Gender health for adults

At St Catherine’s Surgery we are dedicated to improve the health and wellbeing of all our patients. This resource has been made to best summarise the support available locally and nationally for patients who do not identify as their assigned gender, and what we as a practice are able to offer. Whether you are questioning, coping, struggling or needing advice, we hope this leaflet will be helpful.

GP practice role

Signposting to help and support

If you are questioning your gender identity, wanting support, or needing information about legalities for example, there is a comprehensive list and services that allow you to find relevant local resources through the GIC website. The list is long and thorough, and there are plenty of resources here you may find helpful no matter where you are on your journey:

https://gic.nhs.uk/info-support/

Alternatively, our GPs and Wellbeing practitioners have a wealth of knowledge in relation to local and national support. If you would like to book an appointment, please contact reception or fill in an econsult online.

Making you feel comfortable in our practice

We know that people who do not identify as their assigned gender may choose to use different pronouns or a different name, and that to be called their birth name may cause discomfort when visiting our practice. We can update your name and pronouns on our computer system so that you can be addressed by the correct name, regardless of where you are at in your journey in a more temporary fashion, or more permanently (combining hospital records as well). You don’t need to have undergone any formal treatment or diagnosis for this. If you have gone through the legal process of changing your name by deed poll, we would encourage you to change these with us as it can help with any future requests for legal change of gender on other legal documents. And if you have changed your gender legally then we are happy to update these details. Please contact reception or follow the instructions for “Change in your details” on the St Catherine’s website

https://www.stcatherinessurgery-wirral.nhs.uk/doitonline.aspx

Mental health management

Questioning gender can cause a strain on mental health. If you are concerned about your mental health, please speak to one of our GPs for support.
If you don’t feel you can keep yourself safe right now, seek immediate help:

• Go to any Accident & Emergency (A&E) department
• Call 999 and ask for an ambulance to take you to A&E
• Ask someone else to call 999 for you or take you to A&E

If you need urgent support but don’t want to go to A&E, you can:

• Call Samaritans on freephone 116 123 any time
• Or the local crisis line on 0800 145 6485 any time
• Contact the surgery and ask for an emergency appointment within hours
• Contact NHS 111 (England) any time
• Contact your local crisis team, if you’re under their care

Referral to secondary care

Secondary care (Gender Identity Clinic) referrals can be made by the GPs. The support you may receive in secondary care includes psychological therapies, hormonal treatments, speech and language therapy, and surgical treatments. The wait times for Gender Identity clinics are currently in the region of years (18-22 months at the time of writing).

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

There is currently an additional clinic called CMAGIC (The Cheshire and Merseyside Adult Gender Identity Collaborative) which is funded over the next few years as a pilot. It is one of only three collaborations between primary care and sexual health. The idea is to begin the supportive process in gender health. To be referred to this service, you have to have not yet had your first appointment with a GIC but be on their waiting list, and be over 18yrs.

https://www.merseycare.nhs.uk/our-services/liverpool/sexual-health/cmagic-cheshire-and-merseyside-adult-gender-identity-collaborative

We can also refer you to one of the psychosexual counsellors, who help explore gender identity with you.

Legal role

In order to change gender on legal records such as your birth certificate, you need to be able to supply evidence of living in your gender for at least two years. A piece of evidence that can be used is that of a letter from your GP. If you would like for us to supply this evidence, please contact reception.

Physical health

Thinking about the future – getting prepared before your first appointment:

General health:

There may be lots to think about ahead of taking hormonal therapies or having surgery. For example it is important to know that you will only be offered surgical intervention if your BMI is less than 30, due to the surgical risks. You will not be offered hormonal treatments unless you have not smoked in the preceding three months due to the increased risk of blood clots. If you are awaiting your first appointment but want to explore what aspects of your health you can address to ensure that you can access all types of intervention, please don’t hesitate to contact one of the GPs or Health Coaches.

