gender reassignment surgery nhs england

You are here: Home > Services > Surgery services > Chelsea Centre for Gender Surgery (CCGS)

Chelsea Centre for Gender Surgery (CCGS)

Our Trust has been commissioned by NHS England to provide lower masculinising gender affirmation surgery. The Chelsea Centre for Gender Surgery is passionate about helping patients alleviate their gender dysphoria. We work with service specialists and the transgender community to deliver a high quality, patient centred service, supporting patients through their surgical journey. 

The Chelsea Centre for Gender Surgery service is based at the St Stephen Centre at our Chelsea site.

Get in touch

For more information, please visit the  Chelsea Centre for Gender Surgery  microsite. You can also contact us on the below email address. E:   [email protected]

NHS Gender Dysphoria National Referral Support Services

• Skip to content
• Cookie Policy
• Accessibility

Call us:  0115 876 0160

Search the Transgender website

• Service Users Research Advice Group
• Pride in our flag
• Your feedback
• Patient updates and service announcements
• My Transgender Journey
• Your fertility
• Hormone therapies
• Psychology and Psychotherapy
• Hair removal
• Finding your voice
• Waiting list update
• Support groups
• Changing your details
• Frequently asked questions
• Making referrals
• Prescribing Guides
• Speech and language therapy
• Other GP guidance
• Changing patient's NHS details
• Your Fertility
• Finding Your Voice
• Research Papers
• Get in Touch (Young People's Service)
• Young Person's Service FAQs
• Freedom of Information Requests
• Nottingham Centre for Transgender Health
• Meet the building
• Get in touch

NHS Arden and Greater East Midlands Commissioning Support Unit (AGCSU) is one of the largest commissioning support units in the country and works with local and national NHS bodies to help deliver health services.

AGCSU has been commissioned by NHS England (NHSE) to provide a seamless service between the NHS Gender Identity Clinics and the NHS Surgical Providers (hospitals), to process referrals for specialised gender surgery for people over the age of 17 in England, Scotland, Wales and Northern Ireland. This service is known as the GDNRSS. NHS Gender Dysphoria National Referral Support Service (GDNRSS).

If you and your clinician decide that a referral for surgery would be appropriate for you, your referral will be handled by the GNDRSS.

The GDNRSS also runs a support line to talk about aspects of your surgery if you need further advice or support:

Tel: 01522 857799 Monday to Friday, 9am-5pm

If you do opt for surgery, and it is considered appropriate by your gender specialist clinicians, then it will be undertaken by surgeons commissioned by NHS England in line with the national service specification.

If you want to find out more about GDNRSS, download this leaflet -  NHS Gender Dysphoria National Referral Support Service.pdf

For patients

• Your appointments
• Your treatment

For GPs and professionals

• Treatments offered

The Nottingham Centre For Transgender Health © 2024

Powered by VerseOne Group Ltd

We use cookies to personalise your user experience and to study how our website is being used. You consent to our cookies if you continue to use this website. You can at any time read our cookie policy .

How to get help and support - Gender dysphoria

You may have to wait some time for a referral for an assessment at a gender dysphoria clinic because of more people needing gender dysphoria services. However, there are things you can do to help.

For children and young people under 18

If your child or teenager is distressed, ask the GP to refer them to the local Children and Young People's Mental Health Service (CYPMHS). CYPMHS may be able to offer psychological support while they wait for their first appointment at the Gender Identity Development Service.

The school or college may be able to offer additional support.

You and your GP can find a wide range of information and support on the Gender Identity Development Service (GIDS) website.

While you're waiting for your first appointment at a gender dysphoria clinic (GDC), or waiting for treatment, there are several things you can do.

If you are struggling with your mental health, speak to your GP about getting support and treatment.

Quit smoking if you smoke

It's advisable to stop as smoking can increase the risks of side effects of hormone treatment and surgery. Get advice on stopping smoking .

Lose weight if you are overweight

Certain risks from cross-sex hormones are increased if you are overweight.

Do not self-medicate with hormones

You do not know what you're being sold and you could harm yourself without regular monitoring. Hormones may also affect your future fertility.

Use contraception if you are sexually active

Ask your GP or sexual health service for contraceptive methods to suit your needs.

The UK Faculty of Sexual and Reproductive Healthcare (FSRH) has a useful guide to contraception for transgender and non-binary people .

