Prescribing hormones and blockers for transgender patients: Engagement Report

Background

Currently, anyone aged 17 or over, registered with a GP in England, who experiences gender incongruence can access the services provided by one of a number of Gender Identity Clinics (GICs), funded by NHS England. 

GICs make recommendations around what medications should be prescribed to patients but are not responsible for providing those prescriptions or monitoring the medications, with that service usually being provided by the GP practice that patients are registered with.

NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) carried out a listening exercise to help inform the commissioning of a new service to prescribe and monitor hormones and blockers for adult transgender patients in Nottingham and Nottinghamshire. 

The ICB were keen to understand peoples’ current experience of receiving prescriptions from their GP practices and how this could be improved. Where GP practices opt not to provide this service It is important to understand what would need to be included in an alternative service.

This involved seeking the views of people from and organisations representing the transgender community and local transgender health services. 

The listening exercise ran from 28 July 2025 and concluded on 12 September 2025. A number of engagement methods were used, including an online survey, online and in person focus groups, online interview and visits to community groups. The ICB Engagement Team heard from 114 individuals.

Key Findings

• 67% (n = 50) respondents to the survey reported difficulties in accessing hormone treatment and bloods monitoring through an NHS GP, with 25% (n = 19) stating no difficulties with access and 8% (n = 6) preferred not to say.

• A minority of individuals stated that certain GPs openly acknowledge their lack of specialist knowledge in transgender healthcare.

• Long waiting times, limited access to gender-affirming treatments, and inconsistent support at GP surgeries have left some individuals feeling frustrated and angry towards the NHS.

• GPs declining to enter into an agreement to prescribe can represent barriers for individuals to access consistent and safe gender-affirming care.

• Administrative issues at GP surgeries have led to delays in accessing medication, including unsigned prescriptions, late test result transfers to specialists and difficulty securing GP appointments when medication is due.

• While some individuals shared positive experiences of being prescribed medication and having blood tests monitored at GP surgeries, these were less common.

• 48% (n = 38) of survey respondents would prefer to access hormone treatment and blood test monitoring at a GP practice, 25% (n = 20) said they did not mind. 9% (n = 7) would prefer a location that isn’t their GP practice within Nottingham and Nottinghamshire.

• To access treatment 42% (n= 33) of survey respondents would travel one bus or tram with 33% (n=26) willing to travel two busses or trams. 30% (n = 22) of car users were willing to travel 20 minutes by car, 19% (n = 14) would travel 45 minutes by car with 22% (n = 16) travelling an hour by car.

• Within the design of the new service specialist staff, peer support in healthcare settings and easily accessible support information, were regarded as important inclusions.

Next steps

The recommendations from this report will be utilised to inform the design of a new service to prescribe hormones and blockers for transgender patients living in Nottingham and Nottinghamshire.

Conclusion 1: Many individuals reported waiting several years to be prescribed hormones or blockers and bloods monitoring on the NHS which caused distress to individuals. Delays occurred at multiple stages, from GP referrals to Gender Identity Clinics, assessments, and treatment. Administrative issues in GP practices have contributed to delays and issues with patients accessing medications and the associated monitoring.

Recommendation 1: Ensure the new service for prescribing and monitoring medications has an efficient flow of transgender patients through the system, and where possible, allow block booking appointments for follow up monitoring.

Recommendation 2: Share the report and information on the concerns people have about long waits, the impact on their mental health and associated risks of harm with the commissioners and providers of NHS Gender Identity Clinics and encourage them to take appropriate action.

Conclusion 2: There is a lack of transparency around waiting list positions and expected timelines for Gender Identity Clinics. These delays were described as emotionally distressing, with some individuals linking poor communication about wait times to mental health deterioration and are compounded by uncertainty around GP provision of healthcare.

Recommendation 3: Alongside communicating publicly which providers are delivering the new service for prescribing and monitoring medications, ensure wait times are kept to a minimum. Share the report and information on the concerns people have about the lack of transparency around waiting lists and waiting list management with the commissioners and providers of NHS Gender Identity Clinics and encourage them to take appropriate action.

Conclusion 3: A significant number of respondents felt forced to self-medicate due to lack of timely care. GPs were reported to refuse monitoring blood levels or prescribing bridging hormones. This led to concerns around safety, harm reduction, and the emotional toll on individuals and their communities.

