Gender-affirming hormone therapy

Hormone therapy may involve the use of oestradiol medication and testosterone-blocking medication. Oestradiol medications offered with the NHS can be administered by gel, patches or oral tablets.

Testosterone blocking medications are given by an injection either under the skin or into the muscle, or by oral tablets. These medications can be discussed with your clinicians at Sussex Gender Service and offered in collaboration with your GP.

Effects on hormone levels

We will discuss with you your individual goals and hopes from hormone therapy. Some people want full effects from hormone therapy, and some people want partial effects. For full changes, the aim will be to increase your oestradiol level and decrease your testosterone level to what feels right for you and is safe. For partial changes, it may be finding a balance of oestradiol and testosterone levels.

Effects on the body

People experience a range of changes in their body from oestradiol therapy; there is no guarantee of which changes someone will experience. Possible physical changes include:

• Softening of the skin
• Reduction in skin oiliness
• Thinning and slowing of body hair growth
• Facial hair growth may not change; there is NHS funded hair reduction treatment available for face and neck hair
• Breast growth (can take 2-3 years for maximum effect)
• Decreased testicular and penis size (called genital atrophy or shrinkage)
• Reduced muscle mass
• Redistribution of body fat: less fat on the stomach area and more fat on the hips, buttocks and chest
• Scalp hair loss slows, particularly when testosterone level is low (there is no guarantee of scalp hair regrowth)
• People may also experience mood changes (both positive and negative) but these do not often require treatment
• Change in libido (sex drive) - you may have a different feeling of libido, or lower libido, and reduction in frequency and strength of erections

Hormone therapy will not change

• The pitch of your voice
• The Adam's apple (laryngeal prominence)
• Scalp hair loss which has already occurred
• Oestradiol is not a contraceptive

When might I see changes?

*This may be different for a young person who has been on a hormone blocker prior to taking oestradiol, where they may experience an increase in sex drive

Table taken from Vincent, B. (2018). Transgender Health A Practitioner's Guide to Binary and Non-Binary Trans Patient Care. UK: Jessica Kingsley Publishers.

Effects on sex life

Taking oestradiol will likely cause a decrease in size of your penis and testes. You are also likely to feel a decrease in sex drive (libido). You are likely to have a reduction in frequency and strength of erections. Some people are unable to get an erection or ejaculate after some time on hormone therapy.

Fertility

You are likely to become infertile (not able to conceive children or make someone pregnant) whilst taking hormone therapy and this might be permanent. If you wish to have biologically related children in the future, you should consider gamete (sperm) storage before starting hormone therapy. Your clinician can discuss this with you.

Although hormone therapy is likely to make you infertile, this is not guaranteed. Therefore, you should use contraception (e.g. condoms) if you engage in penile-vaginal intercourse as there is still a chance of pregnancy.

Blood tests

Hormone therapy may cause changes to your liver function, because your liver breaks down the hormone medication in your blood. We also measure a hormone called prolactin which could require further investigation if the level becomes high. You may not have symptoms if these levels rise, but they could be a sign of serious illness. It is therefore important for you to have your blood tested regularly, so that we can ensure your hormone therapy is safe for you. This would need to continue as long as you are on the hormones.

Other possible risks

Research on gender-affirming hormone therapy is currently limited, especially regarding longer term risks. More evidence may be found in future about the risks of hormone therapy and our guidelines may update in future.

Blood clots

There is a risk of developing blood clots (also called ‘deep vein thrombosis’ or 'DVT') from oestradiol therapy. This is important as it may result in serious illness or even death, particularly if it is not treated quickly. The chance of getting a blood clot is greater with if you smoke, are overweight, or have certain other health conditions. There is more information here.

Cardiovascular

Other risks include cardiovascular issues such as heart attack and stroke which can make you very ill or even cause death. These risks will be increased if you are overweight, smoke, have high blood pressure, migraines, diabetes or high cholesterol levels. Your clinician can advise you how to access information about reducing these risks. There are also certain health conditions that will increase risks. This will be discussed with you as part of your hormone counselling appointment.

