gender reassignment surgery in the uk

Treatment - Gender dysphoria

Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

What this means will vary from person to person, and is different for children, young people and adults. Waiting times for referral and treatment are currently long.

Treatment for children and young people

If your child may have gender dysphoria, they'll usually be referred to one of the NHS Children and Young People's Gender Services .

Your child or teenager will be seen by a multidisciplinary team including a:

• clinical psychologist
• child psychotherapist
• child and adolescent psychiatrist
• family therapist
• social worker

The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.

Depending on the results of the assessment, options for children and teenagers include:

• family therapy
• individual child psychotherapy
• parental support or counselling
• group work for young people and their parents
• regular reviews to monitor gender identity development
• referral to a local Children and Young People's Mental Health Service (CYPMHS) for more serious emotional issues

Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.

Hormone therapy in children and young people

Some young people with lasting signs of gender dysphoria who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist). This is in addition to psychological support.

Puberty blockers and gender-affirming hormones

Puberty blockers (gonadotrophin-releasing hormone analogues) are not available to children and young people for gender incongruence or gender dysphoria because there is not enough evidence of safety and clinical effectiveness.

From around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones alongside psychosocial and psychological support.

These hormones cause some irreversible changes, such as:

• breast development (caused by taking oestrogen)
• breaking or deepening of the voice (caused by taking testosterone)

Long-term gender-affirming hormone treatment may cause temporary or even permanent infertility.

However, as gender-affirming hormones affect people differently, they should not be considered a reliable form of contraception.

There is some uncertainty about the risks of long-term gender-affirming hormone treatment.

Children, young people and their families are strongly discouraged from getting puberty blockers or gender-affirming hormones from unregulated sources or online providers that are not regulated by UK regulatory bodies.

Transition to adult gender identity services

Young people aged 17 or older may be seen in an adult gender identity clinic or be referred to one from a children and young people's gender service.

By this age, a teenager and the clinic team may be more confident about confirming a diagnosis of gender dysphoria. If desired, steps can be taken to more permanent treatments that fit with the chosen gender identity or as non-binary.

Treatment for adults

Adults who think they may have gender dysphoria should be referred to a gender dysphoria clinic (GDC).

Find an NHS gender dysphoria clinic in England .

GDCs have a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including:

• psychological support, such as counselling
• cross-sex hormone therapy
• speech and language therapy (voice therapy) to help you sound more typical of your gender identity

For some people, support and advice from the clinic are all they need to feel comfortable with their gender identity. Others will need more extensive treatment.

Hormone therapy for adults

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery.

It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team.

In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen.

Both usually have the additional effect of suppressing the release of "unwanted" hormones from the testes or ovaries.

Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating.

It's also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.

The effectiveness of hormone therapy is also limited by factors unique to the individual (such as genetic factors) that cannot be overcome simply by adjusting the dose.

Find out how to save money on prescriptions for hormone therapy medicines with a prescription prepayment certificate .

Risks of hormone therapy

There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP.

The most common risks or side effects include:

• blood clots
• weight gain
• dyslipidaemia (abnormal levels of fat in the blood)
• elevated liver enzymes
• polycythaemia (high concentration of red blood cells)
• hair loss or balding (androgenic alopecia)

There are other risks if you're taking hormones bought over the internet or from unregulated sources. It's strongly recommended you avoid these.

Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.

Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic.

Read more about fertility preservation on the HFEA website.

Surgery for adults

Some people may decide to have surgery to permanently alter body parts associated with their biological sex.

Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery.

In addition to you having socially transitioned to your preferred gender identity for at least a year before a referral is made for gender surgery, it is also advisable to:

• lose weight if you are overweight (BMI of 25 or over)
• have taken cross-sex hormones for some surgical procedures

It's also important that any long-term conditions, such as diabetes or high blood pressure, are well controlled.

Surgery for trans men

Common chest procedures for trans men (trans-masculine people) include:

• removal of both breasts (bilateral mastectomy) and associated chest reconstruction
• nipple repositioning
• dermal implant and tattoo

Gender surgery for trans men includes:

• construction of a penis (phalloplasty or metoidioplasty)
• construction of a scrotum (scrotoplasty) and testicular implants
• a penile implant

Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.

Surgery for trans women

Gender surgery for trans women includes:

• removal of the testes (orchidectomy)
• removal of the penis (penectomy)
• construction of a vagina (vaginoplasty)
• construction of a vulva (vulvoplasty)
• construction of a clitoris (clitoroplasty)

Breast implants for trans women (trans-feminine people) are not routinely available on the NHS.

Facial feminisation surgery and hair transplants are not routinely available on the NHS.

As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.

Life after transition

Whether you've had hormone therapy alone or combined with surgery, the aim is that you no longer have gender dysphoria and feel at ease with your identity.

Your health needs are the same as anyone else's with a few exceptions:

• you'll need lifelong monitoring of your hormone levels by your GP
• you'll still need contraception if you are sexually active and have not yet had any gender surgery
• you'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment
• you may not be called for screening tests as you've changed your name on medical records – ask your GP to notify you for cervical and breast screening if you're a trans man with a cervix or breast tissue
• trans-feminine people with breast tissue (and registered with a GP as female) are routinely invited for breast screening from the ages of 50 up to 71

Find out more about screening for trans and non-binary people on GOV.UK.

NHS guidelines for gender dysphoria

NHS England has published what are known as service specifications that describe how clinical and medical care is offered to people with gender dysphoria:

• Non-surgical interventions for adults
• Surgical interventions for adults
• Interim service specification for specialist gender incongruence services for children and young people

Review of gender identity services

NHS England has commissioned an independent review of gender identity services for children and young people. The review will advise on any changes needed to the service specifications for children and young people.

Page last reviewed: 28 May 2020 Next review due: 28 May 2023

• Media & Government
• News and Views

The history of gender reassignment surgeries in the UK

For Pride Month, we are recognising the plastic surgeons who pioneered gender reassignment surgeries (GRS) in the UK. Gender reassignment surgery, also known as gender confirmation surgery or gender affirmation surgery, is a sub-speciality within plastic surgery, developed based on reconstructive procedures used in trauma and in congenital malformations. The specific procedures used for GRS have only been practised in the last 100 years.

Over the last decade, there has been an increase in society acknowledgement and acceptance of gender diverse persons. This catalysed an increase in referrals to gender identity clinics and an increase in the number of gender affirmation surgeries. GRS help by bringing fulfilment to many people who experience gender dysphoria. Gender dysphoria - a distress caused by the incongruence of a person's gender identity and their biological sex, drives the person to seek medical or surgical intervention to align some or all of their physical appearance with their gender identity. Patients with gender dysphoria experience higher rates of psychiatric disorders such as depression and anxiety. Gender-affirming medical intervention tends to resolve the psychiatric disorders that are a direct consequence of gender dysphoria.

Norman Haire (1892-1952) was a medical practitioner and a Sexologist. In his book, The Encyclopaedia of Sexual Knowledge (1933), he describes the first successful GRS. His patient, Dora Richter underwent 3 procedures reassigning from male to female between 1922-1931. The procedures included a vaginoplasty (surgical procedure where a vagina is created).

In the UK, gender reassignment surgeries were pioneered by Sir Harold Gillies. Harold Gillies is most famous for the development of a new method of facial reconstructive surgery, in 1917. During the Second World War, he organized plastic surgery units in various parts of Britain and inspired colleagues to do the same, training many doctors in this field. During the war, Gillies performed genital reconstruction surgeries for wounded soldiers.

British physician Laurence Michael Dillon (born Laura Maude Dillon) felt that they were not truly a woman. Gillies performed the first phalloplasty (surgery performed to construct the penis) on Dillon in 1946. In transitioning from female to male, Dillon underwent a total of 13 operations, over a period of 4 years.

Roberta Cowell (born Robert Marshall Cowell) is the first known Brit to undergo male to female GRS. After meeting Dillon and becoming close, Dillon operated illegally on Cowell. The operation helped her obtain documents confirming that she was intersex and have her birth gender formally re-registered as female. The operation that helped her transition was forbidden as it was considered “disfiguring” of a man who was otherwise qualified to serve in the military. Consequently, Gillies, assisted by American surgeon Ralph Millard performed a vaginoplasty on Roberta in 1951. The technique pioneered by Harold Gillies remained the standard for 40 years.

Gillies requested no publicity for his gender affirmation work.  In response to the objections received from his peers, he replied that he was satisfied by the patient's written sentiments: “To Sir Harold Gillies, I owe my life and my happiness”. “If it gives real happiness,” Gillies wrote of his procedures, “that is the most that any surgeon or medicine can give.” These words highlight the importance of plastic surgery in the mental wellbeing of transgender patients.

The BAPRAS Collection and Archive has an extraordinary assembly of fascinating archive and historical surgical instruments dating from 1900. Visit https://www.bapras.org.uk/professionals/About/bapras-archive or email [email protected] for more information.

Please refer to our Privacy policy for important information on the use of cookies. By continuing to use this website, you agree to this.

Sorry, your browser isn't supported

Please click here to find out about upgrading.

You can also view the BAPRAS website on your tablet or mobile.

Cosmetic Surgery

Cadogan Clinic is a leading specialist cosmetic surgery clinic based in the heart of London. We’re home to the leading specialists in Breast Augmentation, Liposuction, and a comprehensive range of face, breast and body treatments.

