Gender transition

Your health experts: Michelle Lopacki, Corporate Lead Clinician, and Dr Naveen Puri, Associate Clinical Director
Content editor review by Rachael Mayfield-Blake, March 2021
Next review due March 2024
This information resource has also been created with help from the transgender and non-binary community. We’d like to thank all those involved for their help and support.

This information is aimed at people aged 17 and older

The sex you’re said to have (assigned) when you’re born may not match the gender you identify with. This mismatch isn’t a problem. But if it makes you feel uncomfortable or distressed that’s not okay. This is sometimes called gender dysphoria or gender incongruence. If you’re feeling like this, it’s important to get help and support.

Gender dysphoria

Everyone is unique and so too are our experiences. Some people notice the misalignment between the sex they were assigned at birth and their gender identity when they’re a child. For others, it happens later when they’re a teenager or adult. The medical term for this mismatch is gender dysphoria, or gender incongruence.

You may identify with the following.

• You may feel very strongly that your gender identity doesn’t align with the sex you were assigned at birth.
• You might feel more comfortable when people treat you in line with your gender identity. For example, if they talk about you using words you prefer, such as him, her or them. These kind of words that are used instead of your name are called pronouns.
• You may feel uncomfortable and have a strong desire to hide or change characteristics that associate you with the sex you were assigned at birth. For example, your chest, genitals, body hair or voice.

People who identify as non-binary can experience these feelings too. If you identify as non-binary, you may feel that your gender identity falls between the binary model (for example, boy and girl, or man and woman), or outside of them completely. You may identify as having no gender or a different gender completely. Your gender identity may also be fluid, fixed or change over time.

Help and support

If you feel that your gender doesn’t match the sex you were assigned at birth you might need some support. You may find it helps to talk to someone you trust at first, such as friends or family. Or you could speak to a counsellor, or your GP. You can take someone along to your appointment if you’ll feel more comfortable.

Your GP can help you to access services and support in the best way possible. They’ll talk to you about how you’ve been feeling and may do a general check-up to prepare for any future treatment.

It helps to prepare for your appointment. You might want to think about what type of care you feel would help you. For example, you might be interested in hormone therapy or mental health support. Not all GPs have experience of gender dysphoria and gender transition so don’t be afraid to lead the conversation around how you want to be addressed and any other needs.

If you don’t feel that your GP can help you, make an appointment to see a different doctor. You could also try contacting a charity or organisation that can help you to access the care you need. Some of these are listed at the bottom of this page.

You might also find it helps to speak to people in a similar situation to yourself through online or offline peer-to-peer support groups. If your feelings are affecting your mental health, there is support available. See the section Mental health support below for more information on these services.

Gender dysphoria clinics (GDC)

Your GP may refer you to an NHS Gender Dysphoria Clinic (GDC). You might have also heard these called Gender Identity Clinics (GICs). A GDC includes a team of health professionals from a range of specialists who can help you. These include:

• surgeons
• endocrinologists (hormone therapy experts)
• sexual health physicians
• speech and language therapists
• psychologists
• counsellors

Other health professionals such as psychologists, psychiatrists or a sexual health centre can also refer you to a GDC.

The clinic can help you to access specialist advice and care and discuss your needs and options going forward. But, while these services are available, the reality is that access to GDC services can be limited. There will likely be a very long waiting list. If you’re able to, you can also refer yourself and pay to access private gender specialist services.

Deciding to transition

There are lots of things you can do that might help you to feel more comfortable in yourself. What works for one person, might not work for another, and you might not want to make any changes at all. It’s your decision to make. Take your time, explore your options and make a decision that’s right for you.

This is the process of changing certain things about yourself to help you feel closer to the gender you identify with and is sometimes called transitioning. Transitioning is different for everyone, and it can include medical and non-medical options.

Non-medical options include:

• changing your name
• using pronouns that better reflect your gender identity, such as he/his, she/her, or non-binary pronouns like them/their or ze/hir
• changing how you dress, use make-up or wear your hair
• changing your voice and mannerisms

Medical options include:

• taking hormone therapy
• having surgery

Non-medical transition

There are lots of non-medical ways to change the way you express your gender. You might choose to do one or all of these. You might also choose to medically transition as well. Usually, you’ll be expected to make some non-medical changes first.

Changing your legal gender

You can apply for a Gender Recognition Certificate (GRC) to legally change your gender once you meet certain criteria. Contact Citizens Advice if you need help with the process. It’s quite easy to change your name by deed poll and once it’s done, you can change your gender on identity documents, such as your passport and driving licence. You can change your name at any time, without meeting any criteria first.