Recommendation 4: Explore opportunities to work with local harm reduction services, to create or share existing harm reduction materials with GP practices for transgender patients, and if possible, allow for blood monitoring for those accessing medications privately.

Conclusion 4: A minority of respondents shared positive experiences with supportive GPs who followed endocrinologist guidance, provided timely prescriptions, and monitored bloods effectively. Reception staff were also praised for being responsive and helpful with administrative tasks, updating NHS numbers and managing arrangements where GPs agree to prescribe hormones and blockers.

Recommendation 5: Explore opportunities for sharing good practice across GP surgeries with advice on where changes can be made to support trans affirming care.

Conclusion 5: Where a separate clinic is being considered a guarantee of an all-inclusive offer of medical services, to include both prescribing medication and bloods monitoring, is important to simplify the process of accessing the service and reducing the number of necessary appointments and travel.

Recommendation 6: In the design of the service ensure, both prescribing of medications and bloods monitoring are offered by specialist staff. Select a location that is reasonably accessible to those areas that are not expected to have GP practice provision.

Conclusion 6: Many members of the transgender community either do not have access to a car or are unable to drive. The shortest travel distance, either one bus or tram or a 20 mins drive was preferred.

Recommendation 7: Ensure that parking and good transport links are available.

Conclusion 7: Accessing the service at a GP practice was preferred for its convenience. However, where this would be the case a location being safe and accepting of transgender people is a key priority for the new service.

Recommendation 8: Identify which GP practices are intending to provide the service on a permanent basis and ensure both clinical and administrative staff are trained and upskilled to provide a high standard of trans affirming care.

Conclusion 8: Within the design of a new service, reliable and timely access to hormones and blockers and bloods monitoring with specialist staff, peer support in healthcare settings, and more general support and information from healthcare providers were key priorities.

Recommendation 9: Explore opportunities to involve transgender support organisations in peer support roles and the development of information materials and advice for transgender patients.

Recommendation 10: Embed robust and efficient administrative mechanisms to provide a timely and seamless service.

Recommendation 11: Provide specialist training to healthcare providers prescribing medications and monitoring bloods.

Bridging prescriptions: Temporary prescriptions for hormone replacement therapy prescribed by a GP or other healthcare professional while individuals wait for assessments at the Gender Identity Clinic.

Cis gender: A person whose gender identity aligns to the sex they were assigned at birth.

Gender: Gender refers to an individual’s internal sense of whether they are a woman, a man or non-binary.

Gender affirming care: A broad term which includes measures taken to affirm ones identity. This could include respecting chosen pronouns, hormone replacement therapy, puberty blockers, changing ID and birth certificates. It can also mean social transition such as haircuts, clothing, voice training, shaving and electrolysis (this may not be a conclusive list).

Gender affirming hormone therapy: Gender affirming hormone therapy aligns an individual’s physical characteristics with their gender identity.

Gender dysphoria: Sense of unease or distress arising from discrepancy between birth-assigned sex and gender identity.

Gender incongruence: A term used to describe a discrepancy between birth-assigned sex and gender identity.

Gender Identity Clinic (CIG): The GICs are commissioned to undertake a specialist assessment, deliver non-surgical care packages and certain surgical interventions and immediate associated after care. They are not commissioned by NHSE to prescribe hormone treatment.

Hormone blockers: Are medication that is used to supress the body’s natural sex hormones.

LGBT+: Stands for lesbian, gay, bisexual, transgender with + symbol referring to other identities such as, queer, questioning, asexual, Intersex, non-binary.

MX title: MX is a gender-neutral title preferred by some non-binary and transgender individuals as an alternative to Mr, Miss, Ms and Mrs.

NCTH: Nottingham Centre for Transgender Health

Sex: This refers to the category assigned to a person at birth, generally based upon external appearance, rather than hormones and/or genetic factors such as male, female, or intersex.

Shared care agreement: Is a formal voluntary arrangement between a specialist and a General Practitioner (GP) sharing the responsibility for a patient’s hormone therapy.

Transgender: A term for people whose gender identity differs from their assigned sex at birth. 

