Accessing HRT as a trans person in the UK
So you’ve decided that you want to start HRT, what now?
Firstly, congratulations on taking this step! There’s a lot of information out there on HRT access, and it can be overwhelming to sort through into something manageable, so hopefully this guide will make the process less of a headache.
When it comes to options for accessing HRT there are four main paths to access, these are:
- Your GP after being seen by a Gender Identity Clinic (GIC)
- A private gender service
- A shared care agreement
- Self medicating
The following sections will provide a high level overview of each pathway and point you towards some additional resources to help you reach a decision about which option is right for you.
Accessing HRT the NHS way
Accessing hormones through the NHS pathway involves getting a referral to a Gender Identity Clinic (GIC), from your GP or self referral if your chosen GIC accepts them, going onto a waiting list for many years to get an initial appointment, and then several months more waiting for a second appointment, at which point the GIC can make a recommendation for hormones for your GP to prescribe.
If you are aged 16 and under, this process is similar, however there are differences to be aware of, check out this article for more information on this process.
This process is prohibitively lengthy. However it is advisable to get a referral ASAP, especially if surgery is part of your transition journey, as receiving gender confirming surgery for free through the NHS requires you to have gone through this process.
Going through the GIC pathway does have the benefits of being free, and once you’ve completed the process, in theory you have NHS provided access to HRT in perpetuity.
See current GIC waiting times at this resource from TransActual
This resource from TransActual gives some information about what to expect at your first appointment.
If you want to create a supporting document to take to your GP when you ask for a referral, check out our document generator.
Going Private
Accessing HRT solely through a private service is a relatively quick process, whilst the specifics vary between providers, generally you pay for an appointment or two, get assessed, and then they can prescribe for you.
Whilst choosing a private gender service can be relatively quick, it is prohibitively expensive, with costs easily running into the 1000’s, just for initial appointments, assessments and blood tests. The re-occurring fees can also be very expensive to have follow up assessments, blood tests, prescription fees and actual medication costs.
Check out this resource from TransActual if you’re interested in choosing a private provider.
If you are aged 15 and under, you cannot currently access HRT from a UK private gender clinic, however there are options internationally, most notably GenderGP. If you choose this route, be aware of concerning actions from NHS England regarding trans youth healthcare outlined in our article for trans youth.
The best of both worlds: utilising both private and GP services
A shared care agreement is when your GP agrees to work with a private gender specialist, in which the GP will provide a prescription for HRT, and carry out any bloodwork and administer injections as necessary, under the advice of the private provider who will interpret bloodwork results and provide regular reviews on your hormone treatment.
Shared care allows you to access HRT through the NHS with two documents, a formal diagnosis of gender dysphoria (or similar term) and a letter of recommendation for HRT. The upfront cost is significantly cheaper than going purely private, and a lot faster than waiting for a GIC appointment.
Unfortunately this process still carries a price tag out of the reach of many, can be overwhelming in complexity, and is reliant on your GP agreeing to work with a private service.
Shared care is not available for those under 16, and those aged 16–17 should only try to enter shared care when working with a UK based, GMC registered private provider. be aware of additional concerns, specifically “safeguarding” actions, as highlighted in our article for trans youth.
To learn more about the shared care process, check out our guide to shared care.
To create a supporting document to take to your GP when asking for a shared care agreement, check out our document generator.
If the system is broke, do it yourself
When talking about DIY, it’s not meant that you’ll actually manufacture the medication yourself but rather take the sourcing into your own hands.
DIY is possibly the quickest route to accessing HRT, with waiting times dependant on suppliers and the postal service. There’s no upfront assessments or invasive sessions with therapists, and the whole process can be completed from the comfort of your home.
DIY does carry numerous risks, when taking your health into your own hands you should do the due diligence to minimize the risk as much as possible. This usually involves taking an array of blood tests, and thoroughly researching your chosen supplier before purchasing from them.
For the ultimate guide to all things DIY, check out The DIY HRT Directory.
Disclaimer: Nothing within the contents of this article constitutes to medical advice, this is purely our interpretation of the available information. Further independent research is highly advised.
Article content last updated: October 2024