Live in your preferred gender (social transitioning)

For some, this is an important part of managing gender dysphoria at home, work and socially.

You would need to do this before you can have gender surgery. Gender dysphoria clinics need to know the changes you want to make in your social role will improve your life and be sustainable over time, so that they can help you with this process.

As part of social transitioning, most gender dysphoria clinics recommend you change your name by deed poll . You can do this for free and then use it to change your name on your passport and other personal documents, at your bank, work and at the GP surgery.

Once the GP has a copy of your deed poll, they should contact Primary Care Support England to change your name on medical records and issue you with a new NHS number.

Non-binary identities are not officially recognised, but the GP can make a note of your chosen name and preferred pronouns.

Page last reviewed: 28 May 2020 Next review due: 28 May 2023

Cookies on GOV.UK

We use some essential cookies to make this website work.

We’d like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services.

We also use cookies set by other sites to help us deliver content from their services.

You have accepted additional cookies. You can change your cookie settings at any time.

You have rejected additional cookies. You can change your cookie settings at any time.

• Health and social care
• Public health
• Population screening programmes
• NHS abdominal aortic aneurysm (AAA) programme
• NHS population screening: information for transgender people
• NHS England

NHS population screening: information for trans and non-binary people

Updated 4 January 2023

Applies to England

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people

This information is for trans (transgender) and non-binary people in England. It tells you about the adult NHS screening programmes that are available in England and explains who we invite for screening.

We use trans as an umbrella term to embrace the diverse range of identities outside the traditional male/female definitions. These include transgender, gender fluid and non-binary. Find more trans health information on NHS.UK .

Screening for trans people at a glance

Trans women and non-binary people assigned male at birth who are registered with a GP as female:

• are invited for breast screening
• are invited for bowel cancer screening
• do not need cervical screening as they do not have a cervix
• are not routinely invited for abdominal aortic aneurysm ( AAA ) screening but can request screening

Trans women and non-binary people assigned male at birth who are registered with a GP as male:

• are not routinely invited for breast screening but can request screening
• are invited for AAA screening

Trans men and non-binary people assigned female at birth who are registered with a GP as female:

• are invited for cervical screening
• are not invited for AAA screening

Trans men and non-binary people assigned female at birth who are registered with a GP as male:

• are not routinely invited for cervical screening but can request screening
• are invited for AAA screening but do not have a high risk of AAA

Trans men who are pregnant should be offered the same antenatal and newborn screening tests as all other pregnant individuals.

Breast screening

Breast screening is a free NHS test that is carried out at breast screening centres and at mobile breast screening units across England.

Breast screening can find cancers when they are too small to see or feel. Finding and treating cancer early gives you the best chance of survival. Screening will miss some cancers, and some cancers cannot be cured.

Taking part in breast screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Breast screening invitation process

All individuals from 50 up to their 71st birthday who are registered as female with their GP are automatically invited to breast screening. When you are due for screening, we will send you an invitation letter. It is not possible for individuals registered as male to have mammograms as part of the NHS Breast Screening Programme, but your GP can refer you for mammograms at a hospital near you (see the information for people registered as male below).

We invite you for breast screening every 3 years. Your first invitation will arrive sometime between the ages of 50 and 53. If you are trans it is important that your GP makes sure that your records are up to date so you are invited for screening correctly.

If you do not want to be invited for breast screening, you need to contact your local breast screening office. They will explain how you can opt out of breast screening.

It is important that you feel that you are treated with dignity and respect at all times.

Let your screening service know if you would:

• like your appointment at the beginning or end of a clinic
• prefer to be screened at your local breast screening centre rather than a mobile breast screening unit

Visit NHS.UK for your service’s contact details.

Trans men and non-binary people assigned female at birth

Registered with a gp as female.

If you are aged from 50 years up to your 71st birthday and registered with a GP as female, you will be routinely invited for breast screening. We recommend you consider having breast screening if you have not had chest reconstruction (top surgery) or still have breast tissue.

If you are worried about visiting a breast screening unit you can ring to arrange a more suitable appointment. For example, we can arrange for you to have an appointment at the beginning or end of a clinic.

Registered with a GP as male

If you are registered with a GP as male, you will not be invited for breast screening. If you have not had chest reconstruction (top surgery) and are aged 50 or over we suggest you talk to your GP . They can arrange a referral for you to have mammograms at a hospital near you.