Breast Surgery

Cadogan Clinic offers a full range of cosmetic breast surgery to help make the changes you want to your breasts under the guidance of the best surgeons in the UK.

• Breast Enlargement
• Breast Reduction
• Breast Lift
• Natural Breast Enlargement
• Breast Implant Replacement
• Breast Reconstruction
• Nipple Reduction

Body Surgery

Cadogan Clinic offers a range of cosmetic surgery to help make the changes you want to your body under the guidance of the very best surgeons in the UK.

• Brazilian Butt Lift (BBL)
• Liposuction
• Mummy Makeover
• Laser Liposuction
• Vaser Liposuction
• Buttock Lift
• Cellulite Treatment
• Extended Tummy Tuck
• Hernia Surgery
• 360 Liposuction
• Scar Revision
• Umbilicoplasty

Cosmetic Gynaecology

Cadogan Clinic provides a wide range of cosmetic gynaecological surgery procedures performed by a multi-disciplinary team of the best surgeons in the UK.

• Labiaplasty
• Gynaecological Fat Transfer
• Vaginal Rejuvenation
• Vaginal Tightening

Facial Surgery

Cadogan Clinic offers a wide range of facial cosmetic surgery procedures to help you make the changes you want, under the guidance of the very best surgeons.

• Rhinoplasty
• Mini Facelift
• Eyelid Surgery
• Chin Liposuction
• Alar Base Reduction
• Chin Augmentation
• Buccal Fat Removal
• Deep Plane Facelift
• Earlobe Repair
• Forehead Reduction
• Micro Facelift
• Nose Tip Rhinoplasty
• Septoplasty
• Septorhinoplasty
• Fat Transfer

Fat transfer, also referred to as fat grafting and lipofilling, has become widely accepted as the optimal means of soft-tissue filling in all areas of the body, including the face, breasts, hands and buttocks

• Fat Transfer to Face
• Fat Transfer to Body
• Fat Transfer to Breasts

Cadogan Clinic provides both female and male cosmetic surgery. Almost all of our procedures are suitable for men as well as women.

• Blepharoplasty for Men
• BBL for Men
• Face Lift for Men
• Hair Transplant
• Male Breast Reduction
• Otoplasty for Men
• Penis Enlargement
• Rhinoplasty for Men
• Liposuction for Men
• Abdominoplasty for Men

Gender Surgery

Gender dysphoria is a term used to describe how an individual feels a strong sense of disassociation between their gender identity and biological sex.

Facial Feminisation Surgery

FTM Top Surgery

MTF Top Surgery

Non-Binary Surgery

Dermatology

Cadogan Clinic is a leading dermatology clinic based in the heart of London. We’re home to some of the leading acne, eczema and rosacea specialists, and are experts in the mole and skin cancer diagnosis and removal process.

General Dermatology

Skin is incredibly important to your health and your appearance. The Cadogan Clinic has one of the largest and experienced teams of consultant dermatologists.

• Acne Treatments
• Hair Loss Treatment
• Milia Removal
• Paediatric Dermatology
• Bacterial Skin Infections
• Excess Hair Growth
• Hyperhidrosis (Excessive Sweating)
• Pigmentation
• Skin Allergies
• Skin Health MOT
• Vaginal Dermatology
• Verruca Removal
• Viral Skin Infections

Mole & Skin Cancer

We are all becoming increasingly aware of the risks posed by sun damage to the skin, as well as the need to protect our skin in day-to-day life.

• Mole Removal
• Cryotherapy
• Mohs Surgery
• Cyst Removal
• Skin Cancers and Melanomas
• Skin Lumps (Warts, Moles, Skin Tags)
• Lipoma Removal

Skin Rejuvenation

At the Cadogan Clinic, we offer a comprehensive range of non-surgical cosmetic treatments, to refresh and rejuvenate your appearance.

• Microneedling Dermapen
• Varicose Veins
• Scar Treatment
• Non-Surgical Eyelid Reduction

Injectables

Cadogan Clinic is a leading non-surgical cosmetic clinic based in the heart of London. We’re home to some of the leading injectables and dermal filler specialists, and are experts in the anti-ageing process.

There are many factors which contribute to ageing skin and when deciding on a treatment solution, these are important to consider.

• Anti-Wrinkle Injections
• Cheek Fillers
• Dermal Fillers
• Lip Fillers
• Non-Surgical Rhinoplasty
• Tear Trough Filler
• 8 Point Facelift
• Dissolving Filler
• Hand Rejuvenation
• Jawline Filler
• Non-Surgical Facelift
• Temple Filler
• Cheek Concerns
• Eye Concerns
• Filler Complications
• Forehead Concerns
• Lower Face Concerns
• Nose and Mouth Concerns
• Skin Concerns

All Services

We are experts in a wide range of Andrology treatments, in both elective and medical conditions.

• Adult Circumcision
• Erectile Dysfunction
• Frenuloplasty
• Male Fertility
• Penile Implants
• Peyronie's Disease
• Premature Ejaculation

Gynaecology

• Coil Insertion / Removal
• Hysterectomy
• Hysteroscopy
• Myomectomy (Fibroid Removal)
• Ovarian Cystectomy
• Perineum and Pelvic Floor Repair
• Prolapse Surgery
• Polyp Removal

Hand Surgery

We are experts in a wide range of hand problems, in both elective and traumatic conditions.

• Carpal Tunnel Treatment
• Dupuytren's Contracture Surgery
• Hydrocortisone Injections
• Ganglion Hand Cysts
• Trigger Finger Surgery

Cosmetic foot surgery can help by firstly eliminating the sources of chronic pain or deformity and secondly, reshaping the feet for aesthetic appeal, often resulting in smaller, slimmer feet with a reduced shoe size.

• Bunion Removal
• Cinderella Foot Surgery
• Corn Removal
• Toe Shortening & Straightening

Before & After

• Breast Augmentation
• Blepharoplasty
• Mini-Facelift

Cost & Finance

• Breast Implant Removal
• Skin Treatments
• Nipple Surgery

We were founded in 2004 by world renowned plastic surgeon Mr Bryan Mayou, best known for his pioneering work in the area of liposuction, lasers and microvascular surgery. We continue to collaborate with pioneers in our field.

• Our History
• Our Specialists
• Outcomes and Safety Data
• Patient Journey
• Surgical Aftercare
• Ask the Expert

0207 901 8500

Gender Affirming Surgeries for Trans Patients

Gender surgeries alter the physical appearance of the body to address concerns such as gender dysphoria, where a person’s physical features do not match with the gender they mentally and emotionally relate to. Transgender men and non-binary patients may opt for FTM Top Surgery , which involves the surgeon removing the breasts, in a procedure known as a Mastectomy. This creates a flatter, more masculine looking chest. MTF Top Surgery creates a more feminine chest for trans women, using breast implants or fat transfer techniques, in a breast enlargement procedure. Gender top surgeries also regularly address the position, size, and shape of the nipples to ensure the final result is flattering and suits the overall body. Some MTF patients also choose to undergo facial feminisation surgery , which is a bespoke approach to softening the more traditional mascluine appearance of the facial bone structure and soft tissues. Gender affirmation surgery allows the patient to express themselves confidently, including being able to dress in the way that feels most comfortable such as being able to wear swimwear or sportswear that reflects their gender.

View All Gender Surgery Treatments (4)

Gender dysphoria can be a very uncomfortable feeling for a lot of people. Sometimes these feelings can cause a great deal of mental distress, anxiety and depression. This can have an overwhelmingly negative impact on a person’s day-to-day life.

Gender reassignment surgery is used to help the person concerned to resolve this disconnect by permanently altering the body parts associated with their biological sex. 

There are a number of different surgeries that fall under the category of gender reassignment. Top surgery encompasses surgery that is carried on the upper half of the body. This includes mastectomy (breast removal) and nipple repositioning in transmen and breast augmentation in transwomen. 

We offer gender reassignment surgery UK here at the Cadogan Clinic in Chelsea, London, and encourage any trans or non-binary patients seeking a safe top surgery procedure to contact us to arrange an initial consultation. Our team of experts will ensure that you will be treated with respect and dignity at all times during your treatment with us, as we acknowledge that these affirming surgeries are not strictly cosmetic surgery , but a new source of freedom.

Helpful Reading

Facial Treatments

24th Jul 2024

How To Fix Breast and Nipple Concerns After Pregnancy

19th Jul 2024

How to Fix Loose Skin After Pregnancy

8th Jul 2024

What Are the Different Types of Eye Shapes

28th Jun 2024

How to Treat Ozempic Butt

27th Jun 2024

Understanding Your Skin Presentation at Queen's Gate School

25th Jun 2024

What Are the Different Types of Acne and Which Treatments Are Best?

14th Jun 2024

What Is Ozempic Face and How to Treat It

17th May 2024

Cadogan Clinic Wins Best Clinic Awards

Body & Breast

12th Apr 2024

Breast Haematoma After Surgery: Possible Causes and Solutions

5th Apr 2024

What Are the Most Natural Looking Breast Implants?

A state of the art, award winning clinic.

Founded in 2004 by world renowned plastic surgeon Mr Bryan Mayou, we now work with over 100 leading consultants and successfully treat over 20,000 patients each year. We have been winning industry awards since inception.