Prostate cancer

The risk of prostate cancer may be lowered by taking oestradiol therapy and testosterone blocking medication. However, if you have symptoms such as new lower back pain, bladder or urine issues, please tell your healthcare provider that you have a prostate so they can investigate appropriately. The usual blood tests which check for prostate cancer can be falsely low when taking oestradiol therapy.

Osteoporosis

If you are on a testosterone blocker or have had surgery to remove your testes, then your testosterone levels will be low. If your testosterone level is low, you must take oestradiol therapy regularly. You must also have regular blood tests to make sure you are taking enough oestradiol. Otherwise, there is a risk that you could develop heart disease and osteoporosis (thinning of the bones) which increases the risk of breaking your bones (fractures).

Breast cancer

Taking oestradiol therapy may increase your risk of developing breast cancer. The length of time you are on hormone therapy, family history of breast cancer, body weight, and genetic factors can influence your level of risk.

In the UK, people taking oestradiol hormone therapy are recommended to attend the NHS breast screening programme between the ages of 50-71. Please ask for our leaflet on NHS screening programmes for transgender and non-binary people for further information.

Stopping hormone therapy

Some people choose to take hormone therapy life-long. Other people may choose to pause or stop their hormone therapy (for example, if transition goals have changed, or due to a physical health concern). You can stop hormone therapy at any time. If you have had surgery to remove the testes however, you will not produce your own internal hormones and will need to take some form of hormone replacement therapy. It is not safe to take a testosterone hormone blocker alone without oestradiol therapy.

If you are unable to attend follow-up appointments or blood test appointments as advised, we may no longer be able to safely support your hormone therapy plan and your GP may stop your prescription. If you are having trouble attending follow-up appointments or blood test appointments, please contact us or your GP surgery for support.

If you stop hormone therapy, there will be effects that are likely to be permanent, and do not reverse when you stop hormone therapy. Breast development is a permanent change. Infertility, reduced penis and testicular size, reduced libido and erectile dysfunction may also be permanent.

How do I start hormone therapy?

Having read the information here, if you would like to explore your options for hormone therapy, we can arrange an appointment with one of our team. This will be with a gender clinician GP, clinical psychologist or a clinical nurse specialist.

We will explore your goals, expectations, and any concerns, before recommending an individualised hormone therapy plan.

We require you to have blood tests before we can recommend hormone therapy. This will be explained to you in your appointment. Blood tests will subsequently be every 2-3 months until your hormone levels are stable. You must then attend a blood test once per year whilst taking hormone therapy, to ensure your hormone regime remains safe.

If you have needle phobia, this is something that you should manage prior to starting hormone therapy. Please see this NHS leaflet on needle phobia management: www.guysandstthomas.nhs.uk/health-information/needle-phobia-and-overcoming-your-fear

NHS hormone therapy options

Oestradiol gel

Common brand names: Oestrogel pump and Sandrena sachets

Usual dose and method:

• Applied daily to the lower abdomen or thigh
• 2-6 pumps daily, or 1-4 sachets daily, applied in the morning to clean and dry skin

Oestradiol tablets

Common brand name: Progynova 1mg or 2mg tablets

Usual dose and method:

• Taken daily in the morning, swallowed whole with a glass of water
• 2mg-8mg daily

Oestradiol patches

Common brand names: Estradot, Estraderm or Evorel 50mcg-100mcg patches

Usual dose and method:

• Applied twice per week (e.g. on a Monday and a Thursday) to clean and dry skin, removing old patches before applying new ones
• 50mcg-400mcg patch dose

Testosterone-blocking medications

Injections (most effective testosterone blockade) or tablets (partial testosterone blockade)

Injections include: Decapeptyl, Zoladex, Prostap

Usual dose and method:

All given every 12 weeks by GP practice nurse by below methods

• Decapeptyl - injection into muscle
• Zoladex - implant injected under the skin
• Prostap - either by injection under the skin or into muscle

Tablets include: Finasteride or dutasteride.