You should keep aware of the symptoms of breast cancer , and contact your GP if you notice any unusual changes.

If you have had chest reconstruction (top surgery), we advise you have a conversation with your surgeon about the amount of breast tissue you have remaining. If they confirm you still have breast tissue, you can ask your GP to refer you for mammograms at a hospital near you.

Trans women and non-binary people assigned male at birth

Registered with a gp as a female.

If you are aged from 50 up to your 71st birthday and registered with a GP as female, you will be routinely invited for screening. Long-term hormone therapy can increase your risk of developing breast cancer so it is important that you consider going for breast screening when you are invited.

If you are registered with a GP as male, you will not be invited for breast screening.

If you have been on long-term hormone therapy you may be at increased risk of developing breast cancer. Your GP can arrange a referral for you to have mammograms at a hospital near you.

Breast screening test

A breast X-ray called a mammogram is used to look for signs of cancer. Each breast is pressed firmly between the plates of an X-ray machine for a few seconds. The pressure is needed to get good images and also reduce the radiation dose. Your test will be carried out by a specially trained female mammographer.

Some people say having a mammogram is uncomfortable and a few may find it painful, but the discomfort should pass quickly.

Breast screening usually involves 2 X-rays of each breast. People who have implants are offered the choice of additional X-rays so the mammographer can see as much breast tissue as possible.

Preparation

If you are a trans man or non-binary person assigned female at birth who is registered with a GP as female, has not had chest reconstruction (top surgery) and wears a binder, you will need to remove this before having your mammogram.

Private changing facilities will be available so that you can remove your binder just before having your mammogram. If you have any concerns about your appointment, you can contact your local breast screening service.

Breast screening results

For most people the mammograms will show no signs of cancer. If changes are seen on your X-rays, you will be recalled to an assessment clinic for more tests which will include:

• a breast examination
• more X-rays or ultrasound scans

You may also have a biopsy, where a small sample of tissue is taken from the breast with a needle.

Sometimes breast screening can pick up cancers that would never have caused harm, so people are treated for breast cancer that would never have been life-threatening.

Reducing your risk

Screening reduces the number of deaths from breast cancer by finding signs of disease at an early stage.

It is important to know what is normal for your body. If you notice any changes report them to your GP .

Cervical screening

Cervical screening (also known as a smear test) is a free NHS test that is carried out at your GP surgery or at some sexual health clinics. The test looks for early changes in the cells of the cervix.

Cervical screening aims to prevent cancer from developing in the cervix (neck of the womb).

It is important to go for screening as finding changes before they become cancer gives you the best chance of successful treatment.

Nearly all cervical cancers are caused by human papillomavirus ( HPV ). HPV is a very common virus – most people will be infected with it at some point in their life. It can be passed on through any type of sexual activity.

Screening will not prevent all cancers and not all cancers can be cured.

Taking part in cervical screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Cervical screening invitation process

We invite people registered as female for cervical screening every 3 years from the age of 25 to 49 and every 5 years from the ages of 50 to 64. We also invite people who are over 65 who have not been screened since age 50 or those who have recently had abnormal tests.

We send an invitation letter when the cervical screening test is due, asking you to make an appointment.

If you are trans it is important that your GP contacts the NHS Cervical Screening Programme so you are invited for screening correctly. If you do not want to be invited for screening you should contact your GP . They will be able to remove you from the cervical screening invitation list.

It is important that you feel that you are treated with dignity and respect at all times. If you are worried about having cervical screening, talk to your doctor or practice nurse.

If you are aged 25 to 64 and registered with a GP as female, you will be routinely invited for cervical screening. We recommend that you consider having cervical screening if you have not had a total hysterectomy and still have a cervix.

If you are aged 25 to 64 and registered with a GP as male, you will not be invited for cervical screening. However, if you have not had a total hysterectomy and still have a cervix, you should still consider having cervical screening. This is especially important if you have had any abnormal cervical screening results in the past. If this applies to you, let your GP or practice nurse know so you can talk to them about having the test.

If you are a trans woman or non-binary person assigned male at birth, you will not need to be screened as you do not have a cervix.

If you are registered with a GP as female, you will be routinely invited for cervical screening unless your GP has already told us you’re not eligible. We can update our records so you are not invited unnecessarily.

If you are registered with a GP as male, you will not be invited for cervical screening.