Best in Class Facilities

All of our treatments take place at our beautiful boutique premises in Chelsea. We have six consulting rooms and five operating rooms, as well as a dedicated pre and post-operative suite, and a full team of specialist nursing staff.

A Strong Tradition of Innovation

We were founded in 2004 by world renown plastic surgeon Mr Bryan Mayou, best known for his pioneering work in the area of liposuction, lasers and microvascular surgery. We continue to collaborate with pioneers in our field.

At Home in Sloane Street, London

We are proud that our state of the art award-winning clinic is located in one of the best neighbourhoods in the country

Clinics Nationwide

We offer surgical consultations in London, Birmingham , Chelmsford and Bristol, and attract international patients from all corners of the globe such as as the USA, the Middle East and Europe.

Aesthetic Medicine 2024

UK Clinic of the Year

Aesthetic Awards

Best Clinic, London

Aesthetic Medicine

Highly Commended

MyFaceMyBody

Best Plastic Surgery Clinic, UK

MyFaceMyBody Awards

Gender Clinics

What are gender clinics.

In the UK, people who are changing things linked to gender are supported by a set of specialist centres, often known as ‘gender identity clinics’ (GICs) or ”gender dysphoria clinics’ (GDCs), which offer formal diagnosis, psychological support, speech therapy, and access to other services like hormone medications and surgeries.

What do NHS Gender Clinics offer?

The services offered vary from clinic to clinic, but generally they offer assessment for hormone treatment and referral for gender confirming surgeries and hair removal, as well as initially monitoring hormone treatment and well-being in relation to gender dysphoria. Many GDCs offer counselling, peer support and speech therapy.

How can I access an NHS gender clinic?

Take a look at our Getting referred to a gender clinic page for more information on this .

NHS gender clinics

NHS care for under 18s

A different waiting list and referral system operates for under 18s wishing to access NHS gender services in England and Wales. There is a national waiting list for NHS Gender Services for Children and Young People – currently there are more than 5,600 people on the list. Some people have been on the waiting list since August 2018. You can find the most up to date information about the referral process on the National Referral Support Service website.

About our waiting time data

Waiting time information shown on this page is taken from information given directly to genderkit.org.uk by the services or from information published on their website. The waiting time information was last updated in April 2024. Waiting times indicate how long patients who have just been invited for an appointment have waited for. As demand is currently increasing over time, this means it is likely you will wait longer than the time shown on this page.

Transferring to a different waiting list

The following clinics will honour your original referral date if you transfer onto their waiting list. Please note, there are different arrangements for young people transferring to adult waiting lists.

• Cardiff – Welsh Gender Service
• Edinburgh – Chalmers Gender Identity Clinic
• Glasgow – Sandyford Gender Identity Clinic
• London -The Tavistock and Portman NHS Foundation Trust: Gender Identity Clinic for Adults

This information was based on information on the websites of the services when it was last checked, but you may wish to confirm what rules would apply to you by contacting the gender service yourself before arranging a transfer to them.

What is a pilot or new style clinic?

There were a number of pilot clinics in England, some of these are now out of their pilot phase. The purpose of these clinics is to explore a more holistic and comprehensive model of how gender clinics can function, with patient agency centred more in the process.

These clinics generally have a much shorter wait, but are only open to people who’ve already been referred to another clinic, and who meet particular requirements. Waits vary, usually depending on how long you’ve been on the waiting list for the other clinic.

How much will it cost?

British citizens are able to access the NHS and HSC gender services for free. If you are not a British citizen, you may still be able to access these services for free, and more details can be found on genderkit.org.uk ‘s Immigration page .

Patients in Wales being referred to gender services for children and young people will need to ask their GP to apply for funding from their local Health Board.

You may be able to get help with the cost of travelling to attending appointments at NHS or HSC gender services. Further information about travel costs can be found:

• on the NHS website (valid across the whole of the UK)
• on the Welsh Government website
• on the NGICNS website (Scotland only)
• on the HSC Northern Ireland website

More information about travel funding is also available on the London GIC website .

Where can I find more information?

https://www.nhs.uk/live-well/healthy-body/how-to-find-an-nhs-gender-identity-clinic/

https://www.ngicns.scot.nhs.uk/gender-identity-clinics/

https://clareproject.org.uk

https://www.nhs.uk/conditions/gender-dysphoria/

https://gires.org.uk

https://genderkit.org.uk/

https://www.england.nhs.uk/publication/service-specification-gender-identity-services-for-adults-non-surgical-interventions/

https://www.england.nhs.uk/publication/service-specification-gender-identity-services-for-adults-surgical-interventions/

Errors or omissions

Is there something missing from this page? Have you spotted something that isn’t correct? E-mail [email protected] to let us know.

Does something look familiar?

This page is based on information originally posted on  genderkit.org.uk  with permission.

A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of legal services.

Page last updated:

• UK Politics
• News Videos
• Paris 2024 Olympics
• Rugby Union
• Sport Videos
• John Rentoul
• Mary Dejevsky
• Andrew Grice
• Sean O’Grady
• Photography
• Theatre & Dance
• Culture Videos
• Fitness & Wellbeing
• Food & Drink
• Health & Families
• Royal Family
• Electric Vehicles
• Car Insurance Deals
• Lifestyle Videos
• Hotel Reviews
• News & Advice
• Simon Calder
• Australia & New Zealand
• South America
• C. America & Caribbean
• Middle East
• Politics Explained
• News Analysis
• Today’s Edition
• Home & Garden
• Broadband deals
• Fashion & Beauty
• Travel & Outdoors
• Sports & Fitness
• Climate 100
• Sustainable Living
• Climate Videos
• Solar Panels
• Behind The Headlines
• On The Ground
• Decomplicated
• You Ask The Questions
• Binge Watch
• Travel Smart
• Watch on your TV
• Crosswords & Puzzles
• Most Commented
• Newsletters
• Ask Me Anything
• Virtual Events
• Wine Offers
• Betting Sites

Thank you for registering

Please refresh the page or navigate to another page on the site to be automatically logged in Please refresh your browser to be logged in

Gender reversal surgery is more in-demand than ever before

But what are the consequences, article bookmarked.

Find your bookmarks in your Independent Premium section, under my profile

Stay ahead of the curve with our weekly guide to the latest trends, fashion, relationships and more

Gender reassignment surgery has been available on the NHS for more than 17 years.

It’s a treatment for those experiencing gender dysphoria, whereby a person recognises a discrepancy between their biological sex and their gender identity.

Gender identity clinics are in place throughout the UK to provide support to those feeling distressed by the condition - but what happens when a trans person undergoes surgery and later decides to revert back to their original gender?

Is it possible? Is it safe? And is it available on the NHS?

These are not questions that are not easily-answered. Five phone calls and endless emails later, the details regarding what circumstances would allow for such a treatment to be carried out on the NHS remain muddled.

It's potentially why some of those seeking “reversal” surgeries are heading to a clinic in Serbia, where Professor Misoslav Djordjevic has been performing them for five years at the Belgrade Center for Genital Reconstructive Surgery.

A specialist in genital reconstruction with 20 years of experience, Prof Djordjevic began conducting the innovative procedures after a transgender patient who had undergone surgery to remove male genitalia requested a reversal.

It's by no means a common practice. He has performed just 14 surgeries to date and is currently in the process of treating two “reversal” patients, reports The Daily Telegraph , explaining that the procedure is extremely complex and can cost up to €18,000 (£15,965).

However, his services aren't easily-accessed. Djordjevic will only treat patients who have undergone a full one-year-long psychiatric evaluation and he stresses the importance of post-surgery aftercare, revealing that he remains in contact with the majority of his patients.

It's not simply a case of people regretting their decision, explains James Morton, manager at the Scottish Trans Alliance , who told The Independent that a range of factors could catalyse the desire for a gender reversal including unusual surgical complications, being worn down by transphobic harassment, family rejection, or developing religious or political beliefs that being transgender is unacceptable.

"If a person has regret about undergoing gender reassignment, it is especially important that they receive counselling and in-depth assessment before undergoing any surgery to attempt partial reversal as their chance of regretting further surgery could be even higher," he said.

"Any further NHS surgery is determined on an individualised case by case basis because the numbers are so tiny."

So far, Djordjevic has exclusively treated transgender females who have asked to recreate their male genitalia.

Known as phalloplasty, the procedure entails the construction of a penis from skin taken from the groin, abdomen or thigh. Though the surgery produces aesthetic results, many mistakenly assume that it will ultimately render one’s genitalia physically futile.

However, a 2013 study revealed that the introduction of penile stiffeners has allowed some plastic surgeons to create a fully functioning organ.

It is a much more risky procedure than its male to female counterpart, vaginoplasty, whereby the testicles are removed and the skin of the penis is used to artificially create a vagina.

Whilst awareness of non-binary issues has increased in recent years, gender reassignment remains a severely under researched topic, so much so that the NHS has produced an online e-learning guide to GPs who might be unfamiliar with gender dysphoria.

The severe lack of understanding surrounding the topic - and its reversal counterpart - became particularly prevalent last week, when a proposed study to explore why transsexual people may want to “detransition” was reportedly shut down by Bath Spa University so as “not to offend people.”

“The fundamental reason given was that it might cause criticism of the research on social media and criticism of the research would be criticism of the university and they also added it was better not to offend people,” James Caspian, the psychotherapist behind the proposed research, told BBC Radio 4 .

