Second assessment

Your second appointment is where we can go over anything discussed at the first appointment, talk about any developments and discuss a diagnosis of gender incongruence. We will also discuss treatment options.

Please bring details of any changes to medications since your last appointment.

We encourage you to bring along anything that will make you feel more comfortable and settled during your appointment, such as fidget toys or comfort items. You are welcome to bring a friend, carer or family member to your appointment if you wish.

You may wish to write down a list of questions to ask us, to help you remember. If we are unable to answer your questions during your second assessment, we can find out the answers and get back to you, or advise you of who might be able to help.

Don't worry if you forget any of these items, they help the appointment to run smoothly but are not requirements.

You will see one of our clinical (healthcare professional) team; either a GP or a psychologist.

Each member of the clinical team has been trained for this assessment. As you continue through the service, you may be allocated a certain team member depending on your care plan.

This can vary, depending on what you would like from your appointment. Everyone is at a different stage in their journey, and may have accessed medicines or services already. This means you may need a longer or shorter appointment.

We estimate that your second assessment will take from 45 minutes up to 2 hours.

We appreciate that some people may want to record their assessment to help them remember what was discussed. As per other healthcare consultations, we ask that you are open about this request, and discuss with your clinician before recording.

Please be assured that our clinicians will not record your consultation.

Your second assessment is a follow on from your first assessment. You might have found your initial appointment was quite detailed, and the clinician may want to clarify some parts or ask more around the things which were discussed.

This may include your personal journey before your referral, and what has happened since you were previously seen by us. We also invite you again to tell us your care goals, and specific services or treatments you wish to access.

There is also some specific information that we will ask you. This is quite thorough and can include personal and sensitive information. If you feel uncomfortable or if you need a break, please let us know. Asking these questions ensures we are being safe, and we do not miss any important information which may shape the care we provide.

The information you tell us is confidential and held within our clinic medical notes, and is not shared with anyone without your consent.

Examples of questions: asking about smoking - smoking can affect some choices for medication or surgery, so asking this question means we can provide extra support and advice to help people reduce smoking if needed.

Here are the questions you will be invited to answer at your appointment, and why we ask them:

The second assessment differs from the initial appointment, because we might offer a diagnosis of gender incongruence and gender dysphoria. Some people need a few more sessions with us before a diagnosis is offered, this is discussed below.

A diagnosis of gender incongruence is needed to access the treatment pathways. We offer a diagnosis of gender incongruence at your second assessment.

Gender incongruence is characterised by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

A diagnosis of gender dysphoria can also be offered. This refers to the discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth.

People interpret these words in different ways, and no words will be a perfect fit for everyone. Some people don't like to have a diagnosis at all.

Having a diagnosis can also be helpful to have in a clinical letter to apply for certain things, for example a gender recognition certificate.

We offer the same diagnosis to everyone but we are aware that these can be felt differently by different people. The most important thing is how you feel, and the care you receive - we will always want to focus on your individual and personalised care and strive for the best outcomes for you.

There is no checklist that we use in Sussex Gender Service, but instead we have a conversation together about your lived experience of gender, and how you would feel accessing gender-affirming treatment, or how you feel about the treatment you might have already received. There is no requirement for you to have socially transitioned, or changed your name, or anything else, for us to offer you a diagnosis.

We will ask questions such as how you feel about the gender you were assigned at birth and how this matches, or mismatches, how you feel now. We will ask about your treatment goals within the service. We may also check your understanding about benefits or drawbacks of specific therapies you would like to access, such as hormone therapy.

When you have your assessments, there are no trick questions, we just want to make sure we offer the right therapies at the right time to ensure your best outcomes. It might be that you are offered a diagnosis of gender incongruence but do not want to access treatments such as hormones or surgery currently. In this case, we can chat about the best way forward, and it may be that you choose to be discharged back to the care of your GP, and re-referred when you feel ready. You would not need to go to the back of the waiting list.

At the end of your second assessment, if we are still not sure that what you are experiencing is gender incongruence we might offer you extra appointments with a gender specialist psychologist to explore in depth what you are experiencing and how we can best support you. We provide a safe space to talk with a clinician over the course of several sessions.

If you have any more questions or feedback about this, please email the team or discuss with your clinician during an appointment.

If a diagnosis of gender incongruence is made at the second assessment, then we will go on to talk about treatment options in more depth. You may be interested in knowing more about some, all, or none of the options. We can provide written information about each treatment option if you want to reflect more on what you might need.

Treatment options include:

You will be able to ask us any questions you may have as the assessment goes along, or at the end, if you prefer.

Your follow-up appointments will be dependent on which treatment options you choose. Waiting times vary for each treatment option, and we can give you rough estimates for the waiting times for these.

If you feel you need more time to decide, we can offer a third assessment at a later date.