What will happen
In order to assess your individual needs and goals, we ask a number of questions about your background, current circumstances and future plans. The purpose of these questions is to help us gain a clear idea of how we can help you.
During your appointment
- Don’t be afraid to ask if you don’t understand. For example, ‘Can you say that again? I still don’t understand.’
- If you don’t understand any words, ask for them to be written down and explained.
- Write things down, or ask a family member or friend to take notes.
Before you leave your appointment
- You’ve covered everything on your list.
- You understand.
- You know what should happen next, and when.
- You know who to contact if you have any more problems or questions.
We will look at your blood test results (if previously forwarded to us) or ask you to have bloods taken, usually via the phlebotomy service at Charing Cross Hospital. The blood tests are to establish basic good health (in terms of liver function etc.) and to obtain a baseline hormone screen. If any concerns arise from your blood test we will contact you and your GP as soon as possible. Otherwise the results of tests taken on the day of your first assessment will usually be discussed at your second assessment.
Individuals who smoke are advised to stop altogether, at least 3 months prior to starting hormones. This is because the thromboembolic (clotting) risk with oestrogens, and polycythaemia (thickening of the blood) risk with androgens is raised to unacceptable levels in people who smoke. Additionally, surgical outcome is better in non-smokers. All methods of nicotine replacement, including electronic cigarettes, are considered safe. Advice and support around stopping smoking can be accessed through your GP and other NHS smoking cessation services http://www.nhs.uk/smokefree/help-and-advice/local-support-services-helplines.
Hormones at first assessment
We will normally only recommend the use of hormones after your second assessment appointment.
Based on your individual needs and circumstances your clinician will explore with you what may happen next with your gender care. For example, if you would like to, but have not yet made a social gender role transition, they may explore with you any possible obstacles in your way and help you consider ways to address these.
Additionally, in order to support you through the transition process, clinicians may discuss with you the possibility of referrals to other services within the GIC or local to you (which your GIC clinician can ask your GP to make).
We will keep your GP up-to-date about your progression through the clinic and you will be copied into the reports sent. Your clinician will also be able to offer you information and advice about other forms of support that you may find helpful as you move along your gender care pathway.