Faqs

TransPlus is an exciting new pilot of an NHS Gender Dysphoria Clinic for adults (17 and over) that is integrated into an existing sexual health and HIV service at 56 Dean Street.

56 Dean Street is an award-winning sexual health and HIV service based in Soho, the heart of London’s LGBT+ community. Set to run for 3 years, the TransPlus pilot integrates specialist gender care with a range of sexual health and wellbeing services.

TransPlus will offer flexible, tailored support options, assessment for and diagnosis of gender dysphoria, hormone therapy (including prescriptions and monitoring), voice therapy, as well as referrals to surgical providers. The service will work to NHS England’s National Service Specification for gender dysphoria services.

TransPlus doesn’t have a waiting list, as such. As a pilot service, we are seeing a limited number of service users over the course of three years. You are eligible to access TransPlus if you meet ALL of the following criteria

• You are 17+, eligible for NHS treatment and registered with a GP in England

And

• You were registered as a user of sexual health services provided by 56 Dean Street, 10 Hammersmith Broadway or the John Hunter Clinic (all part of Chelsea & Westminster Hospital NHS Foundation Trust) ON or BEFORE 01/01/2020.

And

• You are on a waiting list for an existing NHS Gender Dysphoria Clinic AND are yet to attend your first appointment.

We are contacting eligible people directly in order to let them know about the service and invite them to join TransPlus as a service user.

If you meet all of the above criteria, please read through the rest of this Service User FAQ and decide whether or not you would like to transfer your care from your current waiting list to TransPlus at 56 Dean Street. Details about how to access the service are included in the questions below.

You may not have heard from us for a number of reasons. For instance, we may not be aware that you are currently on a waiting list for an NHS Gender Dysphoria Clinic (i.e. we don’t know that you’re eligible for the service), or you may have changed your phone number since your last visit.

If you meet the eligibility criteria for the TransPlus service, please read through the rest of our Service User FAQs. If you think you would like to use TransPlus or you would like to ask us further questions in order to decide, please contact us via: TransPlusInfo@ChelWest.NHS.uk

TransPlus is the first NHS Gender Dysphoria Clinic in England to offer gender-affirming interventions alongside sexual & reproductive health services and HIV care. We are an experienced, multi-skilled team of trans and LGBQ practitioners and allies.

We offer a flexible, holistic service that supports people who are exploring their gender. We can provide assessment for (and diagnosis of) Gender Dysphoria, and subsequent access to various elements of medical transition (should people choose it). Additionally, we aim to support all our service users in optimising their sexual health and wider wellbeing.

Some of the services we offer may be familiar to you within the context of a gender dysphoria clinic:

• Support and advice around gender identity (inc. peer support)
• Assessment and diagnosis of Gender Dysphoria
• Speech and language therapy
• Prescription and monitoring of hormone therapy
• Assessment and recommendation of readiness for surgery (and referral)
• One-to-one and group interventions with an experienced psychologist

We also offer:

• One-to-one and group psychosexual therapy (a space to explore and reduce gender dysphoria as it relates to your sex life, as well as a range of sexual problems)
• Workshops to improve self-esteem, reduce dysphoria and improve wider wellbeing
• Workshops and activities to improve health, fitness and nutrition
• Full sexual and HIV health services (from prevention inc. PEP and PrEP, rapid testing and results, HIV and STI treatment and care)
• Specialist reproductive health services for trans/non-binary people (including expert advice on contraception and specialist cervical screening service for trans men and AFAB non-binary people in partnership with Tavistock & Portman NHS Hospital Trust)

If you haven’t already heard from us, but think you might be eligible to use the service please contact us via TransPlusInfo@chelwest.nhs.uk with your name, date of birth, the date you were referred (and the name of the service), and your mobile telephone number.

Once you’ve contacted us:

• One of our team will call you on the phone. This gives you a chance to ask any questions you might have about the service and how it works.
• We’ll ask you some brief questions about your health and wellbeing needs and any accessibility requirements you may have.
• We’ll also need to confirm which NHS Gender Dysphoria Service you have been referred to and how long you’ve been waiting.