Cervical screening test

The nurse or doctor will put an instrument called a speculum into the vagina to help them see the cervix. They will then take a sample of cells with a soft brush.

If you are a trans man who has taken long-term testosterone, you may find screening uncomfortable or painful. You may want to talk to your doctor or nurse about using a different size speculum and some extra lubrication.

Cervical screening results

For most people their test results are normal. If cell changes are found you may need another cervical screening test, or an appointment at a colposcopy clinic where the cervix is looked at in detail.

Nearly all cervical cancers are caused by a virus called human papillomavirus ( HPV ) which is passed on through any type of sexual activity. If you are worried about your risk of developing cervical cancer you may want to speak to your GP or practice nurse.

We recommend you consider going for cervical screening every time you are invited, even if you have had a previous normal result.

Let your GP or practice nurse know if you think you should be invited for screening.

Even if you have had the HPV vaccine we still recommend you consider going for cervical screening when invited.

Consider stopping smoking, as smoking increases your risk of cervical cancer.

If you have symptoms such as unusual vaginal discharge or bleeding, or pain during or after sex, please speak to your doctor even if you have had a normal cervical screening result.

AAA screening

AAA screening is a free NHS test that is carried out in the community, including hospitals, health clinics and GP practices.

AAA screening involves a simple ultrasound scan to measure the abdominal aorta.

The aorta is the main blood vessel that supplies blood to the body. Sometimes the wall of the aorta in the abdomen can become weak and stretch to form an abdominal aortic aneurysm ( AAA ). There is a risk that an AAA may split or tear (rupture).

There is a high risk of dying from a ruptured AAA . Finding an aneurysm early gives you the best chance of treatment and survival. AAA screening reduces your risk of dying from a ruptured AAA .

Taking part in AAA screening is your choice. You can find out more information about AAA screening from your GP or by visiting NHS.UK .

AAA screening invitation process

AAAs are far more common in men aged over 65 than in women and younger men. That’s why the NHS AAA Screening Programme only invites for screening individuals registered as male. However, any trans woman will have the same risk as a man and should consider accessing screening.

Individuals registered as male are invited for an ultrasound scan to check the size of their abdominal aorta when they are 65.

Individuals over 65 can request a scan by contacting their local AAA screening service directly. Visit NHS.UK for contact details.

If you are trans it is important that your GP contacts the NHS AAA Screening Programme so you are invited for screening correctly. If you do not want to be invited for AAA screening, you will need to let us know.

If you are not sure if you should be screened or not, contact your local screening office. You will find your local screening office number and more information about clinic locations on NHS.UK .

Trans men and non-binary people assigned female at birth do not have the same risk of AAA as people assigned male at birth.

If you are registered with a GP as female, you will not be invited for AAA screening.

If you are a trans man aged 65 who is registered with a GP as male, you will be sent an appointment to attend for AAA screening. You can have AAA screening if you wish even though your risk is lower. If the clinic location or appointment time is not suitable, you can contact your local screening office to change this. You will find your local screening office phone number on your invitation letter.

If you are registered with a GP as female, you will not be invited for screening. However, if you are 65, you will have the same risk as a man aged 65 and should consider accessing screening. You can contact us to arrange a suitable appointment. Visit NHS.UK for contact details.

If you are aged 65 and registered with a GP as male, you will be invited for AAA screening.

Any trans woman or non-binary person assigned male at birth will have the same AAA risk as a man and should consider accessing screening.

AAA screening test

The test is a simple ultrasound scan of your abdomen to measure the size of the aorta. Your screening appointment usually takes about 10 to 15 minutes.

The screener will check your personal details and ask for your consent (permission) to do the ultrasound scan.

You will be asked to lie on your back and lift up your top. You will not need to undress completely. If you are wearing a binder, you may be asked to remove it.

The ultrasound scan is usually painless. It can be slightly uncomfortable as the screener may need to apply some pressure.

AAA screening results

The screener will give you your results following your scan.

It is not always possible to see your aorta at your screening test so you may be referred to hospital.

If your aorta is found to be bigger than normal, you will need regular scans to check if it is growing. Some people never need surgery for their AAA .

If your AAA is large you will be referred to a specialist team to discuss planned surgery. Large AAAs can be treated successfully with surgery.

Consider taking part in AAA screening and follow-up when you are invited.

You should also consider:

• stopping smoking
• drinking less alcohol

It is also important to maintain a healthy weight through a healthy diet and physical activity.

