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Gender Identity Clinic
 

COVID-19: Please see attached guidance for Hormone Treatment Alternatives (18/03/2020). 

This Page is currently under development and content is not finalised (Dec18)  

Gender Identity Clinic (GIC), Chalmers Sexual Health Centre

 
The Chalmers GIC offers services to people over the age of 17 residing in Borders, Fife and Lothian NHS Board areas. It supports people who may be considering or undergoing transition in connection with gender incongruence or dysphoria, a condition where there is a marked and persistent incongruence between a person’s experienced gender and assigned sex. This is not a mental disorder and is categorised in the sexual health chapter of ICD-11.
 
The multidisciplinary team includes specialists in gender, reproductive endocrinology, mental health, sexual health, pharmacy and speech and language.
 
The GIC offers assessment and referral for interventions specific to gender identity. These include fertility preservation, facial hair removal, speech and language, endocrine treatment, gender confirmation surgery including some feminising surgeries.
 
Treatment for people accessing gender services in Scotland is defined by the Scottish Government Gender Reassignment Protocol, CEL 26 (2012). There is a highly effective managed clinical network, the National Gender Identity Clinical Network for Scotland (NGICNS  www.ngicns.scot.nhs.uk).

​

​Who to refer

 
Anyone over the age of 17 interested in assessment and/or exploration of treatment options connected with their gender identity.

 
Who not to refer

 
People under the age of 17 should be referred to the Sandyford Young People's Gender Clinic in Glasgow - please see here for details
 

How to refer

 
For people in Fife and Lothian referral is accepted through SCI Gateway to Chalmers or the Gender Identity Clinic by GP letter.
 
For people in the Borders referral is via Dr Joanna Smith, Consultant Liaison Psychiatrist at Huntlyburn. This also provides an opportunity for the person to have a discussion about their experience and to be aware of any local support that might be helpful. We record the referral date to the GIC as being that of the referral to Dr Smith.
 
It is helpful to include relevant background information including a full medical history especially if it is possible that the person might want to explore endocrine or surgical options.

Considerations

  • It is common for there to be uncertainty and/or ambivalence. The GIC staff will support someone to explore their experience and would prefer an early referral.

 

  • There can be a long wait to be seen by the GIC. People should be advised to access the GIC website at lothiansexualhealth.scot.nhs.uk/gic for information.

 

 

  • There is an increased risk of self harm and suicide for people identifying as transgender ('trans'). Access to and awareness of supportive healthcare interventions are important. Unresolved gender incongruence or dysphoria is associated with significant clinical distress for many people. Please ensure timely and appropriate supportive interventions and management for people experiencing distress.

There is also an increased risk of mental health difficulties. Trans people should be offered referral to mainstream services, where appropriate, and gender considerations should not delay such referrals.

 

  • There is an excellent short term counselling service based in Edinburgh by LGBT Health & Wellbeing (http://www.lgbthealth.org.uk) to which people can self-refer. (They may be asked to contribute a fee for this, but according to an individual's means).

 

Primary Care Management
​We ask GPs to:
 
1.      Prescribe based on our specialist recommendation for people accessing endocrine treatment
2.      Provide phlebotomy in connection with some clinic appointments
3.      Provide normal management of any incidental findings
 
We believe that a strong and supportive relationship is vital between the individual, ourselves and clinicians providing the person’s primary care. We welcome questions and are always happy to discuss individuals’ care and to support colleagues.  A shared care agreement for hormonal therapy is currently being discussed (Dec 18)

For most people endocrine treatment will last for many years and possibly lifelong. Our experience is that with the right support and information, management in primary care is straightforward once someone’s treatment is stable.
 
Treatment is recommended based upon the clinical network’s guidance (available at http://www.ngicns.scot.nhs.uk/endocrinology/). The GIC is supported by Professor Richard Anderson, Consultant Reproductive Endocrinologist.
 
Until someone’s treatment is stable they will be offered regular review appointments with us. We may sometimes ask for phlebotomy in connection with these appointments especially as on occasion some endocrine blood levels must be taken as trough. Progression is assessed based predominately on the clinical picture in conjunction with the person’s expectations and supported by biological markers.
 
Follow up arrangements are being discussed (Dec18). Guidance is available at http://www.ngicns.scot.nhs.uk/endocrinology/ and from the GIC.
 
Please note that clinical assessment should usually be based on reference values for the gender most aligned to the person’s hormone profile.
 
We are also available by secure email: chalmers.clinicaladv@nhslothian.scot.nhs.uk
 
Bridging Prescriptions
 
For people already established on an endocrine regime this should normally be continued. Please contact us to discuss in this situation. If continuation of this is the sole outstanding aspect of their gender care it is unlikely they will need to be referred to us.
 
Some people may choose to self-prescribe hormone treatment. We do not make any prescribing recommendation until assessment is completed. Whilst we caution people against this, we are happy to discuss in this situation. The GMC has recently updated its guidance which may be helpful (https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#mental-health-and-bridging-prescriptions).
 

Health Screening

1.      Cervical screening
People changing to a male CHI number in Scotland after 14/06/2015 will continue their enrolment in the cervical screening programme. However people with a cervix who change CHI prior to this or have moved to Scotland may need to be manually enrolled.
 
2.      Breast screening
Trans-women and some trans-men may be at risk of breast cancer. For further detail on screening please see: https://www.nhsinform.scot/healthy-living/screening/screening-information-for-the-transgender-community#breast-screening
 
3.      Aortic Aneurysm screening over the age of 65.
This is a gender-specific programme and further details are available on the nhsinform website: https://www.nhsinform.scot/healthy-living/screening/screening-information-for-the-transgender-community#abdominal-aortic-aneurysm-aaa-screening
 

Changing Names, Gender, Titles and CHI

 
It is good practice to facilitate people changing their details at a time of their choosing.
 
CHI contains a binary gender marker (the penultimate digit: even for female, odd for male). For non-binary people this is unsatisfactory and they may not be aware of this. The system is scheduled to be updated but in the meantime people may only select male or female as their gender in connection with CHI. If the practice changes someone’s gender on its system, Practitioner Services will write to the person to confirm how their details should be updated and issue a new CHI if required.
 
Practice systems will accept the gender-neutral title “Mx”. Please remember to ask the person what title they would prefer and check that all paperwork including prescriptions is updated.  People may be upset by being accidentally misgendered.
 
 

Confidentiality

 
Always gain consent when disclosing someone’s gender history, even to other clinicians: in some cases not doing so can be a criminal offence. Please also be aware of gender identity information being pulled forward automatically through READ codes. Gender history should not be included in an insurance report and we recommend you encourage any patient in this situation to view their report before it is finalised forwarded.
 

Contact Details

 
Gender Identity Clinic
NHS Lothian
Chalmers Sexual Health Centre
2A Chalmers Street
Edinburgh
EH3 9ES
 
0131 536 1570
lothiansexualhealth.scot.nhs.uk/gic
 
Clinicians can obtain rapid information and support from chalmers.clinicaladv@nhslothian.scot.nhs.uk
 
Please address your message to the gender team. We will normally respond within two working days. Messages are secure if sent from an NHS address and via an NHS network.

Resources

Training
 
We are happy to come and visit your practice to offer training and discussion about gender healthcare. We regularly attend protected learning events.
 
We run clinics at Chalmers every weekday except Friday. We welcome people coming to visit and it is usually possible to sit in clinic. This can form part of CPD and feedback is that it is very helpful.
 
Please contact us to discuss if you are interested
 
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