This call is not an assessment and there is no right or wrong way to answer any of the questions.

Then what?

We understand that choosing your gender clinic is a big decision. You don’t have to give us an answer on the spot and we want you to have all the information you need to make the best choice for you. Take some time to read through our webpages and any information we send you. We’ll call you back in 7 days to see if you would like to book your first appointment with us.

In the meantime:

• Talk the decision through with friends, family, or partners if it feels helpful to do so.
• Read through our Service User FAQS if you haven’t already.
• Think of any additional questions you need answering in order to decide.

If you are happy to join TransPlus, you’ll need to let your current Gender Dysphoria Service know that you no longer need to be on their waiting list.

This doesn’t need to be hard or complicated. We’ll send you an example e-mail that you can copy and paste your details into before you send it off to them.

Booking your appointment:

We’ll call you back and ask if you’re happy to book your first appointment. If you’d like to go ahead, we’ll arrange a time and a date that’s convenient for you to come into 56 Dean Street. We’ll text you the details of your appointment, and you’ll also get another reminder message a few days before your visit too.

• We’ll ask you to notify your existing Gender Dysphoria Service that you are transferring your care as soon as possible (if you haven’t already).
• We’ll send you your unique login code for our website so that you can access a range of resources and information personalised to your needs.

It doesn’t count against you in any way. If you’ve read through all of our information and decided that TransPlus isn’t right for you, we hope you’ll continue to use our other services as and when you need them.

You don’t need to give us a reason and you can keep using Dean Street Express, 56T (our weekly dedicated service for trans/non-binary people and their partners) or any of our other sexual and reproductive health services at 56 Dean Street.

Your first appointment at TransPlus is split into two stages. Each stage is an hour-long, with a short break in between. This is to maximise your time spent with us and to reduce the need for multiple appointments (and therefore multiple trips).

We’ll ask you if this is ok when we’re booking your appointment. Some people may opt to spread their first appointment over two separate days for a number of reasons (e.g. chronic health conditions, difficulty concentrating, fatigue etc). This is fine by us, and you don’t need to give a reason on the phone if you don’t want to.

Stage One: You’ll meet with either our Specialist Health Adviser or one of the Senior Nursing Team. Stage One is an opportunity for you to explore the services we offer in more detail and to ask questions about various aspects of social or medical transition. During this initial discussion, we would also like to learn a bit more about you. This helps us to offer the most appropriate information and support.

We will most likely discuss:

• Your gender identity, your feelings about it and how it may have changed and developed over time
• Your hopes and goals for the future
• Various aspects of your life, such as hobbies, work, or education
• Your wellbeing, including your mental health (both currently and in the past)
• Your relationships and support networks
• Your next steps

Get the most out of your visit:

• Bring a list of questions you would like to ask us
• Take notes during the appointment
• Slow us down or ask us to repeat anything that wasn’t clear
• Bring a friend, family member, caseworker or partner with you*

*Because we see people who experience domestic or sexual abuse, we will always ask service users to come into their appointments alone at first (or with a caseworker if you choose). Once we have asked some confidential questions about you and your safety, your supporter, friend or advocate is welcome to join you.

Stage Two: If you are hoping to access physical interventions such as hormone therapy or referral for surgery via TransPlus, you’ll meet a member of the nursing team for a health check. We’ll ask about your medical history (including any health conditions and/or medication you might be taking). We’ll also measure your height, weight and blood pressure, and take some blood tests. This health check does not involve a genital or chest examination.

In this part of your visit, we’ll also offer a full sexual health screen and vaccinations for some sexually transmitted infections (Hepatitis B and Human Papilloma Virus/HPV). If you have symptoms of an STI, we may offer an examination and treatment but this is separate from your pre-hormone health check (which does NOT require a genital examination). If it feels more appropriate we can arrange for you to come back on another day or see a different member of staff about your sexual health.

By undertaking the health check during your first appointment, we can be ready to start hormone therapy at your second appointment if:

• You’re diagnosed with Gender Dysphoria at your 2nd visit
• You’ve read and understood the information we gave you
• You’re feeling ready to start hormones therapy
• It’s medically safe for you to do so

At the end of your first visit, we will give you some written information about the services we offer, as well as information about hormone therapy and/or gender-affirming surgeries if required.