These block the effects of testosterone without lowering the level of testosterone in your blood. Suitable for people who do not want full testosterone blockade.

The above list is a summary of most commonly recommended hormone medications. A tailored approach can be discussed should you wish to explore alternative options.

A note on progesterone:

Currently progesterone (Utrogestan) medication is outside NHS gender clinic prescribing guidelines. This is because potential long-term risks are currently unknown, and there is not strong evidence there are benefits which would outweigh these potential risks. Our guidelines may update in the future should evidence of efficacy (effectiveness) and safety be advised by the NHS.

Further questions

Please make a note of any questions you may have about hormone therapy, and bring them to your Sussex Gender Service appointment, where your clinician can support you further.

Hormone therapy may involve the use of testosterone medication and oestrogen-blocking or menstrual (period) suppressing medication.

Testosterone medications offered with the NHS can be administered by daily gel or injection into the muscle. Oestrogen-blocking medications are given by an injection either under the skin or into the muscle. Other medications for menstrual suppression (stopping periods) may be given as tablets, injection, implant or coil. These medications can be discussed with your clinicians at Sussex Gender Service and offered in collaboration with your GP.

Effects on hormone levels

We will discuss with you your individual goals and hopes from hormone therapy. Some people want full effects from hormone therapy, and some people want partial effects. For full changes, the aim will be to increase your testosterone level and decrease your oestrogen level to what feels right for you and is safe. For partial changes, it may be finding a balance of oestradiol and testosterone levels.

Effects on the body

People experience a range of changes in their body from testosterone therapy; there is no guarantee of which changes someone will experience. Possible physical changes include:

• Increase in growth of body and facial hair. The texture of body hair is also likely to change
• Loss of scalp hair or baldness over time
• Redistribution of body fat and an increase in muscle mass (with regular exercise)
• Increased skin oiliness and acne. Acne or spots can be treated as usual (your local pharmacist can help)
• Increase in appetite
• Deepening voice. This can take up to 2 years to fully settle
• Mood changes, both positive and negative, but these do not often require treatment.
• Change in libido (sex drive). You may have a different feeling of libido, or higher libido
• Increase in size of clitoris ("bottom growth") and changes to sensitivity, which may be uncomfortable at first
• Change in vaginal discharge, vaginal dryness and vulvovaginal atrophy. This may cause discomfort during penetration and recurrent urine infections
• Menstrual cycle (periods) is likely to stop; however, testosterone is not a contraceptive

Please see the section on menstruation and gynaecological health for further information on contraception, vulvovaginal atrophy and menstrual suppression.

When might I see changes?

Table taken from Vincent, B. (2018). Transgender Health A Practitioner's Guide to Binary and Non-Binary Trans Patient Care. UK: Jessica Kingsley Publishers.

Effects on sex life

Taking testosterone will likely cause changes to your genitals. These include an increase in the size of the clitoris and vaginal dryness. You are also likely to feel an increase in sex drive (libido). Clitoral enlargement can be uncomfortable at first and can take up to two years to see maximum effect.

Vaginal dryness (vulvovaginal atrophy) may cause pain, discomfort or bleeding on penetration. You can buy a personal lubricant (lube) to help with this, or you can use cream or pessaries with small levels of oestrogen in to help (this is not absorbed significantly into your body so will not affect your testosterone therapy). Note that oil-based lubes cannot be used with latex condoms as they can break down the latex.

Fertility

Most people taking testosterone find that their periods stop after around 6 months. If this is not the case, additional medications can be added to suppress your menstrual cycle. Please see the section on 'menstruation and gynaecological health' for more information. We can also discuss this with you during follow-up appointments.

You are likely to become infertile (not able to have biologically related children) whilst taking testosterone. This might be permanent, even if you stop taking testosterone in future. If you wish to have biologically related children in the future, you should consider gamete (egg) storage before starting testosterone. Your clinician can discuss this with you.