He confessed to being “astonished” at the university’s decision.

As of 30 August, there were 213 patients on the list for gender reassignment surgery at Imperial College Healthcare NHS Trust .

At present, there are no statistics regarding gender reversal surgeries in the UK.

Join our commenting forum

Join thought-provoking conversations, follow other Independent readers and see their replies

You are here: Home > Services > Surgery services > Chelsea Centre for Gender Surgery (CCGS)

Chelsea Centre for Gender Surgery (CCGS)

Our Trust has been commissioned by NHS England to provide lower masculinising surgery (metoidioplasty and phalloplasty,) lower feminising surgery and masculinising top surgery. The Chelsea Centre for Gender Surgery is passionate about helping patients alleviate their gender dysphoria. We work with service specialists and the transgender community to deliver a high quality, patient centred service, supporting patients through their surgical journey. 

The Chelsea Centre for Gender Surgery service is based at the St Stephen Centre at our Chelsea site.

Get in touch

For more information, please visit the  Chelsea Centre for Gender Surgery  microsite. You can also contact us on the below email address. E:   [email protected]

• Gender identity
• Support while you wait
• Other sources of support while waiting
• Your feedback
• Accessing our service
• Your assessment
• Care and treatment
• What to expect during transition
• Legal matters
• For GPs and professionals
• For carers, family, friends
• Can I be referred to the clinic if I don’t live in Devon?
• What service is provided?
• How confidential is the service?
• Will you respect my point of view?
• What should I expect at the assessment?
• Tell me more about living in a social role that matches my gender identity
• Will I be offered hormone therapy?
• Do I have to have surgery?
• For people using our service

Transition involves a profound change in your life; this may seem daunting but we are here to help. There are a range of challenges to be addressed during your transition, so we’ve prepared a checklist to help you prepare.

This list is not exhaustive. Transition involves much, much more than the obvious medical interventions of hormone therapy and surgery. You will also need to consider its social and legal implications, from formally changing your name through to dealing with the emotional aspects of informing family and friends.

Helpful hints for transition

• You will be provided with a great deal of new information about gender identity issues by the clinic. We recommend that you keep this and all correspondence relating to your treatment in a file, to support your Gender Recognition Certificate application in the future, should this be required. 
• Living life in your new social role may be very different to your current life and you are likely to have many new experiences; be ready for change and for some challenging situations. Ask your Named Professional for help if you feel overwhelmed by everything; difficult challenges can be overcome with help.
• Medication and hormone treatment may be offered. We strongly discourage self-medication with irregularly sourced drug treatments. Internet-sourced hormone therapies can be dangerous and are sometimes contaminated. Their use is likely to affect blood test results and, if our medical team are unaware of your self-medication, they may inadvertently offer inappropriate advice or recommend unnecessary investigation. Please, be honest with us. 
• Gender reassignment surgery (GRS) cannot be provided until you have lived in a social role appropriate to your gender identity for at least twelve months. 
• At some point, you will want to tell other people about your transition. We can advise you on how to carefully and sensitively inform all those who need to know about your transition, from family members to employers. Employers have legal responsibilities to protect you and Unite have written a guide on Trans Equality at Work, click here to view the Trans Equality at Work Guide . 
• You may be eligible for NHS-funded treatment to reduce your facial hair (epilation).  There is a limit to the amount of treatment funded by the NHS and there is no guarantee that this will reduce your facial hair to your complete satisfaction. If you want additional or future epilation treatment, you will have to pay for this yourself. We can advise you about this.
• Your pension and any benefits arrangements might be affected if you’re a transgender. Seek advice from your private provider and/or the Department of Works and Pensions .  
• Appropriate use of pronouns may become an issue. Politely advise people of your preferred pronoun.
• Transphobic hate incidents may happen and can take many forms including verbal and physical abuse through to threatening behaviour and online abuse.  Transphobic hate crime is a criminal offence.
• As you prepare for your new life you may require assistance with clothing, footwear, wigs, and cosmetics. You may also need guidance with this, your Named Professional will be able to provide advice on all these matters.

In this section

• Gender identity information

You appear to be using an old version of Internet Explorer, which is not supported by our website — so you may find some parts of the page don't display correctly. Please upgrade to the latest version of Internet Explorer, or use an alternative browser such as Chrome or Firefox , for an improved experience.

Take a look at our quality and safety measures (including PSIRF) and  CQC ratings .

The highest standards of clinical care in state-of-the-art facilities, with Consultant-led treatment, spotlessly clean rooms, and a team of dedicated and experienced nurses.

• Our Hospitals
• Tests and scans
• Book your consultation
• For Healthcare Professionals
• Payment and Insurance

Ways to pay

Paying for yourself, medical insurance.

• Personal medical loans
• Supporting information
• Patient information
• NHS Patients
• Medical assurance
• Case reviews and procedural changes
• Handling complaints
• Open events

Find out if you benefit from a discounted membership .

The most important thing to us is getting you fit and healthy with our network of fitness experts and cutting-edge facilities.

• Our Locations
• Gyms in London
• Book a tour
• Pricing and Membership
• Vitality Discount
• AXA Health Discount
• Advice for New Members
• Services and Facilities
• Gym services
• Exercise classes
• Swimming Lessons & Classes
• Personal Training
• Squash Courts
• Crèche

Take a look at our quality and safety measures (including PSIRF) for our clinical services.

Nuffield Health looks after your health and wellbeing in ways that go beyond getting you fit and getting you back on your feet, that's what makes us specialists in you.

• Connected Care
• Health Assessments
• Physiotherapy
• Private GP Service
• Pathology Direct
• Mental Health Support
• Nuffy Bear Day Nursery
• Medical Centres
• Beauty Suites

Browse  our articles  to find trusted information on training, nutrition, getting back to good health and much more.

Use our list of health topics to reach your destination faster.

• Health Topics
• Back and neck
• Cosmetic surgery
• Mental health
• Family health
• Men's health
• Women's health
• Stomach, bowel and bladder
• Vision and eye surgery
• Fertility treatment
• Prostate health
• Weight loss advice
• Sports training and injury

Gender reassignment surgery

Or call us on

Nuffield Health promise

Our prices are all-inclusive. We will equal any comparable price. There are no time limits on your aftercare.

There are no hidden costs in our treatment prices. The price you see is the price you pay.

We work with you and your insurance provider to get you the treatment you need quickly

Related articles

20 life hacks to turn your health around, how to build a healthy lunch, how to build a healthy dinner, how music therapist claire found inspiration in swimming, i have cancer. can i still workout.

• Media centre
• Corporate healthcare
• Terms and conditions
• Privacy policy
• © 2024 Nuffield Health

+44 204 513 2244

[email protected]

Proud to be a part of your gender journey

#myltcjourney.

Help me start my journey

Friends & Family

Healthcare Professionals & Employers

Meet Mr. Inglefield

Education, treatment, and support to achieve lasting contentment with your gendered self.

I established The London Transgender Clinic in 2015 in response to a noticeable increase in enquires from transgender and non-binary patients. Many of these patients were unable to access quality and timely care from the overwhelmed NHS gender services, resulting in high levels of anxiety and stress with suicide and self-harm a major risk. With 15 years of experience in transgender surgery, I wanted to set up a dedicated specialist team providing holistic care to enable individuals to get to the next stepping stone of their transition, with many services provided under one roof.

My team and I are proud to be part of the journey of so many and the positive feedback received over the years has been incredibly motivating. Many praise the exceptionally high standards of care and their improved confidence, health, and overall wellbeing.

This has spurred me to do more and the future is exciting. We will continue to set up our Centre of Excellence using the latest research and innovative technologies. The goal is to treat, support, train and educate the wider community including patients, family, friends, other health professionals, and employers. Plans include the opening of new clinics in Hatfield, Manchester, and Dublin.

We are internationally recognised for our extraordinary patient care and outstanding surgical results. Mr Inglefield and his team prioritise safety and use advanced surgical techniques with cutting edge technology.

Patient Testimonials

"After 9460 days in the wrong body, Christopher Inglefield and the amazing team at London Transgender Clinic changed my life forever. All my life, I never got to develop a relationship with my body because I knew all along it wasn’t mine to begin with. I existed through the years in a survival mode where living in my head became the only place I felt free to be me and so good at it I became that my external reality didn’t matter. Until one day I decided it did! From first flicking that switch in my head, to having my first consultation, to right up until and after my surgery - the entire team have been nothing short of incredible.I didn’t have much of a life before, but now I have a future and for that I’ll forever be grateful"

"When I arrived I was pleased with the cleanliness of the the clinic. I then met Natalie who was carrying out my appointment. She made me feel really relaxed and comfortable. I really enjoyed my time with Natalie as she made the effort to chat with me and made sure I understood everything that was going on. My appointment went well and I can't fault anything. I am looking forward to returning to the London transgender clinic. "

"I spoke with Natalie and Mary Burke and they were absolutely lovely and very professional. Everything I needed to do and bring was made clear, and they were fast, efficient, friendly and so helpful! Would really recommend them. "

Be the first to find out about our latest procedures, research, news and offers.

@londontransclinic

Londontransclinic.

