Aims:

• Introduce you to the clinic
• Get to know you as a person and understand your expectations

How long will my inital apppointment be?

• Approximitely 60 to 90 minutes

What will be disucssed?

• Your gender experience
• Your mental and phsysical health

Please note that during this initial appointment you will not be starting any form of hormonal or surgical treatment. The appointment pathway guide below explains in more detail what to expect from your treatment.

Before attending your initial appointment with the Gender Identity Clinic, you will be asked to complete and return the ‘my personal story’ document as soon as you are able.

Please aim to have this completed at least seven days prior to your upcoming appointment with Porterbrook clinic. You can download the document here or you can request a paper version by getting in touch with the clinic.

When you have completed this document, please email it to sct-ctr.porterbrookclinic@nhs.net with the subject: 
‘my personal story document’ and detailing your name, date of birth, and the date of your appointment.

If you require support completing this document, you can access the porterbrook clinic’s peer support team. You can find more information about our peer support team here. 

If you are wishing to access hormone treatment or gender affirming surgeries in the future it is important to consider your nicotine use, whether you are a cigarette smoker, or a nicotine vape user. 

Nicotine use can cause increased health risks associated with hormone therapy or gender-affirming surgeries. Nicotine use can negatively impact the effectiveness of hormone therapy and increase the risk of complications during and after surgery. 

Nicotine use can interfere with the effectiveness of both oestrogen and testosterone therapies, potentially slowing down or diminishing desired physical changes. Smoking can also increase the risk of blood clots and other cardiovascular issues, especially in those taking oestrogen. 

Currently, surgery teams require at least six months of nicotine abstinence prior to gender affirming surgeries due to the negative impact of nicotine use on wound healing, infection, and post-operative functional and cosmetic results.

If you are wishing to quit smoking or reduce your nicotine intake you can be referred by your GP, pharmacist, or health visitor to your local stop smoking service to make an appointment with an adviser.

You can find more information on stopping smoking here. 

Due to the strict body mass index (BMI) criteria set by NHS surgical teams, some service users may need to access support around their weight to ensure their physical safety and ability to safely access gender affirming surgeries.

Some health concerns associated with underweight or overweight BMIs can cause an increased risk of physical health concerns such as polycythaemia, thromboembolic disease and liver dysfunction to patients who are taking hormone treatment.

BMI thresholds are strict and non-negotiable, so it is important that you work towards the required BMI as soon as possible if you wish to access gender affirming surgeries through the NHS. 

The BMI criteria is in place to optimise patient safety, maximise current surgical capacity, and ensure those referred for surgery are likely to progress. 

Specific guidelines on BMI criteria for surgery can be discussed during your appointments with the clinic. For example, for most gender affirming lower surgeries the requirement is a BMI below 30. 

We understand that reaching the required BMIs can be challenging. If you need support, please request a referral from your GP. You can find more infromation on weight management here.
 

Many service users wish to access fertility preservation treatment prior to starting hormone treatment. 

• Please be aware: your ability to engage in fertility preservation treatment may have been impacted if you have already started hormone treatment
• If you wish to engage in fertility preservation treatment this must be done prior to engaging with any lower surgery that would eliminate your ability to engage in this treatment
• Fertility preservation treatment will involve a period of time where you will need to remain off your prescribed hormone treatment
• Unfortunately, we can't refer you for this treatment and you will need to book an appointment with your GP surgery for your GP to refer you for fertility preservation treatment
• Fertility preservation treatment is not always funded by the NHS and is dependent on your area of residence
• Please see the links below to find out more on whether fertility preservation treatment would be funded in your area
• If it is not funded by the NHS in your area of residence you may need to fund this treatment yourself

You can find more information on fertility preservation treatment here.

We recommend that anyone thinking about having fertility treatment, for whatever reason, gets plenty of support, whether from family and friends, social networks, organisations or a professional. Treatment can be a very emotional experience so it’s important you’re getting the right support before, during and after treatment.
 

Some patients wish to change their names legally via deed poll certificate. The links below have some useful information about changing your name by deed poll, and the steps you need to take afterwards:

• Free deed poll
• GenderKit

If you decide to change your NHS number, please let us know so that we can update your records on our system.

The information below provides a brief explanation of the treatment pathway and additional services offered by the clinic.

Every service user's care is individual and will look different for everyone. The appointments offered aim to be catered to each service users individual needs and wishes, to provide you with the most appropriate care.

1. Waiting list
After being referred from your GP, you will be added to the waiting list. During this time you are able to access our peer support team for support in preparing for your initial assessment and support around any anxiety or distress around waiting times.

2. Assessment and diagnosis
During the assessment phase of the pathway, you will be assessed to see if you meet the diagnostic criteria for gender dysphoria or gender incongruence which are a requirement for accessing certain gender affirming treatments, such as hormone treatment and gender affirming surgeries.

3. Treatment
During the treatment phase service users can access support based on your wishes and individual needs, including support around the commencement of hormone treatment, access to voice and communication therapy, and psychology or occupational therapy if appropriate.

4. Surgical referral
You will progress through the pathway with support from your named professional and lead clinician during review appointments. These will aid you in safely accessing the treatments and surgical interventions you wish for. Lower surgeries require two different independent opinions one opinion will be with completed by your lead clinician and the second opinion will be completed by a clinician that is not involved in your care.

5. Surgery and discharge
Once you have completed the treatments or surgeries you wish to access, you will be discharged back to the care of your GP. Your GP will continue to be able to access advice from the clinic around your hormone treatment following your discharge from the service. If you wish to be re-referred into the service, your GP can re-refer you at any time as a patient already known to the service, meaning we will aim to see you within six months of re-referral.