Existing research

Lesbian, gay, bisexual and transgender (LGBT+) people face significant barriers to accessing healthcare. There is strong and consistent evidence that this community experiences poorer access to healthcare, outcomes and experiences compared to the general population[1]. These disparities are further highlighted in the Trans Inclusive Healthcare report June 2024[2], which underscores the challenges faced by trans and non-binary people in receiving respectful and appropriate care.

Key issues include misgendering individuals, the use of non-inclusive language and discriminatory attitudes. All of these deter individuals from seeking care and contribute to worsening health outcomes. A lack of inclusive training for healthcare professionals contributes to poor experiences reported by transgender individuals.

The TransActual survey 2021[3]: Enduring the UK’s hostile environment, gathered feedback from 700 transgender individuals about their lived experiences with healthcare and social stigma:

• 70% experienced transphobia while accessing healthcare.
• 45% felt their GP did not have a good understanding of transgender healthcare.
• 57% avoided visiting a doctor when unwell.
• 40% reported difficulty accessing NHS transition-related services.

Healthwatch Nottingham and Nottinghamshire carried out a local study to explore the healthcare experience of the LGBT+ community[4]. This report draws specifically on findings relating to transgender care. Concerns were raised about limited knowledge among healthcare professionals regarding transgender-specific needs, and long waiting times were identified as a barrier to accessing services. Some individuals expressed discomfort about having to disclose their transgender status when it felt unnecessary. Previous negative experiences also contributed to a reluctance to seek support from healthcare services.

Currently, anyone aged 17 or over, registered with a GP in England, who experiences gender incongruence can access the services provided by one of a number of Gender Identity Clinics (GICs), funded by NHS England. 

GICs make recommendations around what medications should be prescribed to patients but are not responsible for providing those prescriptions or monitoring the medications, with that service usually being provided by the GP practice that patients are registered with.

Local context

In June 2025, NHS England advised that prescribing and monitoring for patients with gender dysphoria was not part of the standard GP contract, NHS Nottingham and Nottinghamshire agreed to commission a service by offering a Local Enhanced Service (LES) to those practices who wish to provide it. A LES is a service a GP surgery can opt in to provide beyond the core contract, thereby offering a specific health service to meet the needs of the local population, in this case for patients who are transgender. Where practices do not choose to deliver the LES, an alternative provision will be commissioned.

This service is being delivered on an interim basis initially, pending the launch of a permanent service, informed by the findings of this listening exercise.

Engagement aims and objectives

The listening exercise aimed to understand experiences of adult transgender patients regarding the prescribing of hormones and blockers from their GP practice. The findings will help identify areas for improvement and inform in the development of a new service.

The listening exercise focussed on gathering views to establish if there is a preference for:

• The service to be delivered by a GP or a central provider organisatation.

• What is important to transgender patients to be included in the service.

• Details of what the service could look like.

• How far patients would be willing to travel?

Insights from the listening exercise will contribute to existing evidence base relating to experiences of trans affirming care through NHS GPs specifically in Nottingham and Nottinghamshire.

[1] NHS England » LGBT+ health

[2] Trans-inclusive-healthcare-report-June-24.pdf

[3] TransLivesSurvey2021.pdf

[4] 20170501_Nottingham_Nottinghamshire_Exploring20care20of20Lesbian20Gay20Bisexual20Tr.pdf

The listening exercise commenced on 28 July 2025 and concluded on 12 September 2025.

The ICB Engagement Team specifically wanted to hear from transgender patients who had experience of being prescribed hormones and blockers and from those waiting for treatment. A range of different methods were used to listen to individuals to understand their views.

 In total, 114 individuals shared their views:

• 82 people completed the survey.
• 14 people attended online focus groups.
• 17 people attended an in-person listening event.
• One interview was carried out over Microsoft Teams.

Survey

An online survey was developed in partnership with the Nottingham Centre for Transgender Health (see Appendix 1). Alternative versions and formats of the survey, including in languages other than English, were available upon request.

The invitation to be involved in the listening exercise was shared electronically with 325 organisations and contacts who directly support this community or have an interest in their health/care needs.

A stakeholder briefing was also distributed to MPs and Councillors across Nottingham and Nottinghamshire.

Focus Groups

An open invitation to visit community groups and forums to facilitate focus groups and gather feedback was communicated via the launch email and included within the survey introduction.

