Frequently asked questions
We have tried to address a number of pertinent issues that come up most frequently here. Please also see the 'Information and Support' page as there is a wealth of information contained in the linked sites.
If you have not been able to find an answer to your question please get in touch via firstname.lastname@example.org
How do I book an appointment?
Please send an enquiry to the email above and provide the following information:
a) name and pronouns
b) brief summary of your gender concerns
c) any steps you may have already taken towards social, legal or medical transition
d) what you would like to get out of contact with the service
e) your preference of online or in person appointment
We will then send a link to further information about the service and an online registration form for you to complete and return. The information you provide will help us to determine whether we are able to assist you and ensure that we offer the right type of appointment.
A clinician will review your form and, if appropriate, we will send you a link to a secure online booking and payment system where you will be able to select a convenient date and time to attend.
Appointments can be booked up to 6 months in advance. If you are unable to find a convenient available time you may need to check back later as new appointments are added. Please note that payment by credit or debit card is required at the point of booking. This facility is provided by Stripe, a secure online payment platform.
How are the online appointments set up and delivered?
Following booking your appointment you will receive a booking confirmation by email. This will include a direct link to your online appointment. This is provided by Cliniko, a secure patient management system.
You do not need to download any software or apps and you won't need to create an account or password. We do not use Zoom, Microsoft or Google platforms to deliver clinical services.
In order to access this appointment you will need a laptop, tablet or smartphone with a camera and microphone and access to the internet. You will also need a quiet, comfortable and private place to sit for the duration of your appointment. You are welcome to attend with a supportive other(s) if you feel this may be helpful. You are also advised to ensure you have a telephone and that we have your number as a back up in case of any technical difficulties.
What if I want to see someone in person?
A limited number of in-person appointments are available at our Exeter base; The Consulting Rooms, 34 Denmark Road, Exeter EX1 1SE. Please let us know by email if your circumstances mean that you are unable to use the online facility and would prefer an in-person appointment.
The Consulting rooms are within 5 minutes walk from on street parking and two large car parks. Exeter Coach/Bus Station is 15 minutes walk and Exeter Central Train Station is 20 minutes walk away. Exeter St David's Train Station is around 30 minutes walk but it is possible to take a taxi from the rank outside.
What should I expect from, and how should I prepare for, the specialist gender assessment?
Our clinicians aim to provide a safe and comfortable space for you to share your gender concerns and consider ways in which you might improve your sense of comfort in your body and social world.
We will take sufficient time to explore what gender means to you, your experience of gender thus far and the development of your identity. We will ask you about any distress and difficulty you may have experienced in relation to gender and about any steps you may have taken to manage or alleviate this.
We will ask about your wider physical health, psychological wellbeing and social circumstances. We will ask about any support you may have and are happy for you to bring along a supportive other to your assessment if you feel that this would be helpful. We will explore your specific needs and wishes and hear about your expectations and hopes for the future and consider what help and support may be of benefit to you.
We are aware that people can find the assessment anxiety provoking and for some it may be the first time they have spoken in detail about their concerns to others.The assessment is conducted over two apppointments and takes two hours. There may be times when a further appointment is necessary. We have found that splitting the assessment up into two sessions allows people time to develop a rapport, and feel more comfortable dicussing their concerns, with the clinician. In addition it can be helfpul to have a break between sessions in order for information to be shared and digested, e.g. where it may be necessary to speak to your GP or other healthcare provider or where it is appropriate for you to take time to think things over and discuss with a supportive other.
We also know that there is a great deal of misinformation online about this process and that sometimes this can increase anxiety and/or lead people to believe they need to present themselves in a particular way in order to ensure they are offered treatment. We take an individualised approach, acknowledge the diversity of gendered experience and celebrate the diversity of gender identity, role and expression. We therefore do not expect people to conform to social norms, rules or expectations in relation to gender.
We suggest that you spend some time reflecting upon your situation and experiences and be prepared to talk openly and honestly about this in your appointment. You may find it helpful to make some notes in advance and talk to people close to you, who understand your situation.
What if I am experiencing physical or mental health difficulties?
Having physical or mental health difficulties does not preclude you from accessing gender identity healthcare. In fact we are aware that gender incongruence and dysphoria can impact negatively on people's physical and psychological wellbeing.
We gather information about your wider physical and mental health in order to ensure that we have a good understanding of this, enabling us to take this into account when assessing the likely risks and benefits of any treatment that we may consider and/or recommend. Should your difficulties be deemed likely to detrimentally impact your ability to engage or benefit from treatment then we will discuss this with you and agree a plan of care that is likely to involve additional support and interventions from other healthcare providers.