• Skip to primary navigation
• Skip to main content
• Skip to primary sidebar
• Fotona 4D Laser Facelift
• SmoothEye Laser Treatment
• Lip Laser Treatment (LipLase)
• Erbium Laser Skin Resurfacing
• Laser TightSculpting
• Laser Skin Tightening
• Laser Cellulite Treatment
• Laser Acne Treatment
• Rosacea Laser Treatment
• Facial Thread Vein Removal
• Periorbital Vein Laser Treatment
• Veins Under Eyes
• Nose Thread Vein Removal
• Venous Lake Removal
• Cherry Angioma Removal
• Laser Pigmentation Treatment
• Melasma Laser Treatment
• Age Spot Removal
• Laser Mole Removal
• Xanthelasma Removal
• Sebaceous Hyperplasia Removal
• Syringoma Removal
• Milia Removal
• Wart Removal
• Verruca Removal
• Seborrhoeic Keratosis Removal
• Dermatosis Papulosa Nigra Removal
• Actinic Keratosis Treatment
• Laser Fungal Nail Treatment
• Laser Scar Removal
• Laser Stretch Mark Removal (LineLase)
• Laser Snoring Treatment (NightLase)
• Vaginal Laser Treatment
• Laser Intimate Whitening
• Morpheus8 (RF Microneedling)
• Skin Boosters
• Profhilo Treatment
• Anti Wrinkle Injections
• Frown Lines
• Forehead Wrinkles
• Crow’s Feet
• Bunny Lines
• Gummy Smile
• Jaw Slimming Injections
• Anti Sweat Injections
• Muscle Relaxant Injections for Migraine
• Dermal Fillers
• Facial Fillers
• Lip Fillers
• Cheek Fillers
• Nasolabial Folds
• Marionette Lines
• Chin Fillers
• Jawline Fillers
• Temple Filler
• Tear Trough Filler (Under Eye Filler)
• Non Surgical Rhinoplasty
• Liquid Facelift (8 Point Lift)
• Filler Dissolving Treatment
• Double Chin Injections
• Thread Lift
• Skin Lesion Removal
• Facial Skin Lesion Removal
• Lip Lesion Removal
• Skin Tag Removal
• Mole Removal Surgery
• Cyst Removal Surgery
• Lipoma Removal Surgery
• Dermatofibroma Removal
• Pyogenic Granuloma Removal
• Skin Cancer Surgery
• Osteoma Removal
• Rhinophyma Surgery
• Surgical Tattoo Removal
• Scar Revision Surgery
• Facial Scar Revision
• Micro & Nano Fat Grafting
• Acne Scar Removal
• Hypertrophic Scar Treatment
• Keloid Scar Treatment
• Burn Scars Treatment
• Subcision for Cellulite
• Suction Curettage Hyperhidrosis Treatment
• Rhinoplasty (Nose Job)
• Tip Rhinoplasty (Tip Plasty)
• Alar Base Reduction (Alarplasty)
• Septoplasty
• Turbinate Reduction
• Septorhinoplasty
• Ethnic Rhinoplasty
• Ultrasonic Rhinoplasty
• Preservation Rhinoplasty
• Revision Rhinoplasty
• Male Rhinoplasty (Nose Job for Men)
• Nose Surgery FAQs
• Rhinoplasty Gallery
• Nose Thread Lift
• Blepharoplasty (Eyelid Surgery)
• Upper Eyelid Surgery
• Lower Eyelid Surgery
• Canthoplasty (Almond Eye Surgery)
• Asian Blepharoplasty (Double Eyelid Surgery)
• Revision Blepharoplasty
• Male Eyelid Surgery (Blepharoplasty for Men)
• Eyelid Surgery FAQs
• Blepharoplasty Gallery
• Brow Lift (Forehead Lift)
• Endoscopic Brow Lift
• Temporal Brow Lift (Lateral Brow Lift)
• Brow Lift vs Blepharoplasty
• Hairline Lowering (Forehead Reduction)
• Facelift (Rhytidectomy)
• SMAS Facelift
• Deep Plane Facelift
• Facial Fat Transfer
• Upper Facelift (Forehead Lift)
• Mid Facelift (Cheek Lift)
• Lower Facelift (Jowl Lift)
• Mini Facelift
• One Stitch Facelift
• Male Facelift
• Mini Neck Lift
• Male Neck Lift
• Chin & Neck Liposuction
• Lip Reduction Surgery
• Dimple Creation (Dimpleplasty)
• Buccal Fat Removal (Bichectomy)
• Chin Surgery (Genioplasty)
• Chin Augmentation
• Chin Reduction
• Male Chin Surgery
• Otoplasty FAQs
• Earlobe Repair
• Earlobe Reduction
• Breast Augmentation with Implants
• Mini Boob Job (Mini Breast Augmentation)
• Breast Implant Options
• Breast Implant Check
• Breast Implant Removal (Explant)
• Breast Implant Removal & Breast Lift
• Breast Implant Replacement
• Breast Implant Revision
• Fat Transfer Breast Augmentation
• Hybrid Breast Augmentation
• Breast Lift (Mastopexy)
• Breast Lift with Implants
• Breast Lift with Auto-Augmentation
• Mini Breast Lift (Doughnut Mastopexy)
• Breast Reduction
• Liposuction Breast Reduction
• Inverted Nipple Correction
• Nipple Reduction
• Areola Reduction
• Breast Asymmetry Correction
• Tuberous Breast Correction
• Male Breast Reduction
• Gynecomastia Surgery
• Liposuction
• Stomach Liposuction (Tummy Lipo)
• 360 Liposuction
• Micro Liposuction (MicroLipo)
• Cellulite Treatment
• Male Liposuction
• High Definition Liposuction (HD Lipo)
• Abdominal Etching
• Tummy Tuck (Abdominoplasty)
• Brazilian Tummy Tuck (Lipoabdominoplasty)
• Mini Tummy Tuck
• Male Tummy Tuck (Abdominoplasty for Men)
• Umbilicoplasty (Belly Button Surgery)
• Mons Lift (Monsplasty)
• C Section Scar Revision
• Body Contouring Procedures
• Fat Transfer (Fat Grafting)
• Mummy Makeover
• Pectoral Implants
• Chest Wall Implants
• Calf Augmentation with Implants
• Fat Transfer Calf Augmentation
• Brazilian Butt Lift (BBL Surgery)
• Ultrasound Guided BBL
• 360 Lipo and BBL
• Revision BBL
• Male BBL (Brazilian Butt Lift for Men)
• Brazilian Butt Lift FAQs
• Brazilian Butt Lift (BBL) Photos
• BBL Recovery Guide
• Non-Surgical Butt Lift (HYAcorp)
• Buttock Implants
• Butt Implant Removal
• Butt Implants vs BBL
• Labiaplasty (Labia Reduction)
• Clitoral Hood Reduction (Hoodectomy)
• Labiaplasty Photo Gallery
• Labiaplasty FAQs
• Labiaplasty Revision & Reconstruction
• Vaginoplasty (Vaginal Tightening Surgery)
• Perineoplasty
• Pelvic Floor Repair
• Vaginal Rejuvenation
• Non Surgical Vaginal Tightening
• IntimaLase (Vaginal Tightening)
• IncontiLase (Urinary Incontinence)
• ProlapLase (Pelvic Prolapse)
• RenovaLase (Vaginal Dryness)
• Labia Puffing (Labial Puff)
• O Shot Injection
• G Spot Injection (G Shot)
• Mummy Makeover Photo Gallery
• Mummy Makeover FAQs
• Body Contouring After Weight Loss
• Excess Skin Removal Surgery
• Extended Tummy Tuck
• Fleur de Lis Tummy Tuck
• Apronectomy (Panniculectomy)
• Arm Lift (Brachioplasty)
• Thigh Lift (Thigh Reduction)
• Buttock Lift (Gluteal Lift)
• Lower Back Lift
• Bra Line Back Lift
• Upper Body Lift
• Lower Body Lift
• Belt Lipectomy
• Male Body Lift
• Male Liposuction (Lipo for Men)

Gender Affirmation Surgery

• WPATH Letter for Top Surgery
• Transgender Surgery FAQs
• MTF Top Surgery
• FTM/N Top Surgery
• Double Incision Top Surgery
• Keyhole Top Surgery
• FTM Top Surgery Before & After Photos
• FTM/N Top Surgery FAQs
• Body Masculinisation Surgery
• Facial Feminisation Surgery (FFS)
• Tracheal Shave (Adams Apple Reduction)
• Choosing Your Ideal Surgery Date
• Preparing for Cosmetic Surgery
• Pre-Surgery FAQs
• Anaesthesia for Cosmetic Surgery
• Recovery after Cosmetic Surgery
• Exercising After Cosmetic Surgery
• Post-Surgery Top Tips
• Cosmetic Surgery Risks
• FAQs After Cosmetic Surgery
• Nose Reshaping Surgery
• Facial Plastic Surgery
• Aesthetic Breast Surgery
• Body Contouring Surgery
• Cosmetic Gynaecology Surgery
• Post Pregnancy Surgery
• Post Weight Loss Surgery
• Male Plastic Surgery
• Facelift Surgery FAQs
• Neck Lift FAQs
• Breast Augmentation FAQs
• Breast Lift FAQs
• Breast Reduction FAQs
• Fat Transfer Breast Augmentation FAQs
• Breast Implant Removal FAQs
• Gynecomastia Surgery FAQs
• Liposuction FAQs
• Tummy Tuck FAQs
• Vaginoplasty FAQs
• Arm Lift FAQs
• Thigh Lift FAQs
• Extended Tummy Tuck FAQs
• Body Lift Surgery FAQs
• Eyelid Surgery
• Otoplasty (Ear Reshaping)
• Breast Augmentation
• Brazilian Butt Lift (BBL)
• Labiaplasty
• Calf Augmentation
• About Centre for Surgery
• Clinic FAQs
• Baker Street Clinic
• Meet The Team
• Choosing Your Surgeon
• Pre-Consultation Check List
• Cosmetic Surgery Consultations
• Your Financing Options
• Your Patient Journey
• Day Surgery Benefits
• Cookie Policy
• Website Terms & Conditions
• Privacy Policy
• Complaints Policy
• Care Quality Commission

Gender affirmation surgery  helps people change their bodies with plastic surgery to match their true identity. Centre for Surgery is considered one of the leading gender surgery clinics in the UK, specialising in gender-affirming surgery. Our specialist plastic surgeons have years of experience in gender surgery and MTF & FTM Top surgery to help you achieve optimal results.