Please read this information before you come back for your second appointment (usually in 2-4 weeks) and highlight or make notes of any areas you would like more information about.

There’s no set way to dress ‘like a man’, ‘like a woman’ or ‘like a non-binary person’ and we strive to provide a space where all trans/non-binary people can be themselves. We recognise that gender identity is very different from gender expression, all we ask is that people dress however they feel most comfortable on the day.

For some people, Dean Street might be one of the few places they are able to dress in ways that feel authentic (whatever that might look like). By all means, bring a change of clothes (wigs, make-up etc.) to your appointment. Just make sure you dress for you, and not for us.

You’re welcome to change in any of the bathrooms on site. The toilets on the clinic floors are available but often busy as they’re used for STI screening. The bathrooms on the Lower Ground Floor are the quietest in the building and are not in constant use. Just ask our team at ground floor reception to buzz you through the door.

We are a team of professionals from a range of backgrounds and disciplines (inc. nursing, psychology, social work, sexual & reproductive medicine). You can find out more about the TransPlus team here.

As a pilot Gender Dysphoria Clinic, our team will be receiving on-going training and clinical supervision from an experienced Specialist Consultant in Gender Dysphoria.

To support the learning and development of the TransPlus team, we may ask your permission for either a colleague or a supervisor to sit-in on some of your appointments with us (either physically or via a video link). We will ask your consent when booking your appointment and you are welcome to decline.

Confidentiality is a fundamental component to the running of any sexual health service, and as TransPlus is part of 56 Dean Street we follow the same policies as the wider service. There are strict laws that we must adhere to regarding the use, sharing, disclosure, storage and transfer of patient-identifiable information. This means any personal information you provide us will be held in the strictest confidence. Your TransPlus records are stored within the sexual health clinic’s computer system and kept separate from the general medical notes that are used in the main hospital. Computerised information about our patients is coded and only staff within the clinic are able to access identifiable information (such as your name or address).

You can access a full sexual health screen anytime you visit TransPlus. This can involve blood tests for syphilis, hepatitis B and C, HIV, as well as swabs or urine samples for bacterial infections like chlamydia or gonorrhoea.

You may also need blood tests because you are already taking hormones or you’re thinking about taking them in the future. We can undertake hormone monitoring at the same time as your sexual health screen or HIV care to avoid the need for multiple blood tests.

An important part of hormone care is having regular blood tests to check your hormone levels, your liver and kidney function, and your full blood count. If and when you start taking new medications as part of your TransPlus care, we will most likely check your blood at 1 month, 3 months, and 6 months intervals. Once people are stable on their hormones, blood tests are required every 6 months to 1 year.

We will start you on your medication and take responsibility for monitoring in the early stages. However, we will work to ensure your GP surgery feels competent and confident in carrying out your blood monitoring (and injections – if needed) in the long term.

At your first visit, we’d like for you to undertake a physical health check with our nursing team. This will include taking your medical history and a sexual health screen (if it feels necessary and appropriate). We’d also like to take your blood pressure, measure your height and weight and take a set of blood tests. These tests will look at your full blood count, hormone levels, and your kidney and liver function. We’ll also give you some information about hormone therapy to take away with you and read before your next visit.

Our clinical team will have reviewed your blood results by the time you come in for your second visit (2-4 weeks later) and will have made a recommendation for a prescription. If you receive a diagnosis of Gender Dysphoria at your second appointment, you’ll have the option of starting hormone treatment on that day. This is also the case for people who have already received a diagnosis of Gender Dysphoria from an NHS-approved practitioner elsewhere.

We understand that some people may wish to wait and/or access additional support before starting hormone therapy (if they choose to take hormones at all). We have a range of services designed to support our service users to make the best possible choices about their gender care (including peer support, clinical psychology and psychosexual therapy), and those decisions will always be led by you.

We also ask that all service users who are interested in hormone therapy read the information from the Human Fertilisation & Embryology Authority about trans/non-binary people and fertility preservation here.