A collaboration was established with Notts Trans Hub to enable its members to actively participate in the listening exercise and share their views. The activities included two virtual focus groups, and one in-person event. (See Appendix 2). Prior to the focus group the Engagement Team met with the Chair of Notts Trans Hub who shared advice on how best to engage with the trans community and facilitated access to the venue and online platform.

Data analysis and reporting

Written notes taken from focus groups, interviews and qualitative responses from the survey data, were thematically analysed. Quantitative data was analysed to produce descriptive statistics.

The majority of the responses received 82% (n = 67) were from transgender patients. 10% (n = 8) selected the interested third party category.) 1% (n = 1) worked for a service supporting people who are transgender. 7% (n = 6) were parents, friends of transgender patients or carers.

47% (n = 39) were currently or previously registered with an NHS GP in Nottingham or Nottinghamshire and receiving or have received hormone treatment and bloods monitoring from that GP. 49% (n = 40) were not registered with an NHS GP to receive hormones treatment or bloods monitoring.

The survey included two demographic questions, age and area of residence. A total of 82 individuals responded to the survey, with 74 respondents providing answers to one or both of the demographic questions. The age profile of respondents most reported was the 20-39 years range 62% (n = 46).

26% (n = 19) indicated that they were from Nottingham City whilst 54% (n = 41) were from Nottinghamshire.

Content warning: The findings section refers to treatments including bloodwork.

This section presents the analysis from the responses received through the survey, online interview, online focus groups, and in person focus group. The statistics presented in this report are related to the quantitative data collected in the survey and the themes were developed from the qualitative data.

Theme 1: Difficulties accessing hormones and blockers and receiving bloods monitoring from an NHS GP or practice

Accessing treatment

Many deeply personal experiences were shared at focus groups and via the survey that reflected a sense of being overlooked or misunderstood within the current NHS healthcare system.

67% (n = 50) of survey respondents reported difficulties in accessing hormone treatment and bloods monitoring through an NHS GP, with 25% (n = 19) stating no difficulties with access.

Some individuals stated that certain GPs openly acknowledge their lack of specialist knowledge in transgender healthcare, which can leave patients feeling responsible for educating both themselves and their GP on essential aspects of their care. Long waiting times, limited access to gender-affirming treatments, and inconsistent support at GP surgeries left some individuals feeling frustrated and angry towards the NHS. For those who have sought alternatives, it has often been at great emotional and financial cost.

“The ability for GPs to refuse care should not be possible, but glad something is being done about the service overall.”

“I want informed consent without requirement of an intrusive and degrading gender incongruence diagnosis. I don’t want to tell a stranger my history of homophobic and transphobic assault under duress, to access my healthcare”

Survey respondents shared that some GPs have refused to monitor blood levels, either outright or when individuals are self-medicating. This issue was echoed strongly in focus group discussions, where participants emphasised that access to bloods monitoring is vital in relation to harm reduction and life saving for some where individuals feel they have no choice but to self-medicate, either to bridge the gap before they can receive treatment, or in response to not being able to access the service at all.

Frustration was also expressed when GPs declined to prescribe treatment, particularly in cases where individuals felt they had provided sufficient information and guidance. In many cases, poor experiences in communication have led to a lack of trust and many individuals turning to self-medication. Some respondents shared that, only after approaching the practice manager and sharing their concerns, were they able to access the care they needed.

“Sometimes my GP just doesn’t request the bloods or seem to understand what is being asked of them.”

The value and importance of GPs in providing bridging prescriptions as part of gender-affirming care was emphasised. These prescriptions offer temporary access to hormone treatment while individuals wait for an appointment at a Gender Identity Clinic.

“I’m on a bridging prescription which I could only get after taking unlicensed hormones which feels really dangerous, but I couldn’t wait any longer for my own mental health.”

“Wait list is so long and GPs won’t prescribe bridging prescriptions. Even if you go private, they won’t even do the blood tests anymore, even if they aren’t responsible for monitoring the results.”

Waiting times to access treatment

Feedback clearly reflected concerns about long waiting times for gender-affirming care. Some individuals reported waiting as long as nine years to access hormone treatment. Delays were experienced at multiple stages of the pathway. From initial GP referrals to the Gender Identity Clinic (GIC), which can take up to two months to be received, to further waits for assessment and subsequent treatment and monitoring. A lack of clarity was also expressed as to where people are on the waiting list and expected waiting times.

