Gender Incongruence is classified under ICD11 as a marked and persistent incongruence between an individual’s experienced gender and their assigned sex.
The Chalmers Gender Identity Clinic (GIC) offers an assessment and treatment service for people with gender incongruence. This can include referrals for fertility preservation, facial hair removal, speech and language therapy, hormone advice and referrals for gender affirming surgery.
The GIC team is multidisciplinary team and includes psychiatrists, psychologists, sexual health doctors, endocrinologists, GPs, gender nurses, sexual health nurses, clinical support workers and speech and language therapists.
The team offers clinical advice to other professionals in Lothian either prior to referral, if someone is on the waiting list, or if an issue crops up with a patient already known to the service. Please use SCI Gateway e-advice option. Otherwise, clinical advice is still available by email at loth.gic@nhs.scot – FOR PROFESSIONAL USE ONLY. The service aims to reply to queries within 5 working days.
There is a Lothian Shared Care Agreement (SCA) for prescribing hormonal treatment for gender dysphoria following full assessment by the Chalmers GIC. This will operate from Monday 11th November. Please see Gender Identity Prescribing for full details.
The Primary Care Management page gives further information on CHI changes, screening, confidentiality and support.
Mental health and other support
People who are trans have higher rates of anxiety, depression, self-harm and suicide. They are also more likely to be neurodiverse (ADHD and ASD). It is important that trans people are referred to appropriate mental health services and support services when needed. Please see Resources and Links for further detail.
The Chalmer’s GIC webpage has useful information for patients about what to expect from the service, including a short video about the clinic. There is also information about waiting times and links to organisations that offer support: Gender Identity Clinic | Lothian Sexual Health
C.M & F.C 11-11-24
Who to refer:
The GIC team is happy to see patients who are aged 17 and over who are considering or want to transition, or those who have already transitioned. Referrals are accepted for someone who is 16 but they will not be seen before they reach their 17th birthday.
If someone is questioning their gender identity, we would advise that they be referred for counselling. LGBT health and wellbeing provide an Edinburgh counselling service: please see LGBT Counselling in Scotland. If after counselling, the patient still wishes to transition then please refer.
For patients under 18 years old the service is not able to prescribe any gender affirming hormones following the CMO’s letter relating to the Cass review. However, those patients can still be seen for assessment and to provide other treatments.
Transfer of Care.
Chalmers GIC will accept transfers of care for new residents of its catchment area who have been treated (or are on the waiting list) of other NHS UK gender clinics. If the GIC is in Scotland the patient should contact their previous clinic and ask the GIC to transfer their care to Chalmers.
Outwith Scotland patients can ask their GIC to transfer care or Chalmers will accept a GP referral along with details of their previous assessment and most recent clinic letters. If someone is on the waiting list at another NHS UK gender clinic, the original date of referral is taken into account when added to the Lothian waiting list.
The GIC is unable to prioritise patients who have accessed private treatment and recommends that they are advised to continue their engagement with their existing provider until the GIC has completed its assessment.
Who not to refer:
Young people under the age of 16: please refer to Gender Service for Young People at Sandyford
How to refer:
Please refer via SCI Gateway to Chalmers Sexual Health Centre – Gender Identity.
There is a SCI Gateway e-advice option – please use that where advice is being sought for the first time about a patient. Otherwise, clinical advice is still available by email at loth.gic@nhs.scot – FOR PROFESSIONAL USE ONLY.
Changing Names, Gender, Titles and CHI
It is good practice to facilitate people changing their details at a time of their choosing – please see details of how to change gender, title and CHI numbers.
CHI contains a binary gender marker – the penultimate digit – which is an even number for female, odd for male. For non-binary people this is unsatisfactory, and they may not be aware of the significance of the CHI number. 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 clinical IT 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.
Support.
Mental health and other support are key: please see Resources and Links for more information.
Screening.
If someone has changed their CHI after 14th June 2015 they will be automatically called for screening (cervical, breast, AAA). It is not always possible to identify transgender people who have moved to Scotland or transitioned before 14th June 2015. Further information on screening for trans people in Scotland can be found at transgender screening in Scotland (nhsinform).
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 the recommendation is that patients be encouraged to view such reports before submission.
Contraceptive Choices
Apart from combined hormonal contraception, all methods of hormonal and non-hormonal contraception are suitable – for more detail please see the FSRH Clinical effectiveness Unit guidelines.
Testosterone is not contraceptive and is teratogenic, so it is especially important for patients using it to avoid conceiving.
Gender identity healthcare protocol for Scotland
NHS Lothian gender-specific reference ranges for blood tests.
The Cass Review
Gender Identity Clinic | Lothian Sexual Health
Number 6 –is a support service for people who have an ASD diagnosis. They provide individual and group support and also run a trans and non-binary support group. https://www.number6.org.uk
LGBT health and wellbeing – provide social support, individual support, and a counselling service for trans people. https://www.lgbthealth.org.uk
Beyond Gender – a group for 16 – 25-year-olds trans and non-binary people. It runs every Tuesday 6 – 8 pm in central Edinburgh and is run by LGBT youth. https://www.lgbtyouth.org.uk
Glitter Cannons – a LGBTQ+ youth group run by West Lothian Council based in Boghall, Bathgate. It provides a safe space for 12 – 25 years old and runs on a Thursday 6.30 – 8.30. Instagram page: Glitter Cannons (@wlglittercannons)
Support for relatives:
There are no in-person support services locally for family members but there is some online/ phone support:
The Beaumont Society – have a National 24 hr helpline supporting trans people and their families (01582 412220) www.beaumontsociety.org.uk.
Depend – provides free confidential advice, information and support for all family members, spouses, partners and friends of trans people in UK. Depend – Supporting the families and friends of trans people in the UK.