This is dependent on a number of factors. For instance, some people may be joining the TransPlus service having already received a diagnosis of Gender Dysphoria from an approved provider elsewhere. If this is the case, it may take less time for that person to be assessed for surgery compared to a person who has never had any formal support around their gender dysphoria.

The TransPlus pilot has been commissioned for 3 years. In this time, we hope that eligible service users will be assessed for Gender Dysphoria and (if diagnosed) will subsequently have access to any gender-affirming care that is available via the NHS (including hormones, speech therapy, talking therapies and group work to reduce dysphoria, and surgery).

By the end of the pilot, we anticipate that all TransPlus users will be discharged from the service and will latterly be under the care of their GP.

TransPlus offers a safe, efficient service. The time between your first and second appointments is usually 2-4 weeks (unless you choose otherwise). Some people may choose longer periods between appointments for a number of reasons e.g. to access additional support or services or to spend more time considering the various options available to them. We’re a flexible service and we’ll be led by you.

If you are taking hormones that have not been prescribed to you by a registered medical professional, we can provide blood tests to monitor your hormone levels and the impact of the medication on your body. We have walk-in slots available for at 56T every Wednesday evening.

As you are taking medication that we did not prescribe to you, we’re not able to provide guidance about how to take it. However, we can explain what your blood test results mean and highlight any abnormalities. You can use this information to make an informed choice about how to continue with your medication. If we have serious concerns about any of your blood results, we will ask for your consent to notify your GP.

Not necessarily. We want to make sure that TransPlus is as easily accessible as possible, and we understand that many people will have been diagnosed in private services or abroad and that some may have started hormone therapy or even had some surgeries prior to being seen at TransPlus.

If you received your Gender Dysphoria diagnosis from a health professional who can evidence appropriate training and experience in assessing, diagnosing and prescribing for gender dysphoria then you will not need to receive a diagnosis from TransPlus.

Appropriate training and experience can include:

•   Formal links with an NHS-commissioned specialised Gender Dysphoria Clinic
•   Formal links with relevant professional associations
•   Previous time spent working in NHS-commissioned Gender Dysphoria Clinics
•   Attendance of relevant meetings, workshops or seminars
•   Obtaining supervision from a health professional with relevant experience
•   Participating in credible research related to gender non-conformity or gender dysphoria

A number of people will be joining the TransPlus service at various different life stages. As long as you meet the service criteria and have not already been seen at an existing NHS Gender Dysphoria Clinic, you are eligible to use TransPlus.

Choosing the right surgeon for you is a big step. Make sure you explore the types of procedures you want thoroughly, find out as much as possible about the surgeon, and review pictures of their previous results. These are often available on request from the surgical providers themselves as well as from various community websites.

Whilst we can assess people for their readiness to undergo gender-affirming surgical procedures, we are not responsible for the waiting lists for individual surgical providers. However, many providers will have cancellation lists for people who are able to undergo surgery at short notice.

Some of the factors that might cause delays to surgery include:

Getting to a healthy weight – There are a number of risks associated with procedures that require a general anaesthetic. Each surgical team will have its own guidelines about weight (both under or over-weight), as this will affect a person’s risk of surgical complications. Providers will usually set a weight range for those they consider suitable for surgery, which is often a body mass index (BMI) of 18-30. If you know your weight and height, you can calculate your BMI here, or you can use our free machines in the Level 2 and Level 3 waiting rooms at 56 Dean Street. They can tell you your weight and BMI, as well as checking your blood pressure.

We can help people achieve a number of goals in relation to their weight (both putting it on and losing it) through our workshops and activities.

Giving up smoking – Smokers are significantly more likely to experience complications during or after surgery and some surgical providers will not operate on people who are active smokers. Not only are smokers at risk of serious complications from undergoing surgery, smoking can also affect the healing process and cause tissue death where skin has been grafted. Talk to us about giving up smoking or contact your GP or local Stop Smoking service.

