Here you will find some answers to the most common questions from primary care clinicians and healthcare professionals, including answers to questions about hormones and prescribing.
If your question is not answered here and you would like some clinical advice from one of our GPs, you can email us at firstname.lastname@example.org
Here are a few suggestions:
- Normalise introducing yourself with your name and pronouns
- If you’re not sure how to address someone – ask what pronouns they use
- Don’t assume a patient's gender or sexual orientation
- Avoid gendered language eg. sir, ladies and gentlemen
- Use the patient’s correct name and gender at all times, regardless of whether or not they are in the room
- Correct others when they use the wrong name/gender – this gets easier with time
- Recognise that gender and sexual orientation are on a spectrum and can be fluid
- Don’t ask invasive questions - trans people spend a lot of time answering questions from other people and it gets exhausting
- For further reading check out the GMC guidance on trans healthcare https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare
- Check out the GMC guidance on trans healthcare: https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare
- Have you enagaged with LGBT Foundation's Pride in Practice? More infomation on this training can be found at www.lgbt.foundation/pip
- The following resources may also be helpful
- Indigo can provide training. For more information on this, email email@example.com
We are a new pilot NHS adult gender service in Gender Manchester, which has been commissioned to provide care that is local, timely and easier to access.
Indigo is a partnership between gtd healthcare and LGBT Foundation, delivering a service which has been designed by and for trans communities in Greater Manchester. Our service is an innovative model of trans healthcare which is based in primary care. This means our clinical services are delivered by experienced GPs in practices across Greater Manchester, with additional services being delivered in community settings.
You can find out more about Indigo at https://indigogenderservice.uk/about-us
For more information about our services, please visit https://indigogenderservice.uk/our-services/services-we-offer
Indigo Gender Service is a new pilot service. In order to access our services, patients will need to meet the following criteria:
- aged 17 or over;
- registered with a GP in Greater Manchester at the time of referral and eligible for NHS treatment.
For more information, please visit https://indigogenderservice.uk/our-services/accessing-service
You can change a patient’s name and gender marker without any ‘proof’.
The patient does not have to have undergone any medical intervention for you to
change their record.
Detailed instructions are available here:
GMC guidance is available here:
Indigo Gneder Service will:
- provide patients with assessment, diagnosis and discussion about hormone therapy
- screen for contraindications to hormone therapy and discuss side effects
- undertake pre-hormone blood tests and examination
- discuss fertility including gamete storage and contraception
- communicate recommended treatment and regimes to GPs using formally agreed shared care protocols supported by GMMMG
- act as a knowledge base for questions and concerns from GP colleagues - please email firstname.lastname@example.org and we will aim to get back to you within 2 working days
- discuss and refer for surgical interventions in line with the service specification
GPs are expected to:
- issue prescriptions for the hormones suggested in the patient care record
- refer on for gamete storage using the template letters supplied
- offer contraception as necessary
- offer blood test monitoring in line with the patient care record
- offer NHS screening as per the guidelines: https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people
As the waiting lists for GICs can be as long as 3-4 years for the first appointment, patients may either be self-medicating with hormones bought from the internet, or ask you to provide a bridging prescription.
If a patient is already taking hormones, for harm reduction purposes we recommend doing monitoring bloods and talking to them about the risks.
Consider providing a bridging prescription as an alternative to the patient purchasing hormones from the internet.
Check out the GMC guidance on bridging prescriptions https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#mental-health-and-bridging-prescriptions
Our GPs will write an individualised care plan to support you with prescribing.
If you have specific concerns, please email us at email@example.com and one of our doctors with expertise in this area will be happy to discuss these with you.
Nottingham Centre for Transgender Health is keeping a holding list for Indigo. Details of how to refer to this list are here: https://indigogenderservice.uk/our-services/information-gps
Other medications used in trans and non-binary healthcare
Antiandrogens that are sometimes used are finasteride, spironolactone and cyproterone. These will not be routinely prescribed by Indigo.