Healthcare for transgender and gender diverse people in the UK is facing a sustained attack from anti-trans antagonisers which is having a profound impact on service users. Many are therefore turning to the UK’s private gender clinics who all operate a little differently which can make it tough to figure out which one works for you. Elia Cugini writes;
If you wish to start on hormones through one of the UK’s private gender clinics, there are a range of online and in-person options available. Some services are currently experiencing functioning issues or extended wait times for care, while others have higher price points. This is a rundown of the main services in the UK, some notable things to know about their practice, their prices, and an estimate of their wait time for initial assessment.
The prices for ongoing hormones are dependent on which endocrinologist or service you see, and whether you can get a shared care agreement between your GP and your private provider, which means you pay regular NHS price for your prescriptions. Subscription services generally include the prescription price in the fee, though you may have to pay extra administrative charges for reissuing prescriptions. This all differs between the UK’s private gender clinics and your personal situation with your GP.
GenderGP
GenderGP’s current status is difficult to discern, but it’s clear that there’s been substantial problems with the service in recent months. GenderGP issued a blog post on 20/4/24 that is conspicuously vague, but that appears to be responding to several specific things, including complaints about their use of AI to generate content; delays in processing prescriptions; and lack of response to emails. There is no solid indication that GenderGP is planning to close, but at least for now there appear to be significant issues with GenderGP’s administrative functioning, including some patients being left without prescriptions.
GenderGP is a widely used service for its low wait times and lower costs than some other services. However, it carries risks: GenderGP does not adhere to the ‘shared care agreement’ model, meaning that if your GP isn’t willing to independently prescribe on the basis of GenderGP’s ‘treatment summaries’, you may remain dependent on GenderGP to prescribe & may get stuck at private medication prices. Also, if you wish to pursue surgery down the line, be aware that some surgeons do not accept GenderGP referrals.
Pricing:
£195 starter fee
£30/month subscription
£65 ‘Information Gathering Session’
£30 ‘Follow Up Session’ (mandatory every six months for repeat prescriptions)
If your GP will not prescribe, you must also pay a £15 fee to be referred to an independent prescriber and pay for your private prescriptions, which can range from £4 to £100/month.
A price list can be found here.
Timing:
GenderGP is reputed to be fast under normal conditions, conducting first appointments within weeks. It’s unclear what the pace of processing is with the current delays.
Gender Plus
Gender Plus is new to issuing hormones, opening its Dublin hormone clinic in late 2023 and its Birmingham hormone clinic in early 2024; it also has a base in London. In January 2024, it became the first service officially approved by the CQC – England’s independent regulator of health and social care – to prescribe hormones for over-16s.
The service is run primarily by ex-GIDS staff and is generally being promoted as a more robust and regulated option than GenderGP; it is also explicitly marketing itself to people leaving GenderGP, by providing a less expensive and shorter ‘Transfer of Care’ pathway than its new patients pathway.
Because Gender Plus is new, there is little information on how it functions yet. Like GenderGP, Gender Plus has six-monthly mandatory psychological appointments, attendance of which is compulsory for the prescription to be renewed. Gender Plus’s government-approved status means that it might be pressured to screen patients more thoroughly, and it is worth being aware of this when preparing for your appointments.
Gender Plus also specialises in autism assessments alongside gendered care; it is unclear what role, if any, this may play in their gender care pathway / psychological review process.
One ambiguous aspect of Gender Plus’s care pathway is their mention of‘titrating’ hormones ‘up to a full adult level’. I asked Gender Plus what they meant by this, and a liaison replied:The dosages of hormones increase over a period of time. Typically every six months giving your body time to adjust and stabilise. Every six months a blood test will be taken to determine your response. This will inform the clinician whether your dose can be increased.
It typically takes 12-24 months for this to happen. Once an adult level of testosterone/oestrogen is achieved and tolerated well then the dose will likely remain at the one prescribed at that time. Titration can refer to the process of adjusting hormone doses after bloodwork, which is normal, although I’ve never seen a titration protocol stretch from 12-24 months (most advertise 3-6).
Titration protocols are, however, also associated with starting on a low dose before adjusting upwards, such as 1mg/day of oral estradiol for the first month (Rainbow Health Ontario) or 1mg/twice daily for the first three months(Nottinghamshire Area Prescribing Committee). It is therefore possible that patients at Gender Plus may be stuck on a low dose for a longer time than most titration protocols.
The focus on ‘adult levels’ is also apotential concern, since a patient achieving an average adult normal level doesn’t necessarily mean that that level is correct for them and their goals – particularly for transfeminine people, whose ‘adult level’may be calibrated at the lowest level of a typical cis female cycle. If this is a concern for you, be sure to ask clinicians about this at the assessment stage.
Pricing:
For new patients:
£275 initial fee
£80 per month prescription fee, lasting for 24 months
For existing patients:
£275 transition of care assessment
£275 transition of care consultation
£40/month subscription fee for 12 months
Timing:
As of 14/5/24, there are first assessment appointments available in June 2024 (Birmingham and London) and July-August 2024 (Dublin).