Bowel cancer screening

Bowel cancer screening starts with a test kit that is offered for use at home. If the result shows further tests are needed, you are offered a colonoscopy (an examination of the bowel).

Bowel cancer screening reduces your risk of dying from bowel cancer.

Finding cancer early gives you the best chance of survival.

Screening will miss some cancers, and some cancers cannot be cured.

Taking part in bowel cancer screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Bowel cancer screening invitation process

Both men and women are routinely invited for screening.

Bowel cancer screening is offered every 2 years from the ages of 60 to 74. This age range is gradually being extended down to age 50. People aged 75 and over can request a test kit every 2 years by calling the free programme helpline on 0800 707 60 60.

The home test kit

A bowel screening test kit and information pack will be sent to you when you are due for screening. You are asked to collect one or more samples of your poo using the test kit provided.

You will need to complete the test kit within the timeframe on the instructions and return it using the freepost packaging provided.

The test looks for tiny amounts of blood in the sample which you may not be able to see and which could be a sign of bowel cancer. You can contact the free NHS Bowel Cancer Screening Programme helpline for advice on 0800 707 60 60.

Results from the test kit

If blood is found, you will be referred for further tests. This may involve you having a colonoscopy, which looks at the lining of the bowel using a flexible camera. You may find this more uncomfortable if you have had gender reassignment surgery.

To reduce your risk of bowel cancer you should:

• consider taking part in screening, even if you have had a previous normal result
• try to eat a high-fibre diet with plenty of fruit and vegetables, take regular physical exercise and stop smoking
• visit your GP if you notice blood in your poo, a change in your bowel habit over a number of weeks or unexplained weight loss

Bowel cancer can run in families. If you are worried about your risk please speak to your GP .

Your personal information

It is your decision whether or not to have any of these tests.

The NHS Screening Programmes use personally identifiable information about you to ensure you are invited for screening at the right time. NHS England also uses your information to ensure you receive high quality care.

Find out more about how your information is used and protected, and your options . Find out how to opt out of screening .

Is this page useful?

• Yes this page is useful
• No this page is not useful

Help us improve GOV.UK

Don’t include personal or financial information like your National Insurance number or credit card details.

To help us improve GOV.UK, we’d like to know more about your visit today. We’ll send you a link to a feedback form. It will take only 2 minutes to fill in. Don’t worry we won’t send you spam or share your email address with anyone.

What the trans care recommendations from the NHS England report mean

The report calls for more research on puberty blockers and hormone therapies.

A new report commissioned by the National Health Service England advocates for further research on gender-affirming care for transgender youth and young adults.

Dr. Hillary Cass, a former president of the Royal College of Paediatrics and Child Health, was appointed by NHS England and NHS Improvement to chair the Independent Review of Gender Identity Services in 2020 amid a rise in referrals to NHS' gender services. Upon review, she advises "extreme caution" for the use of hormone therapies.

"It is absolutely right that children and young people, who may be dealing with a complex range of issues around their gender identity, get the best possible support and expertise throughout their care," Cass states in the report.

Around 2022, about 5,000 adolescents and children were referred to the NHS' gender services. The report estimated that roughly 20% of children and young people seen by the Gender Identity Development Service (GIDS) enter a hormone pathway -- roughly 1,000 people under 18 in England.

Following four years of data analysis, Cass concluded that "while a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices."

Cass continued: "The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate," read the report.

Among her recommendations, she urged the NHS to increase the available workforce in this field, to work on setting up more regional outlets for care, increase investment in research on this care, and improve the quality of care to meet international guidelines.

Cass' review comes as the NHS continues to expand its children and young people's gender identity services across the country. The NHS has recently opened new children and young people's gender services based in London and the Northwest.

NHS England, the country's universal healthcare system, said the report is expected to guide and shape its use of gender affirming care in children and potentially impact youth patients in England accessing gender-affirming care.

MORE: Lawsuit filed by families against Ohio trans care ban legislation

The debate over transgender youth care.

In an interview with The Guardian , Cass stated that her findings are not intended to undermine the validity of trans identities or challenge young people's right to transition but to improve the care they are receiving.

"We've let them down because the research isn't good enough and we haven't got good data," Cass told the news outlet. "The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it. The children are being used as a football and this is a group that we should be showing more compassion to."

