taking recreational drugs, but that would not stop us being able to recommend you taking gender-affirming medication.
Which antiandrogen / testosterone blocker should I take?
The best blockers are the GnRHa medications which can be taken as a nasal spray or an injection, but they are expensive if you are having to fund them yourself. If your funds are limited and you are trying to reduce the effects of testosterone then finasteride is the simplest and safest but maybe not the most effective. Spironolactone and cyproterone are probably equally effective, but do require you to have more blood tests. Bicalutamide is no longer recommended because of the risks of liver toxicity.
Do I need a blocker if I am masculinising?
If you can afford it, then the GnRHA nasal spray or blocker are really very good at suppressing the ovaries and stopping them from producing estrogen. However, if funds are limited then after some time testosterone is often enough to suppress the ovaries, stop periods and recur estrogen production.
How do I know how my application is doing?
Once you have submitted your application, had your specialist session, submitted any blood tests and paid your fees then give us a week or so to process everything and that should be it. Really the impetus is on you to complete the necessary steps and get everything completed.
How do I contact you?
You can find plenty of knowledge on our Knowledge Base and there are FAQs to answer most questions. If you want personalised advice that you can’t find in our resources then you can click HERE to book a session with a specialist advisor. If you need to speak to a qualified medic, you can do that by clicking HERE.
What are your consent sessions?
Everyone who joins our service will have an Information Gathering Session. This session is designed to check your understanding and get a feel for your wishes and your preferences. It is not a pass-fail situation, but if there are any concerns that you need more information before making your choices, or if you are struggling to give informed consent to your proposed intervention, then your provider may recommend you have a second opinion session. If you are under 16 then we ask you to have a Capacity to Consent Session which is a formal session with a qualified practitioner who will confirm that you have the capacity to consent to your own medical intervention.
Do I need to have my parents’ consent?
In many countries young people are able to consent to their own medical treatment, as long as they understand the risks and benefits and the effects that the treatment will have. If your parents are not supportive of your actions then you are welcome to give your own consent. If they are supportive then we would love to have them along. If they would benefit from talking to a specialist about their own fears and concerns then they can do that by clicking HERE.
Do I have to tell my partner?
Who you tell, when you tell them and why you tell them is totally up to you. Of course people will begin to notice if your body starts to develop, but who you involve and when you involve them is entirely up to you. If you think they would benefit from some support or some counseling or advice then you can recommend that they speak to a specialist HERE.
How much does it cost?
Everyone pays a standard set up fee of £195 which is our one-time joining fee. Then to remain a member of our service with full access to our systems and processes and services, we charge a £30 membership fee every 28 days. The Information Gathering Session is £65 and we ask you to have a £30 Follow UP Session with a specialist advisor once every six months. If you would like to rather have your sessions with a doctor rather than an advisor then you can pay extra to have that. Blood tests and medication costs are set by the individual pharmacies and pathology laboratories.
Can I get this care through my local Public Health Service eg NHS?
We are a private service and while we are very happy to give you and your doctor as much information and recommendations as you need, they are not always willing to help. Hopefully this will improve as time changes and knowledge and awareness increase.
How do I book my session?
Booking your session is simple, just click HERE and choose when you want to have your session and who you would like to have it with. You can choose to have your session with a doctor or a counselor to a psychotherapist or an advisor to suit you. If you are confident in your choices and your gender identity then you can opt to have your session with one of our very friendly but knowledgeable advisors. If you’ve got loads of medical questions then book with a doctor, or if you are struggling and need to talk to someone, then book with a counselor.
How are the sessions held?
All of our sessions are held by video link. You simply click on the link at the start time and your session provider will be there to meet you.
How long will my prescription last
Most prescriptions are for three months. Make sure you request your updated recommendation in good time in case there are any delays in your application.
How will I get my prescription?
Our algorithms will evaluate all the information you give us and create a bespoke Treatment Recommendation for you. You can either take this to your own doctor to prescribe for you, or if that is not possible then we can refer you to one of our independent prescribers for them to analyse and advise and prescribe as appropriate.
How will I get my medication?