Modifying your body shape

There are several stores that specialise in creating garments for transgender and non-binary people to change their body shape. For example, you may want to flatten your chest with a breast binder or chest tape. You can also buy breast forms and genital packers.

Although wearing these things can help your mental wellbeing, some of them can also cause physical symptoms. For example, using a chest binder can cause pain in your back and chest, and shortness of breath.

Research around binding is limited – there aren’t any official, evidence-based guidelines, but you may find it helps to take days off from binding. If you’re considering it, speak to a medical professional about the risks, benefits and actions you can take to reduce the chance of any problems.

Sometimes you might be able to find lower cost or even free binders from local charities and organisations that support transgender and non-binary people.

Body hair

There are lots of different ways to remove or reduce any unwanted body hair. Some of these you can do yourself at home, such as shaving, waxing or using hair removal cream. You can also see a trained professional by visiting a beauty salon. This can sometimes be safer and less painful than trying to do it yourself.

You might find it stressful to go to a salon for the first time. Some charities and organisations list beauty salons that are welcoming to transgender and non-binary people so that you can feel safe and secure when you’re booking an appointment.

For longer-term hair removal there are also treatments such as electrolysis and laser treatment.

Help with hair pieces, transplants and wigs is also available. Ask your GDC for advice.

Changing the way that you speak

For some people, the tone or depth of their voice causes them to experience gender dysphoria. Speech and language therapy (SLT) can help you learn and practise changes in the way you speak and communicate. This is also sometimes called voice and communication therapy. Your GDC, and possibly your GP, can help with a referral to see a speech and language therapist. This might be one to one, as part of a group, or you can pay to see them privately.

Hormone therapy

Hormone therapy is when you take specific hormones designed to enhance certain characteristics. This is one of many gender affirming medical treatments available.

There are lots of different types of hormones that have different jobs around your body, but the ones involved here are your sex hormones. In general, testosterone is known as the ‘male’ sex hormone and oestrogen as the ‘female’ sex hormone. These hormones produce changes in your body during puberty. These include developing breasts or facial and body hair, and changes to your voice and body shape.

Your doctor may also prescribe you hormone ‘blockers’ to stop your own body from producing hormones so the prescribed hormones can work better.

The aim of hormone therapy is to suppress your current sex characteristics and enhance those of the gender you identify with. This may make you feel more at ease with yourself, both physically and psychologically.

The type and dose of hormone therapy differs from one person to the next. It’ll depend on things like:

• your age
• the effect you want to achieve
• if you have any underlying medical conditions

There are also different ways that you can take hormone therapy, which include tablets, gels, patches and sprays. The way you take your hormones might change over time. Your doctor should monitor your progress regularly.

Below is information about the results you may see if you start hormone therapy. You can alternatively download Bupa's Effects of hormone therapy document (PDF, 0.1 MB). But it’s important to remember that everybody is different and will respond to hormone therapy in different ways. If you have any concerns about the effect your hormone therapy is having, then speak to your GP. 

Transmasculine hormone therapy

Using hormone therapy to make your body appear more masculine can involve:

Below we outline some of the effects and approximate timescales of hormone therapy. Some changes may be permanent, while others can be reversed. So, make sure you discuss your treatment fully with your doctor before you begin.

Transfeminine hormone therapy

Using hormone therapy to make your body appear more feminine can involve:

• oestrogen hormones to enhance traditionally more ‘feminine’ characteristics
• blocker medicines, such as goserelin and leuprorelin, to suppress (slow down) the production and function of some hormones, mainly testosterone. While testosterone is part of a wider group of hormones called androgens. So, you might hear these medicines called anti-androgens.

Below we outline some of the effects and approximate timescales of hormone therapy. Some changes may be permanent, while others can be reversed. So, make sure you discuss your treatment fully with your doctor before you begin.

Risks of hormone therapy

Your doctor will talk to you about the risks and benefits of different hormone therapy. Depending on what you want to achieve and your personal situation, you may need to take hormone therapy for the rest of your life.

Among other things, hormone therapy can potentially cause problems with your heart and circulation and increase your risk of certain cancers. It’s important to discuss these risks with your doctor so you have the information to consent to the therapy if you decide to go ahead. No hormone medicine is completely safe – they all come with an element of risk. But there are things you can do to help improve your chances of staying safe and well. For example, stay a healthy weight and don’t smoke.

Your healthcare team will regularly monitor your health while you take hormone therapy.