In the report, Cass argued that the knowledge and expertise of "experienced clinicians who have reached different conclusions about the best approach to care" has been "dismissed and invalidated" amid arguments concerning transgender care in youth.

Cass did not immediately respond to ABC News' request for comment.

Recommendations for trans youth care

Cass is calling for more thorough research that looks at the "characteristics, interventions and outcomes" of NHS gender service patients concerning puberty blockers and hormone therapy, particularly among children and adolescents.

The report's recommendations also urge caregivers to take an approach to care that considers young patients "holistically and not solely in terms of their gender-related distress."

The report notes that identity exploration is "a completely natural process during childhood and adolescence."

Cass recommends that pre-pubertal children and their families have early discussions about how parents can best support their child "in a balanced and non-judgemental way," which may include "psychological and psychopharmacological treatments" to manage distress associated with gender incongruence and co-occurring conditions.

In past interviews, U.S. physicians told ABC News , that patients, their physicians and their families often engage in a lengthy process of building a customized and individualized approach to care, meaning not every patient will receive any or every type of gender-affirming medical care option.

Cass' report states that evidence particularly for puberty blockers in children and adolescents is "weak" regarding the impact on "gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown."

The NHS has said it will halt routine use of puberty blockers as it prepares for a study into the practice later this year.

MORE: Amid anti-LGBTQ efforts, transgender community finds joy in 'chosen families'

According to the Endocrine Society puberty blockers, as opposed to hormone therapy, temporarily pause puberty so patients have more time to explore their gender identity.

The report also recommends "extreme caution" for transgender youth from age 16 who take more permanent hormone therapies.

"There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18," the report's recommendations state.

Hormone therapy, according to the Endocrine Society , triggers physical changes like hair growth, muscle development, body fat and more, that can help better align the body with a person's gender identity. It's not unusual for patients to stop hormone therapy and decide that they have transitioned as far as they wish, physicians have told ABC News.

Cass' report asserts that there are many unknowns about the use of both puberty blockers and hormones for minors, "despite their longstanding use in the adult transgender population."

"The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group," the report states.

Cass recommends that NHS England facilities have procedures in place to follow up with 17 to 25-year-old patients "to ensure continuity of care and support at a potentially vulnerable stage in their journey," as well as allow for further data and research on transgender minors through the years.

Several British medical organizations, including British Psychological Society and the Royal College of Paediatrics and Child Health, commended the report's recommendations to expand the workforce and invest in further research to allow young people to make better informed decisions.

“Dr Cass and her team have produced a thought-provoking, detailed and wide-ranging list of recommendations, which will have implications for all professionals working with gender-questioning children and young people," said Dr Roman Raczka, of the British Psychological Society. "It will take time to carefully review and respond to the whole report, but I am sure that psychology, as a profession, will reflect and learn lessons from the review, its findings and recommendations."

Some groups expressed fears that the report will be misused by anti-transgender groups.

"All children have the right to access specialist effective care on time and must be afforded the privacy to make decisions that are appropriate for them in consultation with a specialist," said human rights group Amnesty International. "This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people."

Transgender care for people under 18 has been a source of contention in both the United States and the United Kingdom. Legislation is being pushed across the U.S. by many Republican legislators focused on banning all medical care options like puberty blockers and hormone therapies for minors. Some argue that gender-affirming care is unsafe for youth, or that they should wait until they're older.

Gender-affirming medical does come with risks, according to the Endocrine Society , including impacts to bone mineral density, cholesterol levels, and blood clot risks. However, physicians have told ABC News that all medications, surgeries or vaccines come with some kind of risk.

Major national medical associations in the U.S., including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and more than 20 others have argued that gender-affirming care is safe, effective, beneficial, and medically necessary.

The first-of-its-kind gender care clinic at Johns Hopkins Hospital in Maryland opened in the 1960s, using similar procedures still used today.

Some studies have shown that some gender-affirming options can have positive impacts on the mental health of transgender patients, who may experience gender-related stress.