“The wait is soul destroying.”

“The wait time for hormones is causing people to kill themselves. Many GPs don’t have the training for a bridging prescription. I got one because I was mentally in the gutter and doing unlicensed hormones myself. But I would love for GP to be able to prescribe hormones without a patient having to take risks with unlicensed medication and without having to be mentally ill.”

Feedback strongly suggested that there is significant concern about safety for individuals due to self-medicating and from the psychological impact of waiting for treatment. Experiences were shared where individuals had taken drastic measures through self-medicating, despite the associated risks, and as such have come to harm. These experiences spark concern, anxiety and anger for those around the individual and within the wider transgender community. Excessive wait times for treatment and limited access to prescriptions and bloods monitoring at GP surgeries are seen as the reason people in the transgender community take these risks. Comparisons were drawn with non-transgender individuals accessing hormone replacement therapy for menopause where long extensive waits for treatment are not reported.

“In an ideal world being seen and treated in months instead of years….”

“Realistically the greatest barrier to accessing healthcare for trans people is time. Endless waiting lists one after another for additional treatments. Access to every level needs to be widened, including the mandatory psych sessions for diagnosis and surgery referral.”

“Patients should be able to access the treatments that they are willing to consent to.”

Agreement to prescribe

Several individuals shared experiences where GPs initially agreed to prescribe hormones or blockers but later withdrew their support. This reversal often led to significant financial loss and emotional distress, especially for those who had already registered with private clinics.

A recurring theme in the feedback was the reluctance or in some cases, refusal from GPs to agree to prescribe hormones or blockers or enter into shared care arrangements. For many, this represented a major barrier to accessing consistent and safe gender-affirming care.

In instances where shared care arrangements were in place, participants reported practical challenges. Letters from private clinics were sometimes lost or marked as not received, requiring repeated follow-ups and causing delays in treatment.

There were also difficulties with GPs refusing to change names on documents, make referrals or alter gender markers on the clinical system. MX is a title preferred by some non-binary and transgender individuals and is an alternative to gendered titles such as Mr, Mrs, Miss. There is a concern that if gender markers are not correct on the clinical system it could impact on medical care.

“I scarcely visit the GP and am very careful about discussing both physical and mental illness, due to fear that I am taken off of HRT against my will, which has happened locally to others. This survey has not addressed the critical breakdown of trust which has occurred between me and the healthcare services which exist, up to and including the NCTH. I am confident I am not the only person who feels this way.”

“My GP refused to refer me for anything or help with anything that could be even remotely considered gender affirming care. Even if it would be something that would be treated in nontrans individuals.”

“GP felt they did not know enough about hormone treatment for transgender patients to offer it.”

Feedback from focus groups suggested that ADHD and autism is frequently experienced by individuals within the transgender community. It was suggested that care and support would be enhanced by a greater awareness from healthcare professionals.

Administrative issues

Administrative issues at GP surgeries have led to delays in accessing medication for transgender patients. These include unsigned prescriptions, late test result transfers to Gender Identity Clinics, difficulty securing GP appointments when medication is due, poor communication about prescription collection and medication being stopped without explanation. Additionally, changing GP surgeries can disrupt continuity of care, with hormone treatments sometimes halted and taking a long time to restart. There was a preference for the NHS to prescribe progesterone for trans women and injections rather than patches, gels or pills was a preferred method.

“The current system requires a lot of chasing & the GP practices seem to not have a guideline/framework, which can be mentally tiring & lead to long delays. It would be very good to have a clearly defined pathway for GPs to follow to take the confusion away and provide a framework for setting patient expectations of responsibilities etc.”

Theme 2: Positive experiences accessing hormones and blockers and receiving bloods monitoring from an NHS GP or practice

36% (n = 25) of survey respondents selected satisfied or very satisfied with their experience of hormone treatment and blood test monitoring and 37% (n = 26) were dissatisfied or very dissatisfied.