We are aware that people can sometimes withhold information relating to their wider physical and mental health for fear that this may result in them being denied care. We strongly encourage you to be open and honest during your assessment in order that we can agree a plan that is tailored to your specific needs, taking account of your individual and wider circumstances.
How do I access hormone therapy?
International guidelines dictate that patients must complete their specialist gender assessment, followed by a focused hormone therapy consultation and receive a positive opinion regarding their suitability and readiness in order to access hormone therapy.
There are number of gender specialist endocrinologists and specialist nurses around the UK who are able to provide a medical assessment and recommend and/or prescribe hormone therapy. We can provide further details following your assessment. We advise that you consider who you would like to see and contact them for more information about their referral process and to check their availability prior to booking your hormone therapy consultation with us.
How do I access gender affirming surgery?
International guidelines dictate that patients must complete their specialist gender assessment, followed by a focused surgery consultation and receive a positive opinion regarding their suitability and readiness in order to access gender affirming surgeries. In addition there is currently a requirement for patients to have been prescribed hormones (unless there is a contraindication) and have been living continuously in a gender role that is congruent with their gender identity for 1 year prior to accessing genital surgery. In most instances one opinion is required for chest, breast and facial feminisation surgery and two opinions for genital surgery. Some genital surgeons may require one of these opinions to come from a medically trained professional. Please check with your chosen surgeon and arrange a further opinion with a gender specialist accordingly.
There are a number of surgeons providing gender affirming surgeries in the UK. We can provide further details following your assessment. We advise that you or you consider who you would like to see and contact them for more information about their referral process and to check their availability prior to booking your surgery consultation with us.
How do I access fertility preservation?
The Human Fertilisation and Embriology Authority provides impartial, accurate information about IVF, clinics and other fertility treatments in the UK and specific information and advice for trans, non-binary and gender diverse people who may wish to preserve their fertility prior to commencing hormone therapy.
How do I access gender related physical health screening?
Public Health England provides information and guidance related to the NHS screening programme for trans, non-binary and gender diverse people.
Will my private assessment or treatment affect my NHS care?
Your assessment and treatment will not affect your waiting time for or care provided by an NHS gender service. It may be helpful for the service to have the details of your assesment and treatment with us. If this is the case for you and you wish for the information to be shared then we are happy to provide copies of your clinical reports and letters.
How will you work with my GP?
Your GP will need to be directly involved in your care and aftercare. We recommend that you speak with your GP about your gender concerns and let them know that you intend to have contact with our service.
It is our experience that most NHS GP's are supportive of patients who wish to access specialist gender identity healthcare. However, if you find this is not the case then you may wish to try the following:
Make yourself and your GP aware of the following guidelines: https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/managing-patients-with-gender-dysphoria & https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare
Seek support from an advocate: https://www.gires.org.uk/what-we-do/individual-help/ & https://www.intercomtrust.org.uk/item/14-advocacy-and-support/
Transfer to an alternative GP (NHS or private provider)
In order to provide the safest and most effective service we will also need to communicate with your GP. We will share clinical letters and reports and at times, if necessary communicate via email or telephone. We may ask your GP to provide information relating to your wider physical and mental health if this is clinically necessary.
Please note that we are unable to provide a service to patients who do not agree for us to share information with their GP or allow their GP to share information with us.
How long is the wait for an appointment?
We have availability from June 2024. Please also note that there is around a 2 month wait for appointments with gender specialist endocrinologists/nurses at the moment. If you are seeking hormone therapy then you are advised to contact your chosen endocrinologist or specialist nurse to check their availability. You may be able to make an advance booking with your chosen endocrine provider in order to shorten the time between your assessment with us and seeing them.
Do you provide second opinions for surgery? If so what do I need to provide?
If you have undergone assessment and have been provided with a first supportive opinion for surgery from a recognised gender specialist, then we are happy to provide a second opinion. In order for us to complete this and comply with international guidance, you will need to provide copies of reports relating to your assessment, treatment so far and your first supportive opinion. For genital surgery you will also need to provide documents with details of your prescribed hormone therapy regime that must span over one year. In addition you will need to provide a copy of your deed poll and ID documents indicating your new name.
Please note that we are unable to provide a second opinion for surgery where the assessment or first opinion does not come from a recognised gender specialist. In these cases we will need to carry out our own assessment prior to providing an opinion.