GenderCare
GenderCare has received little direct attention post-Cass – no significant reports of disruption to services. (They have no contact with patients under 18, which means they’re likely to be less directly targeted than GenderGP and Gender Plus.) The service has become over subscribed in the past two years, leading to longer wait times with the three initialassessment clinicians (Dr Lorimer, Dr Dundas and Dr Bhatia).
Dr Lorimer’s auto-reply states that he receives “around seven times more enquiries than he is able to see or deal with”, while Dr. Dundas’ liaison quoted a 5-month wait time as of 14/5/24. All three clinicians are using a triage system and are regularly turning away patients. After assessment, you can be referred to one of their staff endocrinologists, who will take over prescribing for you and will seek to enter a shared care agreement with your GP.
If you can get through the waiting list, GenderCare has a robust reputation for providing documents for various aspects of gender change, referrals accepted by a wide range of surgeons, and for securing shared care agreements. They also do not demand a subscription service or continual follow-up appointments for years, unlike GenderGP and GenderPlus.
GenderCare is the only private gender clinic in the UK to have a voice therapist on staff (£205 for initial session, £170 for sessions thereafter).
Pricing:
Initial assessment: £300-450
Follow-up sessions for existing clients: £130-180, usually more for a new surgical assessment
Costs with specific endocrinologists vary widely, depending on how quickly you get a shared care agreement and on your precise medication needs. Private HRT costs max out at about £1000/year, though will usually be half that.
Timing:
Varies, but likely 6-9 months for initial assessment.
GenderDoctors
GenderDoctors, a service run by consultant psychiatrist and former GenderCare staffer Dr Sahota, is a provider of dysphoria diagnoses and hormone/surgical referrals.
GenderDoctors essentially works with the same endocrinologists as GenderCare does, but may be able to get you referred to them faster; more patients are going via Dr Sahota when they can’t see the initial GenderCare clinicians. Note that it’s unclear how well the online form on the website works – if you don’t hear back withina week or two, try emailing.
Pricing:
£450 assessment
Timing:
Generally faster than GenderCare – reports of about 2 months’ wait.
The Gender Hormone Clinic at Fitzrovia (London)
GHC requires a diagnosis of gender dysphoria before you engage with them. Some of their appointments are face-to-face, so it’s better for people in/near London. They issue hormones for 2 years before ideally discharging patients to shared care. If you have not located a GP who will do shared care before the end of the monthly payment plan, you may purchase private prescriptions at £59/month.
Note: There is explicit mention on the GHC website that if you miss 3 reminders to pay, or cancel your plan without notifying the service, they will discharge you and inform your GP before collecting the payments.
Pricing:
Upfront fee: £250
£55/month fee for 24 months
Timing:
About 2-3 months
YourGP / Waterside Clinic (Edinburgh)
Waterside Clinic is more expensive than basically all other private services, but has a comprehensive in-person clinic and a manageable wait time. Some sessions are required to be in-person, so Waterside isn’t ideal for people who aren’t based in/near Edinburgh. Testimonials about the clinicians are generally positive.
Pricing:
Three assessments (initial assessment, second opinion, and psychologicalassessment), each at £396 (£1188 total)
£200 for 30-minute doctor consultation every 3 months (£95 for nurse consultation)
Additional cost for hormone provisions
£35 for repeat prescriptions
Timing:
Unclear – likely a few months to do the 3 initial sessions.
The Gender Clinic (Harley Street, London)
Like Waterside, The Gender Clinic exchanges higher prices for lower wait times. It provides diagnoses and referrals for hormones/surgery. From testimonials and from its website, TGC is very focused on vetting dysphoria: “the clinician will speak with you to establish your history of gender dysphoria, ensure that you have no conditions that could serve as a contraindication and assess your mental capacity to confirm your ability to make fully informed decisions and protect the integrity of your assessment report.” (A call with someone close to you also forms part oftheir dysphoria assessment.)
Some have reported the clinicians at TGC heavily focusing on childhood experiences of gender incongruity and on bodily dysphoria, though this is not universal in testimonials. You may want to take notes about your childhood experiences of gender before the assessment.
Pricing:
£500 initial assessment
£350 for further assessments (such as for surgery referral)
Timing:
TGC advertise a 3-week wait time.
Key advice:
- Private gender services may disapprove of patients who use multiple gender services at once (such as to circumvent delays), or who openly use DIY hormones while also using a private service.This varies a lot by clinician, but patients have experienced retaliation from providers, such as withholding documents or demanding extra assessments.
- Your ability to get a shared care agreement with your GP, and to have potential surgery referrals accepted, may be influenced by the perceived legitimacy of your provider.
- Clinicians will vary widely in terms of what they expect from patients; Reddit (especially r/asktransgenderUK) can provide useful community testimonials about specific doctors, though experiences may vary widely from patient to patient as well. You may have a smoother assessment experience if you have already socially transitioned, if you are changing your name, if you have a clear narrative of childhood gender dysphoria, and if you have clear ideas about what you want from hormones.
- However, you can absolutely access care if you don’t fit those parameters; just be aware of what your clinician wants from you. For instance, there are a few clinicians who want a letter from your employer indicating that you have socially transitioned, which is an obstacle to consider if you’re not out at work or have a hostile employer.
- Stay in contact with other trans people who are taking or have taken hormones. They’re well-placed to know if you’re receiving adequate care and sound advice.