Although testosterone is likely to make you infertile, this is not guaranteed, even if you stop having periods. You should use contraception (e.g. condoms or hormonal contraceptives) if you engage in penile-vaginal intercourse as there are risks to the developing foetus if you become pregnant whilst taking testosterone.

Blood tests

Testosterone hormone therapy may cause changes to liver function, haematocrit (a measure of the thickness of the blood), and haemoglobin (red blood cell) levels. Blood tests can detect changes in these levels that could be a sign of serious illness, even if you have no symptoms. It is therefore important for you to have your blood tested regularly, so that we can ensure your hormone therapy is safe for you. This would need to continue as long as you are on the hormones.

Other possible risks

Research on gender-affirming hormone therapy is currently limited, especially regarding longer-term risks. More research is ongoing and so our hormone guidelines will regularly update to reflect this. More evidence may be found in future about benefits and potential risks.

Blood clots

There is potentially an increased risk of developing blood clots (also called ‘deep vein thrombosis’ or 'DVT') from testosterone therapy. This is important as it may result in serious illness or even death, particularly if it is not treated quickly. The chance of getting a blood clot is greater if you smoke, are overweight, or have certain other health conditions. There is more information here: www.nhs.uk/conditions/deep-vein-thrombosis-dvt

Cardiovascular

Other risks include cardiovascular risks such as heart attack and stroke which can make you very ill or even cause death. These risks will be increased if you are overweight, smoke, have high blood pressure, diabetes or high cholesterol levels. Your clinician can advise you how to access information about reducing these risks. There are also certain health conditions that will increase risks. This will be discussed with you as part of your hormone appointment.

Uterus and Ovaries

Long-term risks are not fully known but potentially include higher risks of cancers of the uterus (womb) and ovaries. Studies currently are inconclusive about the potential risk of cancer. After every 2-3 years of testosterone therapy, you can ask your clinician to arrange an ultrasound scan to screen the uterus and ovaries if you choose. The ultrasound scan is usually from inside the vagina, but it can be external (over the tummy) if needed. A routine screening scan is not a requirement if you do not have symptoms such as abnormal bleeding, bloating or pain. If you do have these symptoms, please speak to your GP who can assess and investigate as needed.

Osteoporosis

If you are on an oestrogen-blocking medication or have had surgery to remove your ovaries, then your oestrogen levels will be low. If your oestrogen level is low, you must take testosterone therapy regularly. You must also have regular blood tests to make sure you are taking enough testosterone. Otherwise, there is a risk that you could develop heart disease and osteoporosis (thinning of the bones) which increases your risk of breaking your bones (fractures).

Breast cancer

Taking testosterone therapy may change your risk of developing breast cancer. If you have surgery to remove your breasts (double mastectomy, or "top surgery"), your risk will be reduced, but you should still monitor for any changes to your chest and armpits such as lumps, skin changes or nipple changes. Please ask for our leaflet on NHS screening programmes for transgender and non-binary people for further information.

Stopping hormone therapy

Some people choose to take hormone therapy life-long. Other people may choose to pause or stop their hormone therapy (for example, if transition goals have changed, or due to a physical health concern). You can stop hormone therapy at any time. If you have had surgery to remove the ovaries however, you will not produce your own internal hormones and will need to take some form of hormone therapy. It is not safe to take an oestrogen hormone blocker alone without testosterone therapy.

If you are unable to attend follow-up appointments or have blood tests as advised, we may no longer be able to safely support your hormone therapy plan and so your GP may stop your prescription. If you are having trouble attending follow-up appointments or blood test appointments, please contact us or your GP surgery for support.

If you stop hormone therapy, there will be effects that are likely to be permanent, and do not reverse when you stop hormone therapy. This includes body and facial hair growth, baldness, a deeper voice and clitoral growth. Infertility may also be permanent.

How do I start hormone therapy?

