Many people are unsure when to seek help and who to approach for support. It is obviously a very sensitive subject but delaying support can often lead to more problems and extra stress. The following is a guide for accessing the support you need.

How soon should I seek help?

The simple answer is as soon as possible. You don’t need to wait until you are sure, or need to have made any decisions about your future. In fact, Specialist Gender Services request that people are referred to them at the earliest point possible. This is because they want to assess the situation with the person, look at the options together and offer support to make the right decision.

Who do I go to see?

In the first instance, the best person to go to see is your GP. Although gender issues are becoming increasingly understood, it is worth preparing what you are going to say in advance, particularly if your GP has little expertise in this area.

How do I tell my GP about my gender feelings?

Remember that you don't need to have made any decisions so don't feel under pressure before you go along. All you need to say is that you have strong feelings about your gender and would like to be referred to see a local psychiatrist in order to explore this in more detail. There may be a specialist Screening Clinic with a local psychiatrist with special gender experience in your area. If not, then you can be referred to the Community Mental Health team that covers your local area.

How do I get an appointment to see a psychiatrist in my area?

Community Mental Health teams are secondary (specialist) services that see patients that are referred by their GP. Your GP will have a local psychiatric team that he or she can refer you to. Ask that the GP includes a request in the letter for you to be seen by a psychiatrist with gender experience, if there is one available.

How can I be referred to the Specialist Gender Service?

In the UK, specialist gender assessment and treatment is available under the National Health Service. Therefore assessment and treatment is free. In order to be referred you need to meet certain criteria. You need to have been seen by a psychiatrist in your area and been given the provisional diagnosis of gender dysphoria or transsexualism. However there is still no expectation for you to have made any serious decisions at this point. Although the specialist services offer treatments, the initial meetings are about assessing you and offering you the right support to make the right decision that is best for you.

What will they ask me?

The local psychiatrist will have several things on his or her mind. They will want to try to understand how your gender feelings affect you. Also they want to rule out any other causes of gender confusion, which include some medical conditions and mental health problems. A consultation usually lasts about an hour. The psychiatrist will ask about your background history, your family and early childhood experiences and your emotional wellbeing. In particular, they will focus on how you became aware of your gender, the feelings associated with this and how you came to feel how you do. A more detailed breakdown can be found on the Psychiatric Assessment page.

Do I have to go to the appointment as my new gender?

This depends completely on how you feel. Some people like to present their true gender, which may involve dressing-up or changing your usual appearance. Clearly this is a brave thing to do and it is certainly not expected. You should not feel pressurised to attend in a certain way to make a point. What is more important is for you to feel as relaxed and as comfortable as possible.

Will I be expected to take hormones right away?

There are no expectations for you to accept treatment. Your local psychiatrist or screening clinic will carry out an appropriate assessment but will not offer you any ongoing treatment. The Specialist Gender Services like to assess people over a period of time before looking at active treatment. Therefore they like to see people as early as possible before they have made any serious decisions. Also you will need to have a number of physical health checks before hormones are prescribed and have a full understanding of their effects and possible side effects. More information can be found on the Hormone Treatment page.

What if I am unsure about surgery?

It is completely normal to have reservations about surgery. This is something that needs to be worked towards over a period of time with careful planning and lots of time to think about it. Therefore noone will expect you to have all the answers right away. Take all the time you need and follow the guidance of the specialist services. For more information about the different types of surgery, go to the Surgery page.

What if I decide that I don't want to change at all?

It is completely normal to be unsure how to proceed when you have concerns about your gender. It is a complex problem that needs to be understood carefully and not rushed. Treatment involves permanent changes and should not be taken lightly. By seeking help from the Specialist Services you can be offered help and support to make what is the right decision for you. For some people, that decision is no change at all. As far as the Specialist Services are concerned, that’s job done! Transition is not for everyone and noone is expected to do anything that they don’t feel comfortable with.

What are the reasons why I may be refused a referral to the Specialist Gender Services?

There may be some concerns around whether you have the diagnosis or not. Sometimes a longer period of assessment is needed or there are other issues clouding the picture. If you are also suffering from a mental health problem, the local psychiatric team or GP may want to offer you some treatment for this before you pursue further help with the gender problems. If you have other problems, such as untreated medical conditions, alcohol or street drug problems, then it is sensible for these to be addressed before being referred. Although there is no expectation for you to receive treatment when you go to the Specialist Gender Services, it makes sense for you to be fit and healthy and in good emotional and mental health before starting the process with them.

What if I am afraid to go to my GP, who else can I see?

If, for whatever reason, you are not comfortable going to see your own GP, then you could ask to be seen by a different GP in the practice, if there is one available. Although going to see your family doctor may cause some discomfort, it is really important to involve them as soon as possible, particularly as they may be offering you a lot of support in the future, with prescribing or post-surgical care. Whatever you tell your GP will be kept completely confidential. Also the referral from your GP is necessary in order for your future care to be funded, so it is important to involve them in the process. Although the temptation is often to see someone new or even pay privately, this is often an unnecessary expense and, unless they have special experience, may not provide you with the help you need. Find out more in the Do I Have to Pay section..