Related Topics

• United Kingdom

Top Stories

Trump immunity case takeaways: Worry over lawlessness or hobbling POTUS dominates

• Apr 25, 9:09 AM

What witnesses said about Trump's handling of classified info while president

• Apr 24, 4:58 PM

Trump trial updates: 'Thank you for handling' McDougal, Pecker says Trump told him

• 22 minutes ago

Harvey Weinstein's rape conviction overturned in New York; DA will attempt to retry

• 34 minutes ago

Plastic bags from Walmart US recycling tracked to facilities in Southeast Asia

• Apr 23, 9:48 PM

ABC News Live

24/7 coverage of breaking news and live events

• Media & Government
• News and Views

The history of gender reassignment surgeries in the UK

For Pride Month, we are recognising the plastic surgeons who pioneered gender reassignment surgeries (GRS) in the UK. Gender reassignment surgery, also known as gender confirmation surgery or gender affirmation surgery, is a sub-speciality within plastic surgery, developed based on reconstructive procedures used in trauma and in congenital malformations. The specific procedures used for GRS have only been practised in the last 100 years.

Over the last decade, there has been an increase in society acknowledgement and acceptance of gender diverse persons. This catalysed an increase in referrals to gender identity clinics and an increase in the number of gender affirmation surgeries. GRS help by bringing fulfilment to many people who experience gender dysphoria. Gender dysphoria - a distress caused by the incongruence of a person's gender identity and their biological sex, drives the person to seek medical or surgical intervention to align some or all of their physical appearance with their gender identity. Patients with gender dysphoria experience higher rates of psychiatric disorders such as depression and anxiety. Gender-affirming medical intervention tends to resolve the psychiatric disorders that are a direct consequence of gender dysphoria.

Norman Haire (1892-1952) was a medical practitioner and a Sexologist. In his book, The Encyclopaedia of Sexual Knowledge (1933), he describes the first successful GRS. His patient, Dora Richter underwent 3 procedures reassigning from male to female between 1922-1931. The procedures included a vaginoplasty (surgical procedure where a vagina is created).

In the UK, gender reassignment surgeries were pioneered by Sir Harold Gillies. Harold Gillies is most famous for the development of a new method of facial reconstructive surgery, in 1917. During the Second World War, he organized plastic surgery units in various parts of Britain and inspired colleagues to do the same, training many doctors in this field. During the war, Gillies performed genital reconstruction surgeries for wounded soldiers.

British physician Laurence Michael Dillon (born Laura Maude Dillon) felt that they were not truly a woman. Gillies performed the first phalloplasty (surgery performed to construct the penis) on Dillon in 1946. In transitioning from female to male, Dillon underwent a total of 13 operations, over a period of 4 years.

Roberta Cowell (born Robert Marshall Cowell) is the first known Brit to undergo male to female GRS. After meeting Dillon and becoming close, Dillon operated illegally on Cowell. The operation helped her obtain documents confirming that she was intersex and have her birth gender formally re-registered as female. The operation that helped her transition was forbidden as it was considered “disfiguring” of a man who was otherwise qualified to serve in the military. Consequently, Gillies, assisted by American surgeon Ralph Millard performed a vaginoplasty on Roberta in 1951. The technique pioneered by Harold Gillies remained the standard for 40 years.

Gillies requested no publicity for his gender affirmation work.  In response to the objections received from his peers, he replied that he was satisfied by the patient's written sentiments: “To Sir Harold Gillies, I owe my life and my happiness”. “If it gives real happiness,” Gillies wrote of his procedures, “that is the most that any surgeon or medicine can give.” These words highlight the importance of plastic surgery in the mental wellbeing of transgender patients.

The BAPRAS Collection and Archive has an extraordinary assembly of fascinating archive and historical surgical instruments dating from 1900. Visit https://www.bapras.org.uk/professionals/About/bapras-archive or email [email protected] for more information.

Please refer to our Privacy policy for important information on the use of cookies. By continuing to use this website, you agree to this.

Sorry, your browser isn't supported

Please click here to find out about upgrading.

You can also view the BAPRAS website on your tablet or mobile.

The NHS Ends the "Gender-Affirmative Care Model" for Youth in England

Following extensive stakeholder engagement and a systematic review of evidence , England’s National Health Service (NHS) has issued new draft guidance for the treatment of gender dysphoria in minors, which sharply deviates from the “gender-affirming” approach. The previous presumption that gender dysphoric youth <18 need specialty “transgender healthcare” has been supplanted by the developmentally-informed position that most need psychoeducation and psychotherapy. Eligibility determination for medical interventions will be made by a centralized Service and puberty blockers will be delivered only in research protocol settings. The abandonment of the "gender-affirming" model by England had been foreshadowed by The Cass Review's interim report , which defined "affirmative model" as a "model of gender healthcare that originated in the USA."