RELATED:  Evolution of Transgender Healthcare in the UK

How  Gender Affirmation Surgery  Works

Gender affirmation surgery is an umbrella term that encompasses a broad range of procedures designed to help individuals transition from their assigned sex at birth to the gender with which they identify. At Centre for Surgery, we offer various procedures, ensuring our patients receive comprehensive, personalised, and compassionate care.

Top surgery, which can involve either breast augmentation or mastectomy, is a critical step for many in their transition journey. For trans women, breast augmentation adds volume and shape, facilitating a more feminine appearance. Conversely, for trans men, mastectomy involves the removal of breast tissue, thereby masculinising the chest area. These procedures are designed with the utmost care to ensure patients feel comfortable in their bodies and achieve a result that reflects their gender identity.

Body contouring surgery is another procedure we offer, focusing on creating a physique that aligns with one’s gender identity. This could involve liposuction , fat grafting, or body implants, and these procedures vary widely based on the individual’s needs. For instance, trans women might undergo liposuction or fat grafting to redistribute body fat to more traditionally feminine areas such as the hips and buttocks. On the other hand, trans men might seek procedures that add more definition to the waist or create a more V-shaped torso.

The benefits of these procedures extend far beyond physical transformation. Research shows a direct correlation between gender affirmation surgery and positive impacts on mental health. Individuals who have undergone these procedures often report a decrease in feelings of gender dysphoria, depression, anxiety, and suicidal ideation. In fact, many patients also experience an improvement in self-esteem, social functioning, and overall quality of life.

Despite these clear benefits, the decision to undergo gender affirmation surgery is a significant one and should not be taken lightly. Our dedicated team of experts at Centre for Surgery is committed to providing each patient with the support, guidance, and care they need throughout their transition. Our main goal is not just to offer surgical solutions but to ensure each patient feels affirmed, respected, and understood on their unique journey.

Gender affirmation surgery can be life-changing in the most profound way, marking a critical milestone in one’s journey towards self-acceptance and authenticity. At Centre for Surgery, we take great pride in helping our patients take this vital step, promoting a future of health, happiness, and congruence between one’s body and identity.

What is Top surgery?

Top surgery is a term used to refer to a variety of surgical procedures that can be performed on the chest area, typically for transgender and non-binary individuals. The most common type of top surgery is a bilateral mastectomy , which is the surgical removal of both breasts. This procedure is also known as “top surgery” and is performed to remove breast tissue and create a more masculine-appearing chest.

Other types of top surgeries include keyhole top surgery , peri-areolar incision, and double incision. The type of surgery that is appropriate for an individual will depend on their individual goals, anatomy, and physical characteristics.

RELATED:  FTM Top Surgery FAQs

Top surgery is a significant decision and should be made after careful consideration, research and discussions with a qualified and experienced surgeon, as well as with your mental healthcare provider. It is also important to be aware that top surgery is not reversible, and it’s important to have realistic expectations about the results.

Additionally, top surgery is not always covered by insurance, and patients may need to pay for the surgery out of pocket. Each insurance company has its own policies regarding coverage for gender-affirming surgery, and it’s important to check with your insurance provider to find out what your options are.

RELATED: How Much Does FTM Top Surgery Cost in the UK?

MTF Top Surgery and FTM Top Surgery

There are two main types of top surgery. MTF/N Top surgery and FTM/N Top surgery . MTF top surgery involves placing breast implants beneath the pectoralis muscle to feminise the chest and breasts. Female to male (FTM) Top surgery involves surgically removing glandular tissue and skin to masculinise the chest. Top surgery is most commonly performed after a program of hormone therapy. Other surgical procedures can then be performed to improve body contour.

Benefits of gender affirmation surgery

Gender affirmation Surgery, also known as gender confirmation surgery, can bring several benefits for patients, including:

• Effective treatment of gender dysphoria
• Improvement in the mental state with a reduction in anxiety and depression symptoms
• A boost in self-confidence with improved emotional well-being.

RELATED: Transgender Surgery FAQs – What to Consider Before Getting Top Surgery

Am I suitable for gender affirming surgery?

People who would like to undergo surgery to enhance their gender identity may be suitable candidates for gender confirmation surgery. All types of gender surgery are surgically invasive procedures which require a period of recovery. Your surgeon will assess you thoroughly to ensure you are in the best possible state of health before having surgery. There are several criteria which your surgeon will take into account when determining your suitability for gender affirmation surgery:

• Mentally and physically healthy with no chronic medical conditions
• Are over the age of 18 and have the capacity to consent to surgery
• Do not have a serious allergy to the prosthetic materials used in gender surgery
• Are non-smokers or are willing to stop smoking at least six weeks before surgery
• Have undertaken a 10 to 12-month course of hormone therapy prior to surgery.
• Have a confirmed diagnosis of gender dysphoria or are suffering from gender identity disorder.
• Have a healthy body mass index (BMI) below 30 to minimise the risk of complications during and after surgery.
• Have undergone a detailed psychological assessment.

You will receive detailed preoperative information on how to prepare for gender surgery and top surgery. You should stop any medicines containing aspirin as this can increase the risk of bleeding during and after surgery. You may also be asked to stop other medications, including herbal supplements, before the procedure.

How to Prepare for Gender Affirmation Surgery

Preparing for gender affirmation surgery is a complex process, requiring a holistic approach to ensure optimal physical and mental health before, during, and after the procedure. At the Centre for Surgery, our dedicated team will guide you through this process, providing expert advice and support every step of the way.

Physical Preparation

Optimising your physical health prior to surgery is crucial. Adopting a balanced, nutritious diet and engaging in regular exercise can significantly improve your body’s healing capabilities. Refraining from smoking at least one month before surgery is paramount as nicotine can hinder blood flow, delaying recovery. Limiting alcohol and caffeine consumption can also promote better healing. Certain medications, particularly those affecting clotting, might need to be discontinued before the procedure. We will provide a comprehensive list of these and will review your current medications during our consultations.

Mental Preparation

Preparing emotionally for gender affirmation surgery is equally essential. It’s entirely normal to experience anxiety or stress leading up to your surgery. Booking appointments with your therapist or mental health professional or simply discussing your feelings with supportive friends or family can help manage these emotions. Don’t hesitate to reach out to your surgical team with any questions or concerns you might have. We’re here to provide reassurance and guidance to ease any worries you may have about the procedure.

Work Considerations

Recovery times for gender affirmation surgeries can vary, and it’s important to plan accordingly. Depending on the nature of your job, you may need to take an extended leave. Desk-based jobs can often be resumed about one week post-surgery, but physically demanding roles might require a longer recovery period.

Setting up Your Recovery Space

Planning your post-operative environment is crucial for a comfortable recovery. Prescriptions for any required medication should be filled in advance, ensuring you have what you need immediately after surgery. Positioning essential items like toiletries, medications, and frequently used items at a lower level can help reduce the need for straining movements during recovery. Also, consider pre-preparing meals or arranging help for the first few days post-surgery when movement may be more difficult.

Preparing for gender affirmation surgery can feel overwhelming, but remember, you’re not alone in this journey. At Centre for Surgery, our experienced team is with you every step of the way, ensuring that your transition process is as smooth and stress-free as possible. Your comfort, health, and well-being are our top priorities.

What does Gender Affirmation Surgery involve?

Gender affirmation surgery encompasses several different types of surgical procedures. Top surgery involves changing the appearance of the chest with breast implants as part of an MTF procedure or with surgical excision as part of FTM surgery. Your surgeon will discuss the precise surgical steps during your consultation. Gender surgery is routinely performed under general anaesthesia, which means you will be asleep throughout the procedure. You will need to be in a good state of health before undergoing general anaesthesia. You will have a pre-operative medical assessment with a member of our nursing team to assess your blood pressure and rule out other serious medical conditions. Top surgery takes 2 to 3 hours to perform, depending on the extent of surgical correction required. Once the procedure is complete, you will recover in our dedicated recovery area until you are fit for discharge later the same day. You will need a responsible adult escort to take you home and look after you for the first few days after surgery.