Having read the information here, if you would like to explore your options for hormone therapy, we can arrange an appointment with one of our team. This will be with a gender clinician GP, clinical psychologist or a clinical nurse specialist.

We will explore your goals, expectations, and any concerns, before recommending an individualised hormone therapy plan.

We require you to have blood tests before we can recommend hormone therapy. This will be explained to you in your appointment. Blood tests will subsequently be every 2-3 months until your hormone levels are stable. You must then attend a blood test once per year whilst taking hormone therapy, to ensure your hormone regime remains safe.

If you have needle phobia, this is something that you should manage prior to starting hormone therapy. Please see this NHS leaflet on needle phobia management: www.guysandstthomas.nhs.uk/health-information/needle-phobia-and-overcoming-your-fear

Testosterone gel

Common brand names: Testogel, Tostran, Testavan

Usual dose and method:

Applied daily to the lower abdomen or thigh

1-4 pumps daily, applied in the morning to clean and dry skin

Testosterone injection

Common brand names: Sustanon, Nebido

Usual dose and method:

Given by injection into the muscle, usually by GP practice nurse

• Sustanon 250mg - every 2-5 weeks
• Nebido 1000mg - every 10-15 weeks

Oestrogen-blocking medications

Common brand names: Decapeptyl, Zoladex, Prostap

Usual dose and method:

All given every 12 weeks by GP practice nurse by below methods

• Decapeptyl - injection into muscle
• Zoladex - implant injected under the skin
• Prostap - either by injection under the skin or into muscle

The above list is a summary of most commonly recommended hormone medications. A tailored approach can be discussed should you wish to explore alternative options.

Further questions

Please make a note of any questions you may have about hormone therapy, and bring them to your Sussex Gender Service appointment, where your clinician can support you further.

Menstruation, or periods/bleeds, generally occur on a monthly cycle when the lining of the uterus (womb) sheds due to fluctuation in hormone levels produced by the brain and ovaries.

For transgender, non-binary and intersex (TNBI) people this may cause dysphoria. Some people wish to suppress and stop their monthly cycle. For other people, menstruation does not cause dysphoria.

This information will discuss options to manage menstrual symptoms and to suppress (stop) menstruation. This leaflet also has information on cervical screening (smear tests) and ultrasound scans for the womb and ovaries.

Ways to manage menstrual symptoms

The menstrual cycle may include symptoms such as mood changes, skin changes, bleeding, cramping, migraines, bloating, chest tenderness and pain.

• Bleeding can be managed by using period underwear/boxers, sanitary pads, menstrual cups, or tampons.
• Heavy bleeding can be improved by using prescribed medications such as tranexamic acid (non-hormonal), or hormonal tablets/implants/injections. These are discussed in the next section and can be started by your GP.
  • If you have a change in your cycle or new heavy bleeding, please speak to your GP or practice nurse, or attend a sexual health clinic.
• Migraines can be managed by your GP; there are medications which may help. You should consider a headache diary to see if you have any triggers, e.g. low blood sugar, stress, or poor sleep.
• Cramping and pain can be managed by tablet painkillers, such as ibuprofen, paracetamol, or naproxen. Please discuss with your GP or practice nurse.
• Mood changes due to hormone fluctuations can be normal. If you feel your mood changes are significant, please discuss this with your GP.
  • Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS). More information is available here.

If you are concerned about any new or changing menstrual symptoms, or feel they are worsening, please contact your GP or practice nurse to discuss.

Medications to suppress (stop) menstruation

Testosterone therapy

Menstruation is usually suppressed after 6 months of full-dose testosterone therapy. If you want full changes from testosterone, this will be the dose recommended by your gender clinician.

If you want to take a lower dose of testosterone (for example, if you want partial changes from testosterone therapy) your menstrual symptoms may take longer to be suppressed, or may not be suppressed at all. Some people continue to have menstrual symptoms despite full-dose testosterone therapy. In either of these cases, you can talk to your gender clinician about adding an extra medication to stop menstruation, such as progestogen-only medications or hormone-blockers (see below).