Fertility:

If you are seeking surgical or hormonal treatment as part of your gender health, it may be important to consider whether you would like to preserve fertility such as through egg or sperm freezing. By considering this early in the process, there will hopefully be no delay to the treatments you want to undertake. There is information at the stonewall charity https://www.ngalaw.co.uk/knowledge-centre/preserving-fertility-before-a-gender-transition and Hewitt fertility centre in Liverpool https://www.thehewittfertilitycentre.org.uk/how-can-we-help-you/i-want-to-preserve-my-fertility/ . If you would like a referral for this service, please contact the GP practice for an appointment.

Monitoring of medications by secondary care:

GPs are unable to initiate hormonal medications without advice from secondary care. As part of a shared care agreement, GPs share responsibility for monitoring health on medications, and helping to supply them once they have been deemed appropriate by secondary care. Part of medication management is thinking about the longer-term impact of medicines on health. Age UK have created this useful document about general health in later life:

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs16_trans_issues_and_later_life_fcs.pdf

Sexual health:

Our GPs and the Sexual Health Clinic (https://www.sexualhealthwirral.nhs.uk/) are available to discuss sexual health in terms of contraception and sexually transmitted infection regardless of gender identity and we would encourage you to get in contact if you are concerned about this in any way. It is important to be aware that hormonal therapy for gender identity is not a method of contraception.

Appropriate screening:

A sensitive area of discussion is that of screening for conditions. Depending on age and gender, the UK screens for numerous cancers such as breast, bowel etc. As a more specific example, assigned female patients will be offered cervical (smear) screening from the age of 25yrs to identify risk of cervical cancer. A person who no longer identifies as female may still be invited to this screening if they are registered as female on our computer systems, and it is important to let us know if there is a wish that this be done in a more sensitive way. For those who are registered on our system as a gender other than their assigned gender, there is a potential that the computer system “misses” them in this screening, with potential implications to their health. Sometimes screening is done through an external body, rather than through our practice. We have ways in which to identify these people to ensure this doesn’t happen but it is important to understand the screening that ought to be offered to you so that you can make an informed decision about whether or not you wish to opt out, or adjust
the way in which you are invited. The information on this link tells you what should be offered based on your assigned gender and for specific circumstances. If you have queries, the GPs would be happy to clarify this with you:

https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people

Support and signposting

General / support networks

The Gender Identity Clinic in London has collaborated loads of useful national support, including TransWiki where you can search local support: https://gic.nhs.uk/info-support/support-groups-and-resources/

General support and advice over the phone about everything LGBT related – runs in the evening for 5 hrs: https://switchboard.lgbt/

Local support network: https://www.facebook.com/WirralLGBT

Mental health

Psychotherapy: https://www.pinktherapy.com/en-us/findatherapist.aspx

Sexual or violent assault support for trans people: https://www.sexualhealthwirral.nhs.uk/media/1075/sexual_violence__transgender.pdf
https://galop.org.uk/#

Physical health

Older person transitioning, Age UK https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs16_transgender_issues_and_later_life_fcs.pdf

Medical screening information leaflet: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/814364/Screening_information_for_trans_and_non_binary_people.pdf

Legal and social

Housing support: https://stonewallhousing.org/services/advice/

Legal support: https://www.stonewall.org.uk/help-and-advice

Information about changing gender or name:

• Name by deedpoll (www.deedpolloffice.com/advice.transgender)
• Change on the birth certificate (www.gov.uk/apply-gender-recognition-certificate)

Parenting (including preservation of fertility for stonewall link):
https://www.stonewall.org.uk/help-advice/parenting-rights/trans-parenting-rights
http://wearefamilymagazine.co.uk/

Religious support:

Imaan – LGBTQI+ Muslim charity Web: https://imaanlondon.wordpress.com/about
Hidayah LGBTQI+ Muslims Web: https://www.hidayahlgbt.co.uk
Jewish LGBTQI+ Group Web: http://www.jglg.org.uk
Rainbow Jews Web: http://www.rainbowjews.com
Christian LGBTQI+ group Web: http://www.onebodyonefaith.org.uk Info: Tel: 01636 673 072
Diverse Church LGBTQ+ Christian support Web: https://diversechurch.website
Sikh and LGBTQI+ group Web: http://www.sarbat.net

We have attempted to make this information as relevant and inclusive as possible. If you have any feedback for how to improve this information, please email us at cmicb-wi.stcatherinessurgery@nhs.net