Once you have a prescription you can choose which pharmacy option you prefer. Some people prefer to have a physical piece of paper prescription to take to their local pharmacy. However the post can be unreliable and if your country allows it then the electronic prescription might be better for you. This can be sent to one of the pharmacies listed on our Directory, or you can choose your own online or High Street pharmacy to dispense for you. The electronic prescription is sent via an electronic token that your pharmacy can access.
How do I order a repeat prescription?
When you need more medication, be sure to apply in good time to get an updated Treatment Recommendation in case there are any delays with blood tests etc. Simply fill in this form and update your history and preferences and your Treatment Recommendation will follow. Be sure to know what blood tests you need and whether or not your Follow Up Session is due or not as these are things that can slow you down.
What do I do if my doctor won’t help?
Sadly many doctors are not totally knowledgeable or comfortable with gender identity and some refuse to help. We have a network of prescribers, nurses, doctors, counselors and advisors who can help you on your journey.
What blood tests will I need to have?
If you are over 40 you should have a general health check periodically anyway, just to make sure things like your cholesterol and blood count are OK, but this is for everyone, not just because you are having gender-affirming care. The specific blood tests you will need for gender-affirming care depend on what choices you make. If you take testosterone you should check your haematocrit, the size of your red blood cells. If you want to have spironolactone then you need to keep an eye on your potassium levels. If you want to take cyproterone then you should monitor your liver enzymes. Of course we also need to check your hormone levels to make sure you are eon enough hormone or blocker.
How often will I need to get blood tests done?
The rule is that you have a blood test every three months until your medication has been stable for a year, and then you have them yearly. If you then change your medication again, you go back to three-monthly until you have been stable for the year.
Who can do my blood tests for me?
Your local doctor, healthcare provider, or service should be able to do these for you. If not then we can recommend pathology services that you can use.
How much do blood tests cost?
That all depends on which service you use, they can vary a lot. As a general rule of thumb they are about £50 per test.
Do I need to have scans and x-rays?
You don’t need to have any other investigations, scans or x-rays. Some services do routine bone scans on young people, but bone density is only at risk if you are on blockers for too long without having hormones. We recommend that all young people have either their own hormones, or gender-affirming hormones by the time they are 14-16.
Do I need to stop my contraceptive pill?
Some contraceptives have estrogen and progesterone and it makes sense to use a progesterone only if you are undergoing masculinization. This is so that the testosterone can suppress the estrogen and reverse and stop feminization. Testosterone alone is not contraceptive and so if you are having vaginal penetration with a penis you should consider your contraceptive options.
How can I go really quickly?
We know that some people have been waiting years for this and want to go super quick. However, your first puberty took years and this one will as well. Keep your hormone levels within the normal cisgender range to give you the best chance of natural development and physical changes.
How can I take things slowly?
Many people want to take things slowly for whatever reason, and that is absolutely fine. You can start on a small dose of hormones, with or without a blocker. But remember that our bodies do need hormones so if you are blocking your natural hormone production, make sure you are topping it up with enough supplementary hormones.
Can I limit breast growth?
Some people want to achieve a certain amount of feminization while preventing too much breast growth. It is not always easy to tailor it to this level, but the Selective Estrogen Receptor Modulators (SERMS) e.g. Raloxifene, have been used for this purpose.
How do I get an increase in my medication?
Everything three months, or sooner if you require, you can have your Treatment Recommendation reviewed. Simply submit your information with some up to date blood tests and we will make sure your recommendations are optimized for you.
Can I stop taking medication?
Yes of course, if you want to stop altogether or reduce or try without for a while, you can do just that. There is no right or wrong way, you don’t need to gradually reduce unless you want to.
Does my doctor have to know?
We encourage you to share your gender journey with any healthcare provider who is also looking out for your health, but it is totally up to you if you wish to do this or not
Does my Guardian(s) have to know?
We encourage you to share your transition with important people in your life but at the end of the day it is your body, your identity, your journey and it is up to you who you share information with. If you want help on how to talk to your parents then our specialist advisors and counselors can help you.
