Gender

the distress experienced when a person's gender identity is not the same as their gender assigned at birth

help people to live in their preferred gender

•Referral by GP to gender specialist or gender identity specialist clinic
•Confirmation of gender dysphoria by a multi-disciplinary team
•If appropriate, hormone therapy
•Oestrogen and anti-androgens for Male to Female (MtF)
•Testosterone for Female to Male (FtM)
•Gonadotrophin-releasing hormone analogue (GnRH) to block puberty in children

•Mental Health Support
•Hair removal (if required)
•Speech and language therapy
Surgery

•Referral to gender identity development clinic (GIDS) for assessment (3-6 months)
Initially psychological treatment (e.g. psychotherapy, family therapy, parental support
•puberty blockers might be considered to pause sexual development.
•From 16 years of ages, cross-sex hormones might be considered if have used puberty blockers for at least 12 months.

Irreversible changes (e.g. breast development, voice deepening) and can lead to infertility

Parenteral/transdermal testosterone

•More body and facial hair
•More muscle
•Periods stop
•Increased libido
•Voice may become deeper

Oestrogen: Estradiol (oral, transdermal patches) or estradiol(parenteral)
•Anti-androgens: cyproterone acetate, spironolactone

•Genital shrinkage
•Less muscle
•Fat on hips
•Lumpy and enlarged breasts
•Less facial and body hair

•Very high risk:
•Thrombosis
•Moderate risk:
•Breast cancer
•Stroke
•Coronary artery disease
•Hypertriglyceridemia
•Pituitary adenoma (benign)
•Gall stones

•Very high risk:
•Increased RBC volume
•Moderate risk:
•Severe liver dysfunction
•Stroke
•Coronary artery disease
•Hypertension
•Breast or uterine cancer