Recovery after Gender Affirmation Surgery

Recovery after top surgery involves taking it easy for the first few days to allow your upper body to heal properly. You should avoid excessive movement of your arms and shoulders to minimise stress on the incision lines. You will need someone to drive you home after surgery, and it is sensible to prepare a dedicated area of your home for rest and recovery. It is normal to experience mild discomfort during the first two weeks after surgery. You should take the prescription painkillers as directed by your surgeon.

• Recovery after MTF Top Surgery – What to Expect
• Recovery after FTM Top Surgery – Top Tips after Breast Removal Surgery

Most types of gender affirmation surgery are surgically invasive procedures which can take several hours to perform. This is why we would recommend taking at least two weeks off work for early recovery. The first few days after surgery will involve feeling sore, and it is important to keep mobile around the home to minimise the risk of blood clots. You should take the antibiotic and painkiller medication as directed by the surgeon. You may also be given a compression garment to wear continuously after surgery. They should be worn for at least six weeks. You should avoid getting your dressings wet to minimise the risk of infection. Sudden movements should be avoided to minimise wound breakdown. Lifting heavy objects should be avoided for a minimum of two months.

Exercise, including going to the gym, should be avoided for at least eight weeks. Always listen to your body and try to avoid doing too much too soon. If you have a sedentary occupation, you may return to work after two weeks if this is desk-based. More demanding physical occupations should lead you to take at least four weeks off work.

Results of gender surgery take time to develop as there will be considerable bruising and swelling after surgery. Ice packs can be used for the first three days to control localised bruising and swelling. Once the swelling begins to disappear after approximately three weeks, you should begin to see the initial results of surgery. It can take three to six months for all swelling to disappear, and you will be able to appreciate the surgery results by this time.

How much does gender surgery cost in London?

The cost of gender affirmation surgery in London will be determined by the type and extent of surgery undertaken. Once you have an in-person consultation, you will be seen by your dedicated patient coordinator, who will give you a detailed quotation which includes the total costs of surgery.

RELATED: How Much Does MTF & FTM Top Surgery Cost In London?

Top surgery costs include surgical fees, anaesthetic fees, and facility fees. Preoperative and post-operative care are included in the total cost of Surgery. Call us today to get an approximate price estimate on 020 7993 4849 and speak to one of our friendly and knowledgeable patient coordinators.

Gender Affirmation Surgery FAQS

What is gender dysphoria?

Gender dysphoria is a condition in which an individual experiences significant distress or discomfort as a result of the sex and/or gender they were assigned at birth. This discomfort with one’s own body can manifest in a variety of ways. It may include a desire to be treated as the opposite gender, a desire to be rid of one’s primary or secondary sex characteristics, or a general sense of unease or dissatisfaction with one’s sex or gender.

Individuals with gender dysphoria may feel that they are trapped in a body that does not match their gender identity and may experience a range of negative emotions such as anxiety, depression, and/or shame. They may also experience social isolation, discrimination, and a lack of acceptance from others.

Treatment for gender dysphoria can include counselling and therapy, hormone therapy, and/or surgery. It’s important to note that not all individuals with gender dysphoria choose to undergo medical intervention, and some may find relief through other means, such as social transition or support groups.

How is gender affirmation surgery different from sex reassignment surgery (SRS)?

Language and terminology around transgender healthcare have evolved significantly over the years. Today, many people prefer the term “gender affirmation surgery” over “sex reassignment surgery” (SRS). The rationale behind this shift in terminology is tied to a broader recognition of individuals’ lived experiences and identities.

The term “sex reassignment surgery” comes from a medical model that assumes a person is born with a sex that is then reassigned through surgical intervention. It posits that the individual is changing their sex and, by extension, their gender. This viewpoint, however, fails to recognise that many transgender and non-binary individuals identify with a specific gender long before any surgical intervention takes place. Therefore, the suggestion of ‘reassignment’ may seem reductive or invalidating to some individuals.

On the other hand, “gender affirmation surgery” reflects a more contemporary understanding of gender as an innate aspect of one’s identity that can be distinct from biological or assigned sex. This term signifies that the surgical procedures involved are not about ‘reassigning’ or ‘changing’ one’s sex or gender, but rather about affirming and recognising an individual’s self-identified gender.

Despite the differences in their connotations, both terms refer to the same group of surgical procedures. These include top surgeries (like mastectomy or breast augmentation), bottom surgeries (like vaginoplasty, phalloplasty, or metoidioplasty), and other procedures that aid in aligning an individual’s physical characteristics with their gender identity. The choice of terminology is mainly about respect, acknowledgement, and affirming the identities of those undergoing these procedures.

What is the minimum age to qualify for gender confirmation surgery?

You need to be a minimum of 18 years of age to have gender surgery.

Will I need to stop smoking before gender surgery?

Yes, you will need to stop smoking at least six weeks before surgery to minimise the risk of wound healing complications.

Is gender reassignment painful?

Gender surgery is performed under a general anaesthetic, which means you’ll be comfortable throughout the procedure. You will be prescribed prescription painkillers to minimise any pain and discomfort after surgery.

What are the potential risks and complications of gender confirmation surgery?

All types of surgery involve risks, and gender surgery is no different. Your surgeon will discuss the potential risks and complications of gender surgery at your in-person consultation.

Will I get scars after Top surgery?

All surgical procedures involving an incision will result in a scar. Our plastic surgeons are highly experienced in positioning scars to minimise their appearance.

Can I still have children after gender affirmation surgery?

Assigned females at birth (AFAB) individuals who undergo top surgery and body contouring, but do not have bottom surgery or hysterectomy (removal of the uterus and ovaries), can still potentially become pregnant. They retain their reproductive organs, and therefore, their capacity to bear children remains intact, assuming no other fertility issues are present.

However, it is important to consider that the hormones used for gender transition might have an effect on fertility. Androgen therapy, often used for female-to-male transitions, can interrupt menstrual cycles and potentially impact fertility. Before starting any hormone therapy, it’s crucial to have a discussion with your healthcare provider about family planning and fertility preservation options.

For assigned males at birth (AMAB) who transition to female and wish to have biological children, considerations are different. Before hormone therapy or bottom surgery (which typically includes removal of the testes), sperm banking or cryopreservation is a common approach for preserving future fertility options.

We can guide you on your options and help you make an informed decision that aligns with your family planning goals and transition journey. Fertility preservation, surrogacy, and adoption are all potential paths to parenthood. The decision is personal, and our team can provide guidance and support to make the choice that is best for you.

What kind of care can I expect as a transgender indivdual?

At Centre for Surgery, we are committed to providing inclusive, compassionate, and comprehensive care for all our patients, including those from the transgender and non-binary communities. Our approach is grounded in respecting and acknowledging your personal experiences, gender identity, and unique medical needs.

First and foremost, we prioritise creating a safe and welcoming environment. You can expect to be treated with dignity, empathy, and respect at all times, and we’ll use your affirmed name and pronouns in all our interactions. All staff, from reception to surgical teams, are trained in cultural competency and sensitive to the specific needs of transgender individuals.

In terms of medical care, we offer a range of services tailored to the needs of transgender and non-binary individuals, from hormonal management to gender affirmation surgeries such as top surgery and body contouring procedures. Our team of experienced surgeons and practitioners are well-versed in these procedures and follows the latest research and best practices to provide the highest standard of care.

We understand that mental health support is a critical part of transgender healthcare, so we ensure that you have access to appropriate resources, including counselling or therapy, to support you during your transition journey. We’re also prepared to coordinate with other healthcare providers, such as your hormone specialist or mental health professional, to provide a comprehensive care plan.

Education and communication are key aspects of our approach. We will provide thorough explanations about any proposed treatments, ensuring you’re well-informed about all aspects of your care. We encourage open dialogue, inviting all your questions and concerns, to help you make the best decisions for your health and wellbeing.

At Centre for Surgery, our commitment to your care extends beyond your medical treatment. We strive to support you holistically throughout your journey, acknowledging your individual experiences and unique transition path. Your comfort, confidence, and health are our ultimate priority.

Is gender affirmation surgery worth it?

Deciding whether or not to undergo gender affirmation surgery, also known as gender confirmation surgery, is a highly personal decision that can be based on a variety of factors.

For some individuals with gender dysphoria, surgery can be an important step in their journey towards aligning their physical body with their gender identity, and can provide significant relief from the distress and discomfort associated with gender dysphoria.

Surgery can also improve an individual’s quality of life, and allow them to live in a way that feels authentic to them. It’s also important to remember that physical transition may be necessary for some individuals to feel comfortable in their bodies and be able to express their gender identity.

Centre for Surgery: Premier Destination for Gender Affirmation Surgery in London

Centre for Surgery distinguishes itself as a specialist plastic surgery clinic with a core focus on providing high-quality gender affirmation surgeries. We’re conveniently located in London and house some of the industry’s most skilled and experienced plastic surgeons. Our dedicated team of professionals specialise in both Male to Female (MTF) and Female to Male (FTM) Top Surgery, delivering excellent care to those seeking to align their physical appearance with their gender identity.

Our surgeons possess a deep understanding of the unique nuances of transgender health care. Leveraging their extensive experience, they provide a comprehensive range of gender affirmation procedures, delivering results that prioritise natural appearance, functionality, and overall well-being of our patients.