Remember that testosterone is not a contraceptive, and so pregnancy could occur if you are having penile-vaginal intercourse. Testosterone could be harmful to a developing baby.

Progestogen-only medications

Progesterone is a hormone which is present in all bodies. The synthesised (lab-made) forms are called 'progestogens'.

Hormone-blocker medications

These are the same medications that are used for blocking puberty in adolescents. They are in the medication class called 'GnRH analogues'. They can be recommended by your gender clinician, particularly if progestogen-only medications are unsuitable. They block your body's own production of hormones and require hormone replacement therapy (e.g. testosterone).

Vulvovaginal atrophy

Vulvovaginal atrophy means thinning of the genital (vulval and vaginal) tissue, which can cause soreness, bleeding, and pain, particularly on penetration, as well as recurrent urine infections. Testosterone therapy can cause vulvovaginal atrophy because it suppresses oestradiol, which is the hormone that keeps the muscular vaginal tissue thickened and healthy.

The most effective management of vulvovaginal atrophy is oestradiol cream or pessaries (tablets you insert into your vagina). These are usually used once or twice weekly. Oestradiol creams and pessaries contain very low levels of oestrogen and do not act on your whole body, as the oestrogen is not absorbed at a significant level into the blood. It thickens the genital tissue and vaginal wall and should reduce symptoms of bleeding or soreness.

Please speak to your GP if you feel you have these symptoms. They may advise an examination to check your cervix and for any lumps or bumps in the vagina, as well as swabs to check for thrush or sexually transmitted infections. You can also attend a sexual health clinic to check for these.

Contraception

Testosterone therapy is not a contraceptive and can be harmful to a developing baby should you become pregnant whilst taking testosterone.

Contraception is recommended for all people who engage in sexual activity which may lead to a pregnancy (i.e. any penile-vaginal intercourse).

Contraception containing oestrogen (e.g. the combined oestrogen-progestogen pill) is not recommended for people taking testosterone therapy. Low-dose combined oestrogen pills are options for people not taking testosterone therapy. For people who would like hormonal contraception, we generally recommend progestogen-only options.

Speak to your GP or practice nurse, or local sexual health clinic, to discuss and access contraceptive medications. More information on contraception can be found on the NHS website.

Cervical screening (smear tests)

People aged 25-64 with a cervix are advised to attend NHS cervical screening, as detection of early cervical cancer means less invasive treatment could be needed.

If your NHS gender marker is 'M' you will not automatically be invited for cervical screening, but you can complete an opt-in form with your GP or practice nurse.

As of June 2025, the NHS launched digital ‘ping and book’ invitations via the NHS App. To access this please download the NHS app, ensure notifications are switched on, and ensure your correct mobile number is registered with your GP.

If you wish to access cervical screening somewhere other than your GP surgery, we recommend Clinic T in Brighton, which is a sexual health clinic run on Wednesday evenings for trans, non-binary and intersex people.

At home testing (self-swab) is likely to be an option from 2027.

There is currently a self-test research project by the University of Manchester called the ACES Choice Study. They are studying whether it is effective for people to self-swab or provide a urine sample for cervical screening. The study is recommended to be alongside your regular cervical screening. If you would like to take part, please see the University of Manchester website.

Ask for our NHS screening leaflet if you wish to know more information about all other NHS health screening programmes.

Ultrasound scan screening

Some studies have shown that testosterone therapy may increase the risk of cancer of the uterus (womb) and ovaries.

If you have a uterus and/or ovaries and you take testosterone therapy and have any new symptoms such as vaginal bleeding, bloating, or pelvic pain it is recommended that you have an ultrasound scan of your womb and ovaries as part of your investigations. This screens for changes such as thickening of the womb, which may be a sign of cancer. Early detection increases the chances of successful treatment.