Table 1. Satisfaction with experience of hormone treatment and bloods monitoring through an NHS GP  (n = 70)

When asked about positive experiences, a number of GPs were acknowledged and mentioned by name for their support and knowledge about transgender healthcare. Some GPs were recognised for their understanding, support and respectful treatment when it came to trans healthcare. Positive experiences were reported for being prescribed medication, bloods monitoring, ease of appointments and the usefulness of appointment reminders. Some patients felt that although their GP was not experienced in trans healthcare, they were willing to listen to and follow guidance from the endocrinologist. Reception staff were also recognised for being helpful and responsive with admin processes, such as managing arrangements where GPs agree to prescribe and with changing NHS numbers when updating a gender marker on medical records.

“I have never had any issue accessing hormone treatment and blood monitoring. From the moment I was prescribed hormones from the Nottingham Gender Clinic, my GP has been supportive and helpful in administering the hormones and taking the blood required of the Gender Clinic.”

“My GP has fortunately never been difficult about prescribing my HRT and I’ve always been able to access nurse appointments for injections on time. They even remind me of when my next injection is due.”

“I was required to submit blood samples on a regular basis, and I explained to the Endo about my previous experience, he then made contact directly with the GP Surgery, and I was then treated as a human being. The Patient Manager at this time was exemplary in her support. Given that you can no longer book appointments to suit what you need, my stress levels would escalate to horrific levels trying to get an appointment when I needed it. …”

There was an acknowledgment that having a positive experience of receiving treatment through the NHS for gender dysphoria was uncommon. Survey respondents with positive experiences felt that they were within a minority, as largely negative experiences were shared within the transgender community. The data collected from this listening exercise reflects that the majority of individuals reported having a negative experience. 67% of survey respondents had difficulty accessing treatment. This was strongly echoed by experiences shared at focus groups. Some individuals were reluctant to name the GP surgery involved, fearing it might become oversubscribed.

There was a strong preference for all patients who are transgender to receive timely support and treatment with understanding and respect from both clinical and admin teams at their GP practice. For some individuals, there was an emphasis on overcoming obstacles which required a lot of self-advocating before the experience turned out to be positive.

“My doctors practice has always been very caring and knowledgeable when monitoring and administering my hormones but having heard the experience of other people I feel like a lucky minority. I wish everyone received this standard of care.”

Theme 3: Location preference and design of a new service to prescribe hormones and blockers and provide bloods monitoring

As shown in the table below, 48% (n = 38) of survey respondents would prefer to access hormone treatment and blood test monitoring at a GP practice, 25% (n = 20) said they did not mind. “Other” answers included reference to a local organisation to provide the service but mostly focused on the chosen location being safe and accepting of transgender people.

Table 2. Preference for where to access hormone treatment and bloods monitoring (n = 79)

During focus groups, the conversation was split between a central location and services centred within GP practices, with the prior being suggested due to the specialised training that would come with it, and the guaranteed access. However, those preferring GP based services highlighting the convenience of attending.

“Availability of a reliable service is the priority as this is an essential medication, availability must improve as a result of this change. Accessibity would be second priority.”

“I would like to flag the fact that although people are willing to travel to access treatment it doesn’t mean that we should, a lot of people have accessibility issues”

“I have a largely positive experience with my GP and am happy with their management of my HRT. It is convenient for me to just pop round the corner to them. It would be nice if everyone could access such good care from their GP as ultimately this is likely to be the most convenient option logistically. There is also something to be said for not ‘othering’ treatment for gender incongruence by putting treatment of it out into a separate service – these drugs are not actually unfamiliar to GPs, and they should be able to manage them in patients whose treatment has been started by the gender clinic.”

30% (n = 22) of survey respondents were willing to travel 20 minutes by car, 19% (n = 14) would travel 45 minutes by car with 22% (n = 16) travelling an hour by car. “Other” answers focused primarily on respondents who were not able to drive, but others highlighted that they would drive as far as was required to get to the service. However, some people said that the distance they would be willing to drive would depend on the amount of services that were being provided during the appointment.

Table 3. Preferred distance to travel by car to receive hormone treatment and bloods monitoring (n=74)

As shown in the below table, 42% (n= 33) of survey respondents would travel one bus or tram with 33% (n=26) willing to travel two busses or trams.

Table 4. Preferred distance to travel by public transport to receive hormone treatment and bloods monitoring (n=78)

42%4242 (n = 33) of survey respondents would travel one bus or tram with 33% (n to travel

“Other” answers for this question highlighted that members of the community may have disabilities or other restrictions limiting them from using public transport.