Hair removal – Certain surgeries might require a person to undergo hair removal procedures before the procedure. E.g. a person having phalloplasty (surgery to create a penis) might want to permanently remove the hair on their forearm if it is being used to create the penis shaft and urethra. Those having vaginoplasty or vulvoplasty (surgery to create a vagina or vulva) will require hair removal on any skin sites that will be resituated to the inside of the body in order to avoid future complications.

Other health conditions – There are a number of physical health conditions which might need to be controlled or treated before undergoing surgery e.g. genital warts if you are having genital surgery.

Optimising your psychological wellbeing is also important. Sometimes just thinking about a hospital stay or having a surgical procedure can cause some people to experience anxiety. Additionally, undergoing surgery with a general anaesthetic can have a big impact on your mood and energy levels. The recovery process can also take a lot out of you and can cause some people to feel lonely, vulnerable or scared. Particularly if you’ve never had an operation before and are unsure if you are healing as you would expect or wondering if you are taking good care of your wounds.

Getting yourself feeling as though you are well prepared for surgery and the healing process is important, as is asking questions to your surgical team if you’re unsure about something once you’re discharged home. A lot of surgical providers are happy to provide remote follow up over the phone or e-mail, including reviewing pictures of any tissue or stitches that you may be worried are not healing as they should.

The short answer is yes. 56 Dean Street has offered sexual health services to marginalised communities for over 10 years. The team has experience in working with people from all walks of life, including the trans and wider LGBTQI+ communities, and those who live with an array of wellbeing challenges.

We understand that trans/non-binary people face day-to-day adversities that can result in poor mental health, including thoughts of suicide and self-harm. These thoughts and feelings do not (in and of themselves) constitute a barrier to accessing care. We strive to provide our service users with the tools and coping strategies they need to improve their mental wellbeing and develop their resilience.

With your consent, we aim to work in partnership with any existing support services you may access (e.g. mental health teams, learning difficulty or eating disorder services) to ensure you feel safe and supported in making decisions about your care at TransPlus.

Additionally, we have specialist clinics for people who hope to make changes to their drug or alcohol use, and for people who work in the sex industry. We encourage and support TransPlus users to access these services if needed and strive to provide a judgement-free service at all times.

56 Dean Street is a specialist HIV care centre and we have provided both sexual health and HIV services to trans/non-binary people since the service opened in 2009. Research indicates that combining HIV care with gender-affirming services and hormone therapy can optimise people’s adherence to their HIV treatment, resulting in better health outcomes.

However, if you are a TransPlus service user who is living with HIV and you receive your care elsewhere, you do not have to transfer your HIV care to us. You are welcome to do so, but it is not a requirement of using TransPlus, Dean Street Express, 56T (our weekly dedicated service for trans non-binary people and their partners) or any other sexual and reproductive health services at 56 Dean Street.

We support trans/non-binary people’s right to self-determination. However, the current process for obtaining legal gender recognition in the UK requires an application for a Gender Recognition Certificate in accordance with the Gender Recognition Act 2004. See the Gov.UK website for further details.

Should you choose to apply, your application requires a report from a:

•   doctor registered with the General Medical Council (GMC)
•   psychologist registered with the Health and Care Professions Council

We are able to provide a medical report for these purposes, which is compliant with the following guidance.

Please request the report at one of your appointments or ask the team via TransPlusInfo@ChelWest.NHS.uk 

We love to hear feedback about the services we provide. Whether it’s positive or negative, your views help us shape and develop our services and allows us to deliver the best possible care. If you would like to give feedback or talk to us about a problem or complaint you can do so via Chelsea & Westminster Hospital Trust’s Patient Advice and Liaison Service.

We also have paper feedback forms in all of our waiting rooms and at the reception desks. If you prefer to use these, please hand them to our clinical team or the reception staff.

TransPlus can offer assessment and referral to providers of gender affirming surgeries. If you are interested in having any gender affirming procedures (via the NHS) it’s important to research the types of surgical procedures and the results you can expect from each provider.

Below is a list of all the surgical providers who accept referrals for NHS service users.