It is recommended that this scan is internal (via the vagina) for the most effective detection of changes, however you can ask for the scan to be done externally over your abdomen (tummy) if needed. The scan can be organised via your GP surgery.

Fertility

Please see the section on our website about fertility.

Stopping medications

You can stop hormone or menstrual suppression medications at any time. We recommend you speak to your gender clinician or GP first, to ensure this is done safely.

Further resources

Clinic T

Clinic T in Brighton is a sexual health clinic run on Wednesday evenings for trans, non-binary and intersex people.

Terrence Higgins Trust

UK's leading sexual health and HIV charity. Call 0808 802 1221 for support, advice or information, or email info@tht.org.uk. THT have a clinic in Brighton at 61 Ship Street, BN1 1AE for asymptomatic (no symptoms) STI testing, and information on sexual health including PreP and PEP. Visit the THT website.

Contraception information on the NHS website

Visit the NHS website for contraception information from the NHS.

Sussex Gender Service are unable to provide blood tests; however, we work with GP practices under collaborative care agreements to support you with this. The GP practice will provide blood tests and/or blood test request forms (called a 'blood form') which you can take to a local clinic if you are unable to get a blood test at your usual GP practice. Please contact us if you need any support with this.

Once you have a blood form, you can book a blood test at one of these clinics:

• East Sussex -  Bexhill Community Diagnostic Centre, Conquest Hospital or Eastbourne DGH
• Haywards Heath & Brighton - Princess Royal or Royal Sussex County Hospital
• Community Phlebotomy Service - for anyone registered with a Brighton and Hove GP, for home visits, Hove Polyclinic or Moulscoomb Health Centre
• Hove Polyclinic

• Help with NHS prescription costs

A prescription costs £9.90 per item, but prepaying for an unlimited number of prescriptions is:

• £32.05 for 3 months
• £114.50 for 12 months (or 10 Direct Debit instalments of £11.45)

If you pay for NHS prescribed medicines 3 or more times per month, a Prescription Prepayment Certificate could save you money. 

• Buy an NHS Prescription Prepayment Certificate - NHSBSA

If you pay for NHS prescribed oestradiol medicine 3 or more times in 12 months, a Hormone Replacement Therapy Prescription Prepayment Certificate could save you money. 

• NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) | NHSBSA

Outreach pathway to access gender-affirming care with the NHS

After a hormone recommendation from SGS, if your usual GP surgery has declined to provide hormone therapy prescriptions or blood tests, then please get in touch with us as soon as possible. The 'outreach pathway' is an initiative where you can partially register with another GP surgery to access blood forms and gender-affirming hormone therapy prescriptions, whilst staying with your usual GP surgery for other aspects of your healthcare.

The outreach GP surgery can:

• Issue an online blood test form so you can book a blood test at your usual GP surgery or at a local phlebotomy clinic.
• Offer you a blood test appointment if you are unable to access blood taking at your usual GP surgery.
• Issue your gender-affirming hormone therapy prescriptions to your local pharmacy.
• Offer you follow-up appointments to discuss your hormone therapy and blood test results - this is recommended once your hormone therapy is stabilised and your hormonal care has been transferred from SGS back to the GP.

You will be offered regular follow-up with your SGS clinician to discuss your hormonal care.

Sometimes, at a later date, your usual GP team may offer to prescribe your hormonal care and provide monitoring, for example once you are stabilised on your hormone therapy. At this point, the outreach GP surgery can transfer your hormonal care back to your usual GP team.

How can I access this?

If you need to access the hormone therapy outreach pathway, please let us know. You can call or email the SGS admin team or discuss this with a clinician during your appointment.

What happens next?

We will refer you to one of the outreach GP surgeries of your choice, and share your clinic letters, if applicable.

If you need a hormone prescription, the outreach GP team may book an appointment with you before they issue your hormone prescription.

If you need a blood test, the outreach GP team will either issue a blood form you can use with your usual GP surgery/a local phlebotomy clinic, or book you for a blood test at the outreach GP surgery.