When asked about travelling to appointments during the in person and online focus groups, a strong theme arose of members of the transgender community not being able to drive or having access to a car, so strong public transport links would be preferred. However, many participants shared experiences of travelling significant distances, often to different cities or on journeys spanning multiple hours to receive treatment.

“Have travelled 6 hours for a half hour appointment but would DIY rather than travel that distance for hormone treatment.”

“[We] Shouldn’t have to travel that far to access this care, and some people won’t be able to.”

Respondents were asked to rank the below 9 statements in order of importance. The below order ranks the priorities from position one being most important down to number nine being the least. The ranking was reached by weighting the culmination of each position those responding to the survey submitted them as (ie. a respondent putting a statement at number one would positively influence the statements position in the ranking more than placing it at number two). Therefore, while the above answer gives an overall impression of priorities for respondents, it contrasted significantly from some individual responses.

 For example, while some entered “A separate clinic that isn’t my GP practice” as their number one priority (2 respondents), when the weighting is considered, it is still ranked as the overall lowest priority.

Table 5. Ranking statements listed in priority order by survey respondents (n=80)

Feedback from conversations at focus groups reflected a preference for a separate clinic where an inclusive offer could be guaranteed. This would include bloods monitoring and prescriptions. With this in mind, while the ranking above shows an indication of relative importance in relation to these priorities, all factors are important to be considered as opinions on them vary significantly across the transgender community.

During both the survey and focus groups, wait times was raised as a significant issue for members of the community, tied into the accessibility of the service as it stands. It was felt that as hormone replacement therapy for non-transgender people can be processed in a short number of weeks, it should be the same for transgender people. Similarly, with the medications that are prescribed being time sensitive to ensure good health, a long wait time can have significant negative impacts on the patient. Therefore, simple and reliable access to medications in a reasonable time period was put forward as a priority.

“Top priority is making sure people get medications with minimal problems, in a timely, reliable and affordable manner.”

Specialist staff, peer support in healthcare settings, and more general support and information from healthcare providers were each put forward as priorities for the new service design. Many participants highlighted the sense of fear that can arise during the process of transitioning, and that there is a lot of information that needs to be learned to help ensure their best health. The experience of people who attended the focus groups is that often the GPs and health providers have a low level of knowledge, so the availability of specialist knowledge and support in and around appointments was emphasised when discussing the design of future service.

“I would very much like to see some sort of support service at any clinic that is opened. Not necessarily clinicians but trans people of lived experience to help others treading that long pathway. My life has been full of challenges, 30 years as a Police Officer, Skydiving Pilot, Skydiving Instructor, Scuba Diving Instructor, but in all of these experiences by far the most scary, was transitioning, and there was NO help whatsoever.”

Acknowledgements

We would like to thank everyone who engaged and spoke with us during this engagement activity. We also appreciate the support received in promoting and distributing details of this engagement amongst networks and contacts which helped with raising awareness and encouraging involvement.

Appendix 1: Survey questions

Prescribing hormones and blockers for transgender patients

Introduction

NHS Nottingham and Nottinghamshire is seeking feedback from patients who have had medications prescribed for gender incongruence. Your views and experiences will help us understand what’s working well and where improvements can be made.

Gender incongruence is a term used to describe a discrepancy between birth-assigned sex and gender identity. Gender dysphoria describes the sense of unease or dissatisfaction that a person may have due to a mismatch between with their biological sex and their gender identity. For more information about gender dysphoria treatment, please visit this website- https://www.nhs.uk/conditions/gender-dysphoria/treatment/

Current Provision

The Nottingham Centre for Transgender Health is one of a number of gender identity clinics (GICs) funded by NHS England. It offers support, advice, and information about available treatments, helping people make informed and supported decisions. Anyone aged 17 or over, registered with a GP in England, who experiences gender incongruence and wants NHS-funded care, can access the services provided by GICs.

GICs will make recommendations around what medications should be prescribed to patients but are not responsible for providing those prescriptions or monitoring the medications, with that service usually being provided by the GP practice that patients are registered with.

NHS Nottingham and Nottinghamshire ICB is keen to understand people’s current experience of receiving prescriptions for hormone treatment and bloods monitoring from their GP practices and their views as to how the service could be improved.

Your feedback will help shape the design of this new service, which is expected to launch in April 2026.

