Gender Services

• Brief gender-related history- preferred name, assigned sex at birth, gender identity, pronouns used.

Relevant social history, including any safety concerns for the patient e.g., whether it is safe for the Gender Service to contact the patient via the contact details provided in the referral.

• Capacity or medicolegal issues:
  • Any issues impacting patient’s ability to demonstrate capacity e.g intellectual or cognitive impairment; under public guardian.
  • Patient capacity to make informed decisions about their health and health care.
  • For people under 18 years – custody/court orders if applicable and parental opposition to GAHT.
• Nicotine (via smoking or vaping), alcohol and other substance use:
  • – Nicotine use increases the risks associated with gender affirming hormones and may prevent a patient from being able to commence gender affirming hormones. Please discuss and manage any nicotine and other substance use while patient is waiting to be seen by Gender Service.
• Patient’s current risk of pregnancy and current pregnancy prevention:
  • Please discuss and commence appropriate pregnancy prevention for the patient.
  • If the patient is being referred for commencement of testosterone, please consider progesterone-only contraception, including LARCs (long-acting reversible contraception.
• Patient’s desire to preserve their fertility with gamete (egg or sperm) freezing.
• Please refer the patient to a private fertility specialist if they would like to discuss and/or undergo fertility preservation with gamete (egg or sperm) freezing.
• Mental Health diagnoses (Patients must have managed/supported mental health before being prescribed GAHT. Please manage any mental health concerns, including referrals to mental health care providers, while the patient waits for their appointment with the Gender Service). Please provide information on the following:
  • Diagnoses: mood disorder (anxiety, depression), disordered eating or eating disorder, psychotic illness, chronic severe mental health issue and under care of mental health specialist or team.
  • Mental health risks.
  • If no known mental health issues/if stable/well-supported.
• Physical Health diagnoses:
  • All current medical conditions (It is important that Gender Service know of any patient history of cardiovascular disease, cerebrovascular disease, haematological disease, including venous thromboembolism, diabetes, obesity, osteoporosis, hormone-dependant cancer, including breast cancer).
  • Please document if no medical conditions.
• Neurodevelopmental diagnoses (Please manage any concerns, including referring them, if appropriate, for private assessment and management):
  • Diagnosed/suspected (E.g. Autism or ADHD).
• Current medications including dose.
• Allergies.
• Essential blood test results:
  • FBE; E/LFTs; glucose/HbA1C, lipids, FSH, LH, prolactin, oestrogen, testosterone, vitamin D.

For people seeking GAHT, the essential blood tests must have been completed within the last 6 months.

The results of blood tests must be included in the referral, otherwise the referral will be declined:

– Please follow up any abnormal results.

– It is the duty of care of GP ordering blood tests to follow up abnormal results.

Additional desirable referral information

• For people seeking Gender-Affirming Hormone Therapy, the following investigations should be considered:
  • Sexual health check depending on the patient’s sexual risk: anti-HIV/HIV Ag, anti-HAV IgG, anti-HBc, anti-HBs, HBsAg, anti-HCV IgG, syphilis serology, PCR for chlamydia and gonorrhoea on specimens from urine/genitals, pharynx and rectal sites, and cervical screening as applicable.

Please follow up any abnormal results.

It is the duty of care of GP ordering pathological investigations to follow up abnormal results.

Please follow up any issues related to the patient’s sexual health, including HIV and STI screening and management and HIV prevention including PrEP (pre-exposure prophylaxis).

• Relevant family history.
• Height, weight, BMI, BP.