You might be offered follow-up appointments about your hormone therapy with SGS & the hormone therapy outreach GP surgery.

You can choose to see the outreach GP team or SGS for your follow-up hormone appointments, however we do not recommend having both teams providing hormone medication adjustments simultaneously as this may confuse your care.

If you opt to have follow-up appointments with SGS, we will email both your usual GP surgery & your outreach GP surgery with clinic letters about your hormone therapy.

When travelling abroad from the UK, there is no legal requirement to carry a letter explaining that your testosterone medication is prescribed for gender affirming care. Nevertheless, historically testosterone has been removed at border or security checkpoints, and this unfortunately remains the experience for some tourists even now.

Controlled drug

Legally, testosterone is a 'Schedule 4 - Part II' drug. This means it is a controlled drug and legally subject to the misuse of drugs legislation in the UK. It is also a controlled drug in many other countries due to known risk of misuse. There are therefore stricter rules relating to the movement of testosterone across borders compared to other gender affirming medications which are not controlled drugs, such as oestrogen. Current UK government guidance states: “You must carry medicine containing a controlled drug with you in your hand luggage when entering or leaving the UK. It may be taken away from you at the border if you cannot prove it was prescribed for you."

Therefore, if you’re travelling abroad with your gender affirming testosterone medication, it is recommended that you carry a letter of proof that the medication was prescribed to you. Your GP/prescriber should be able to provide this upon request. There may be a fee for this service.

Name differences

If the name on your passport is different from the name on your medication, then you may also need to carry additional information to prove you are the person to whom the medication legally belongs. You may wish to carry a change of name deed poll to help with such scenarios. You may already have other forms of updated photo ID in your possession such as your UK driver's licence to support you.  If you don't have any other documents to help, you could ask your GP/prescriber to evidence the change of name in the letter they write to prove the medication is yours, for example "X, formerly known as Y, is prescribed testosterone medication by [named prescriber]".

Research

You should always do your "due diligence" and research before you travel. Check with the embassy of the countries you are traveling to for their rules regarding visiting with controlled drugs in possession. The country you intend to visit may restrict the types or amounts of a controlled medication that can be brought in.

Check your airline's rules in advance, visit their website and read the small print. Some airline carriers are certainly more restrictive than others.

Think about your hormone routines. For example, all needles need to go in hold luggage. If you administer testosterone with a needle, be mindful of your next due Nebido or Sustanon injection date and plan any long-haul travel. If you administer testosterone by applying gel, you can generally bring a prescribed container into the cabin. Be sure to check the latest guidance: Take medicine in or out of the UK - GOV.UK.

Using medication during travel

Consider the logistics of when and where you will need to apply your testosterone during your travels. If you have no alternative to having to apply your gel mid-flight - please exercise your usual safe application techniques and do not apply near any other passengers due to risk of accidental cross-application (transfer of testosterone gel to another person's skin). In the absence of practical alternatives mid-flight, use the aeroplane toilet cubicle to apply your gel and allow it time to dry in privacy, with access to soap and water to reduce risk of onward cross-transfer to passengers and crew. If you can, think about keeping one medicine packet in your hand luggage and one additional packet in your hold suitcase in case one bag goes missing in transit.

Storage

There are no special storage instructions for Testogel and Nebido. If you are travelling with Sustanon, the advice is to store it below 30 degrees, do not refrigerate or freeze it, store it in the original packaging to protect from sunlight.

If your medicine becomes damaged, for example if it shows signs of deterioration or discolouration when you are abroad - you should seek the advice of a local pharmacist.

Checklist

• Check your medication in advance
• Check it is in the original pharmacy packaging with your name on it
• Check the expiry date
• Check the quantity
• Carry a letter to prove the medication is prescribed to you, and evidence of any name changes if applicable
• Check any restrictions from the airline and any countries you are travelling to
• Order a repeat prescription in good time before you travel, if required
• Carry a copy of your prescription when you travel in case your medicine becomes lost or stolen.