Buying medicines online

It’s important to get medical support with hormone therapy. While you can buy hormones online or from other outlets, it can be dangerous. Your GP can arrange a referral for you to discuss and access hormone treatment safely at a GDC. While it may take time to get an appointment, it’s worth the wait to ensure you get safe care.

Your GP may be able to give you what’s called a ‘bridging prescription’, while you wait to access specialist care. This will give you the option to start you treatment while you wait to be seen at a GDC.

Having children

If you would like to have children in the future, tell your doctor before you start hormone therapy. You may be able to store your eggs or sperm. Your GDC team can give you advice about your options and next steps.

Adoption and fostering are other routes to consider if you want to have children in future. UK law supports the lesbian, gay, bisexual and transgender (LGBT) community when it comes to adoption, whether you’re in a relationship or doing it alone. Organisations such as New Family Social can provide further information and support if you need it.

Surgery

There are different types of operations that may help you to feel closer to your gender identity. What, and how much surgery you have, is up to you. Surgery is part of medically transitioning.

If you choose to have surgery, your healthcare team – including your surgeon and mental health professionals – will discuss your options with you. Together, you can decide what’s right for you. Before you go ahead with any procedures, they’ll make sure that you’re well enough both physically and mentally to have the surgery. Depending on the type of surgery, you may need one or two referrals from a mental health professional.

Your healthcare team will make sure you have all the information you need to give your informed consent for a procedure to go ahead. This will include information on the risks and benefits. If you have any doubts, talk to your surgeon and don’t be afraid to change your mind. This is your decision, so make sure that you feel comfortable with it.

Breast or chest surgery

You can have surgery to:

• masculinise your chest, for example by removing your breasts (mastectomy) – this is often known as ‘top surgery’
• feminise your chest, for example by enhancing or creating breasts – this is also called a breast augmentation

Genital surgery

Genital surgery is also known as gender affirmation surgery. You might sometimes hear it called gender reassignment surgery (GRS).

You may also hear people referring to this type of surgery more generally as ‘bottom surgery’. There are lots of different types and what you have done will depend on your personal situation and goals.

If you were assigned female at birth, you may have the following.

• Surgery to remove your womb (a hysterectomy) and ovaries (ovariectomy, also known as oophorectomy).
• Surgery to remove and/or seal your vagina (vaginectomy).
• Surgery to create a scrotum (scrotoplasty).

You can also have surgery to create a penis. Speak to your surgeon about which type of surgery would be best for you. There are two main types.

• Metoidioplasty (‘meta’ surgery) or phalloplasty, which involves creating a penis from your clitoris. The penis will be small and will depend on how large your clitoris grew following hormone therapy. Your surgeon can add tissue to increase the length and the girth.
• Phalloplasty involves using donor skin (a graft) from another part of your body, for example your forearm, to create an entirely new penis. Some surgeons can leave your clitoris uncovered to make sexual stimulation easier after your operation.

If you were assigned male at birth, you can have surgery to remove your penis (penectomy) and testicles (orchiectomy), and to create:

• a vaginal opening (vaginoplasty)
• the outer part of the genitals (the vulva and labia) known as a vulvoplasty
• a clitoris (clitoroplasty)

Other procedures

There are also many other surgical and cosmetic options, such as:

• facial feminisation surgery (FFS) which can change features, such as the shape of your jaw, Adam's apple, and hair line
• liposuction and lipofiling
• injectable fillers which can enhance features such as your lips, cheekbones, and jawline
• hair transplants to replace hair loss or change your hair line
• tattooing to increase your nipple size, enhance your eyebrows or create make-up effects
• changing the shape of an area of your body such as your waist or chest
• voice feminising surgery to change the pitch and tone of your voice

Supporting your mental health

If you feel uncomfortable with your gender, it can affect your mental health. Or you may experience mental health symptoms because of how society perceives you. You might also experience upsetting reactions from your family or friends. If your feelings are affecting your mental health, your GP can refer you to a mental health professional.

Ask if they have experience in working with transgender people. There are specialists available. You can also access these services yourself without seeing a GP first. Organisations such as Gender Identity Research & Education Society can help you to find someone.

Mental health professionals can help you to understand the different types of gender identity and explore your own. They can also help you with coming out to family and friends. Their goal is to help you to feel comfortable and equipped to deal with challenges and thrive going forward.

Mental health professionals may use talking therapies, such as cognitive behavioural therapy (CBT) or psychotherapy to help you. They can also help you if you have anxiety and depression, or any other mental health problems. They also play an essential role in assessing your mental wellbeing before your doctor refers you to a specialist, for example an endocrinologist for hormone therapy.