How to get involved. You can get involved by completing this surveyor if you would like a member of the team to come and talk to your community group or network to obtain feedback, please do let us know by emailing us at nnicb-nn.engagement@nhs.net or please call 07818584419.

Will my taking part be kept confidential? This survey contains some questions where you can write freely. When providing responses to these, please do not write any information that may identify you (for example, name or address). Your responses may be recorded but the data you provide will be anonymised, so we will not analyse or share any information that will make you identifiable. To read about our privacy notice visit https://notts.icb.nhs.uk/privacy-policy/.

Should you require a hard copy of the survey or the survey in an alternative format or language, please contact nnicb-nn.engagement@nhs.net, or call 07818584419 to request a copy.

The survey is open from the 28 July and will close on the 12 September at 23:59pm

This section will ask you some questions to understand your experience of being prescribed hormone treatment and bloods monitoring?

About You 

1. How are you responding to the survey? (Please tick all that apply)

• I am a transgender patient

• I am a carer of a transgender patient

• I am an interested third party

• Other, please state _____________________________

2. Are you currently, or have you previously registered with a Nottingham or Nottinghamshire NHS GP and receiving/received hormone treatment and bloods monitoring from that GP?

3. Thinking about the hormone treatment and bloods monitoring through your NHS GP, how satisfied were you with your experience?

• Very Satisfied
• Satisfied
• Neither satisfied nor dissatisfied
• Dissatisfied
• Very dissatisfied

4. Thinking about hormone treatment and bloods monitoring through your NHS GP. Have you experienced any difficulties with accessing treatment?

• Yes
• No
• Prefer not to say

5. If you have experienced any difficulties in accessing hormone treatment and bloods monitoring from any particular GP or practice and you would like to share this with us, please tell us about this in the box below. Giving this information is not mandatory and it will not be shared on an individual basis.

6. If you have a positive experience with accessing hormone treatment and bloods monitoring from any particular GP or practice and you would like to share this with us, please tell us about this in the box below. Giving this information is not mandatory and it will not be shared on an individual basis.

7. Where would you prefer to access hormone treatment and bloods monitoring?

• At my GP practice
• At a location that isn’t my GP within Nottingham and Nottinghamshire
• I don’t mind
• Prefer not to say
• Other______________

8. What is the furthest you would drive to access hormone treatment and bloods monitoring?

9. What is the longest public transport journey you would make to access hormone treatment and bloods monitoring?

• One bus or tram
• Two buses or trams
• Other, please state ________________________

10. What would you like us to take into consideration when designing a hormone prescribing and bloods monitoring service? Thinking about your experience, please rank the following statements in priority order. Adding a priority order helps us understand what is most important to you.

11. If there is anything else you would like to share, please do so in the box below.

Demographics

Answering these questions help us to ensure we are hearing from a wide group of people and will allow us to see where the gaps in our knowledge are.

12. Do you consent to providing some further demographic information?

• Yes
• No

13. Which age band do you fall into?

• 16- 24

• 25 -34

• 35-44

• 45-54

• 55-64

• 65-74

• 75-84

• Over 85

• Prefer not to say

14. If you are happy to share the information, please tell us what area of Nottingham and Nottinghamshire you live in?

• Nottingham City
• Ashfield
• Bassetlaw
• Broxtowe
• Gedling
• Mansfield
• Newark and Sherwood
• Rushcliffe
• Prefer not to say
• Other

Thank you for taking the time to fill out this survey

Appendix 2: Focus group questions

• Where would you prefer to be prescribed hormones or blockers and receive bloods monitoring? For example, at your GP practice, at a location that isn’t your GP within Nottingham and Nottinghamshire?

• What is the furthest you would travel to access the service? Up to one hour by car? Up to two buses/trams, other?

• What would you like us to take into consideration when designing the service? Thinking about waiting times, travel, flexible appointments, information provided at the appointment, parking, public transport links, staff with specialist knowledge, what is most important to you?

• If you have a positive experience with accessing treatment and monitoring from an NHS GP or practice and you would like to share this with us, please to tell us about your experiences.

• If you have experienced any difficulties in accessing treatment and monitoring from an NHS GP or practice and you would like to share this with us, please tell us about your experiences.

• Do you have anything else you would like to share with us?