Gender affirmation surgery for trans women/trans femme and other AMAB people (genital/lower)

Dr Phillip Thomas
Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr Charles Coker
Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr Timothy Larner
Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr James Bellringer
Parkside Private Hospital (Aspen Health)
53 Parkside
Wimbledon
London, SW19 5NX

020 8971 8000

Dr Tina Rashid
Parkside Private Hospital (Aspen Health)
53 Parkside
Wimbledon
London, SW19 5NX

020 8971 8000

Dr Roland Morley
Imperial College Healthcare NHS Trust
Charing Cross Hospital
Fulham Palace Road
London, W6 8RF

020 3311 1234

Dr Tina Rashid
Imperial College Healthcare NHS Trust
Charing Cross Hospital
Fulham Palace Road
London, W6 8RF

020 3311 1234

Gender affirmation surgery for trans men/trans masc and other AFAB people (genital/lower)

Prof David Ralph
St Peters Andrology Centre
145 Harley Street
Marylebone
London, W1G 6BJ

020 7486 3840

Dr Nim Christopher
St Peters Andrology Centre
145 Harley Street
Marylebone
London, W1G 6BJ

020 7486 3840

Dr Phillip Rubin
St Peters Andrology Centre
145 Harley Street
Marylebone
London, W1G 6BJ

020 7486 3840

Gender affirmation surgery for trans men/trans masc and other AFAB people (chest/top)

Dr David Ross
Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr Andrew Mellington

Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr Charles Nduka
Brighton Hospital (Nuffield Health)
Warren Road
Brighton
East Sussex, BN2 6DX

01273 624488

Dr Thangasamy Sankar (Referrals via Brighton Hospital)

Leicester Hospital (Nuffield Health)
Scraptoft Lane
Leicester
LE5 1HY

0300 131 1416

Dr Phillip Rubin (Referrals via Brighton Hospital)
Newcastle Upon Tyne Hospital (Nuffield Health)
Clayton Road
Newcastle upon Tyne
NE2 1JP

0191 281 6131

Dr Antony Fitton (Referrals via Brighton Hospital)
Plymouth Hospital (Nuffield Health)
Derriford Road
Plymouth
PL6 8BG

01752 775861

Dr Robert Morris (Referrals via Brighton Hospital)
Plymouth Hospital (Nuffield Health)
Derriford Road
Plymouth
PL6 8BG

01752 775861

Dr Peter Kneeshaw
Hull University Teaching Hospital NHS Trust
Castle Hill Hospital
Castle Road
Hull
HU16 5JQ

01482 875875

Dr Brendan Wooller
Hull University Teaching Hospital NHS Trust
Castle Hill Hospital
Castle Road
Hull
HU16 5JQ

01482 875875

Dr Kartikae Grover
Hull University Teaching Hospital NHS Trust
Castle Hill Hospital
Castle Road
Hull
HU16 5JQ

01482 875875

Dr Dorin Dumiru
Hull University Teaching Hospital NHS Trust
Castle Hill Hospital
Castle Road
Hull
HU16 5JQ

01482 875875

Dr Andrew Yelland
Mount Stuart Hospital (Ramsay Health)
St Vincent’s Road
Torquay
TQ1 4UP

01803 700870

Dr Chris Mills
Mount Stuart Hospital (Ramsay Health)
St Vincent’s Road
Torquay
TQ1 4UP

01803 700870

Dr Catherine Milroy
Parkside Private Hospital (Aspen Health)
53 Parkside
Wimbledon
London, SW19 5NX

020 8971 8000

Dr Victoria Rose
Parkside Private Hospital (Aspen Health)
53 Parkside
Wimbledon
London, SW19 5NX

020 8971 8000

Dr Kate Williams
Pennine Acute Hospitals NHS Trust
North Manchester General Hospital
Department of Breast Surgery
Delaunays Road
Crumpsall
Manchester
M8 5RB

0161 624 0420

Dr Ioannis Ntanof
Pennine Acute Hospitals NHS Trust
North Manchester General Hospital
Department of Breast Surgery
Delaunays Road
Crumpsall
Manchester
M8 5RB

0161 624 0420

Prof Phillip Drew
Royal Cornwall Hospital NHS Trust
Treliske
Truro
Cornwall
TR1 3LJ

01872 250000