In our state-of-the-art facilities, we employ the latest medical technologies and adhere to the highest surgical standards, offering a high level of precision and safety in all our procedures. Our priority is ensuring you receive the best care throughout your journey – from your first consultation, through to surgery and beyond, into post-operative care and recovery.

At Centre for Surgery, we understand that seeking gender affirmation surgery is a significant step in one’s journey of transition. Therefore, we are dedicated to creating a supportive, respectful, and empathetic environment. We’re here to help you navigate your path, providing guidance, assurance, and quality medical care every step of the way.

Embark on your transition journey with us – a trusted partner committed to your well-being and success.

Start your journey with us today

If you have a question about a treatment, or you would like to find out more about how we can help you, call us on 0207 993 4849 or fill in the form below and one of our patient care coordinators will contact you to book a consultation with a specialist practitioner

Subscribe to our newsletter for the latest updates and special offers

To continue, please confirm you have read and understood our Privacy Policy

PLEASE NOTE: we may not be able to process your enquiry without a valid mobile number.

Ask The Expert

How to Avoid Dog Ears After FTM Double Incision Mastectomy

Benefits of Combining FTM Top Surgery with Chest Contouring

How Much Does FTM Top Surgery Cost in the UK?

How to Enhance Your FTM Top Surgery Results

Sign up to our newsletter.

I agree to receive marketing communications from Centre for Surgery ( more information )

The NHS Ends the "Gender-Affirmative Care Model" for Youth in England

Following extensive stakeholder engagement and a systematic review of evidence , England’s National Health Service (NHS) has issued new draft guidance for the treatment of gender dysphoria in minors, which sharply deviates from the “gender-affirming” approach. The previous presumption that gender dysphoric youth <18 need specialty “transgender healthcare” has been supplanted by the developmentally-informed position that most need psychoeducation and psychotherapy. Eligibility determination for medical interventions will be made by a centralized Service and puberty blockers will be delivered only in research protocol settings. The abandonment of the "gender-affirming" model by England had been foreshadowed by The Cass Review's interim report , which defined "affirmative model" as a "model of gender healthcare that originated in the USA."

The reasons for the restructuring of gender services for minors in England are 4-fold. They include (1) a significant and sharp rise in referrals; (2) poorly-understood marked changes in the types of patients referred; (3) scarce and inconclusive evidence to support clinical decision-making, and (4) operational failures of the single gender clinic model, as evidenced by long wait times for initial assessment, and overall concern with the clinical approach.

The new NHS guidance recognizes social transition as a form of psychosocial intervention and not a neutral act, as it may have significant effects on psychological functioning. The NHS strongly discourages social transition in children, and clarifies that social transition in adolescents should only be pursued in order to alleviate or prevent clinically-significant distress or significant impairment in social functioning , and following an explicit informed consent process . The NHS states that puberty blockers can only be administered in formal research settings, due to the unknown effects of these interventions and the potential for harm. The NHS has not made an explicit statement about cross-sex hormones , but signaled that they too will likely only be available in research settings. The guidelines do not mention surgery , as surgery has never been a covered benefit under England’s NHS for minors.  

The new NHS guidelines represent a repudiation of the past decade’s approach to management of gender dysphoric minors.  The “gender-affirming” approach, endorsed by WPATH and characterized by the conceptualization of gender-dysphoric minors as “transgender children” has been replaced with a holistic view of identity development in children and adolescents. In addition, there is a new recognition that many gender-dysphoric adolescents suffer from mental illness and neurocognitive difficulties, which make it hard to predict the course of their gender identity development.

The key highlights of the NHS new guidance are provided below.* 

1. Eliminates the “gender clinic” model of care and does away with “affirmation”

• The NHS has eliminated the “gender clinic” model of care where children are seen solely by a specialist gender dysphoria practitioner, replacing it with standard care in children’s hospital settings.
• Rather than “affirming” a transgender identity of young person, staff are encouraged to maintain a broad clinical perspective and to “embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.”
• “Affirmation” has been largely eliminated from the language and the approach. What remains is the guidance to ensure that “assessments should be respectful of the experience of the child or young person and be developmentally informed.”
• Medical transition services will only be available through a centralized specialty Service, established for higher-risk cases. However, not all referred cases to the Service will be accepted, and not all accepted cases will be cleared for medical transition.
• Treatment pathway will be shaped, among other things, by the “clarity, persistence and consistency of gender incongruence, the presence and impact of other clinical needs, and family and social context.”
• The care plan articulated by the Service will be tailored to the specific needs of the individual following careful therapeutic exploration and “may require a focus on supporting other clinical needs and risks with networked local services.”

2. Classifies social gender transition as an active intervention eligible for informed consent

• The NHS is strongly discouraging social gender transition in prepubertal children.
• diagnosis of persistent and consistent gender dysphoria
• consideration and mitigation of risks associated with social transition
• clear and full understanding of the implications of social transition
• a determination of medical necessity of social transition to alleviate or prevent clinically significant distress or impairment in social functioning
• All adolescents will need to provide informed consent to social gender transition.

3. Establishes psychotherapy and psychoeducation as the first and primary line of treatment

• All gender dysphoric youth will first be treated with developmentally-informed psychotherapy and psychoeducation by their local treatment teams.
• Extensive focus has been placed on careful therapeutic exploration, and addressing the broader range of medical conditions in addition to gender dysphoria.
• For those wishing to pursue medical transition, eligibility for hormones will be determined by a centralized Service, upon referral from a GP (general practitioner) or another NHS provider.

4. Sharply curbs medical interventions and confines puberty blockers to research-only settings

• The NHS guidance states that the risks of puberty blockers are unknown and that they can only be administered in formal research settings. The eligibility for research settings is yet to be articulated.
• The NHS guidance leaves open that similar limitations will be imposed on cross-sex hormones due to uncertainty surrounding their use, but makes no immediate statements about restriction in cross-sex hormones use outside of formal research protocols.
• Surgery is not addressed in the guidance as the NHS has never considered surgery appropriate for minors.

5. Establishes new research protocols

• All children and young people being considered for hormone treatment will be prospectively enrolled into a research study.
• The goal of the research study to learn more about the effects of hormonal interventions, and to make a major international contribution of the evidence based in this area of medicine.
• The research will track the children into adulthood.

6. Reinstates the importance of “biological sex”

• The NHS guidance defines “gender incongruence” as a misalignment between the individual’s experience of their gender identity and their biological sex.
• The NHS guidance refers to the need to track biological sex for research purposes and outcome measures.
• Of note, biological sex has not been tracked by GIDS for a significant proportion of referrals in 2020-2021.

7. Reaffirms the preeminence of the DSM-5 diagnosis of “gender dysphoria” for treatment decisions

• The NHS guidance differentiates between the ICD-11 diagnosis of “gender incongruence,” which is not necessarily associated with distress, and the DSM-5 diagnosis of “gender dysphoria,” which is characterized by significant distress and/or functional impairments related to “gender incongruence."
•  The NHS guidance states that treatments should be based on the DSM-5 diagnosis of “gender dysphoria.” 
• Of note, WPATH SOC8 has made the opposite recommendation, instructing to treat based on the provision of the ICD-11 diagnosis of “gender incongruence.” “Gender incongruence” lacks clinical targets for treatment, beyond an individual’s own desire to bring their body into alignment with their internally-held view of their gender identity.

8. Clarifies the meaning of “multidisciplinary teams” as consisting of a wide range of clinicians with relevant expertise, rather than only “gender dysphoria” specialists

• The NHS guidance clarifies that a true multidisciplinary team is comprised not only of “gender dysphoria specialists,” but also of experts in pediatrics, autism, neurodisability and mental health, to enable holistic support and appropriate care for gender dysphoric youth.
• neurodevelopmental disorders such as autistic spectrum conditions
• mental health disorders including depressive conditions, anxiety and trauma
• endocrine conditions including disorders of sexual development pharmacology in the context of gender dysphoria
• risky behaviors such as deliberate self-harm and substance use
• complex family contexts including adoptions and guardianships
• a number of additional requirements for the multidisciplinary team composition and scope of activity have been articulated by the NHS.

9. Establishes primary outcome measures of “distress” and “social functioning”

• The rationale for medical interventions for gender-dysphoric minors has been a moving target, ranging from resolution of gender dysphoria to treatment satisfaction.  The NHS has articulated two main outcome measures of treatment: clinically significant distress and social functioning .
• This is an important development, as it establishes primary outcome measures that can be used by researchers to assess comparative effectiveness of various clinical interventions. 

10. Asserts that those who choose to bypass the newly-established protocol will not be supported by the NHS

• Families and youth planning to obtain hormones directly from online or another external non-NHS source will be strongly advised about the risks.
• Those choosing to take hormones outside the newly established NHS protocol will not be supported in their treatment pathway by NHS providers.
• Child safeguarding investigations may also be initiated if children and young people have obtained hormones outside the established protocols.

With the new NHS guidance, England joins Finland and Sweden as the three European countries who have explicitly deviated from WPATH guidelines and devised treatment approaches that sharply curb gender transition of minors. Psychotherapy will be provided as the first and usually only line of treatment for gender dysphoric youth.

The full text of the NHS guidance can be accessed here .

 * This is a transitional protocol as the NHS works to establish a more mature network of children’s hospitals capable of caring for special needs of gender dysphoric youth. A fuller service specification will be published in 2023-4 following the publication of the Cass Review’s final report .