The reasons for the restructuring of gender services for minors in England are 4-fold. They include (1) a significant and sharp rise in referrals; (2) poorly-understood marked changes in the types of patients referred; (3) scarce and inconclusive evidence to support clinical decision-making, and (4) operational failures of the single gender clinic model, as evidenced by long wait times for initial assessment, and overall concern with the clinical approach.

The new NHS guidance recognizes social transition as a form of psychosocial intervention and not a neutral act, as it may have significant effects on psychological functioning. The NHS strongly discourages social transition in children, and clarifies that social transition in adolescents should only be pursued in order to alleviate or prevent clinically-significant distress or significant impairment in social functioning , and following an explicit informed consent process . The NHS states that puberty blockers can only be administered in formal research settings, due to the unknown effects of these interventions and the potential for harm. The NHS has not made an explicit statement about cross-sex hormones , but signaled that they too will likely only be available in research settings. The guidelines do not mention surgery , as surgery has never been a covered benefit under England’s NHS for minors.  

The new NHS guidelines represent a repudiation of the past decade’s approach to management of gender dysphoric minors.  The “gender-affirming” approach, endorsed by WPATH and characterized by the conceptualization of gender-dysphoric minors as “transgender children” has been replaced with a holistic view of identity development in children and adolescents. In addition, there is a new recognition that many gender-dysphoric adolescents suffer from mental illness and neurocognitive difficulties, which make it hard to predict the course of their gender identity development.

The key highlights of the NHS new guidance are provided below.* 

1. Eliminates the “gender clinic” model of care and does away with “affirmation”

• The NHS has eliminated the “gender clinic” model of care where children are seen solely by a specialist gender dysphoria practitioner, replacing it with standard care in children’s hospital settings.
• Rather than “affirming” a transgender identity of young person, staff are encouraged to maintain a broad clinical perspective and to “embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.”
• “Affirmation” has been largely eliminated from the language and the approach. What remains is the guidance to ensure that “assessments should be respectful of the experience of the child or young person and be developmentally informed.”
• Medical transition services will only be available through a centralized specialty Service, established for higher-risk cases. However, not all referred cases to the Service will be accepted, and not all accepted cases will be cleared for medical transition.
• Treatment pathway will be shaped, among other things, by the “clarity, persistence and consistency of gender incongruence, the presence and impact of other clinical needs, and family and social context.”
• The care plan articulated by the Service will be tailored to the specific needs of the individual following careful therapeutic exploration and “may require a focus on supporting other clinical needs and risks with networked local services.”

2. Classifies social gender transition as an active intervention eligible for informed consent

• The NHS is strongly discouraging social gender transition in prepubertal children.
• diagnosis of persistent and consistent gender dysphoria
• consideration and mitigation of risks associated with social transition
• clear and full understanding of the implications of social transition
• a determination of medical necessity of social transition to alleviate or prevent clinically significant distress or impairment in social functioning
• All adolescents will need to provide informed consent to social gender transition.

3. Establishes psychotherapy and psychoeducation as the first and primary line of treatment

• All gender dysphoric youth will first be treated with developmentally-informed psychotherapy and psychoeducation by their local treatment teams.
• Extensive focus has been placed on careful therapeutic exploration, and addressing the broader range of medical conditions in addition to gender dysphoria.
• For those wishing to pursue medical transition, eligibility for hormones will be determined by a centralized Service, upon referral from a GP (general practitioner) or another NHS provider.

4. Sharply curbs medical interventions and confines puberty blockers to research-only settings

• The NHS guidance states that the risks of puberty blockers are unknown and that they can only be administered in formal research settings. The eligibility for research settings is yet to be articulated.
• The NHS guidance leaves open that similar limitations will be imposed on cross-sex hormones due to uncertainty surrounding their use, but makes no immediate statements about restriction in cross-sex hormones use outside of formal research protocols.
• Surgery is not addressed in the guidance as the NHS has never considered surgery appropriate for minors.

5. Establishes new research protocols

• All children and young people being considered for hormone treatment will be prospectively enrolled into a research study.
• The goal of the research study to learn more about the effects of hormonal interventions, and to make a major international contribution of the evidence based in this area of medicine.
• The research will track the children into adulthood.

6. Reinstates the importance of “biological sex”

• The NHS guidance defines “gender incongruence” as a misalignment between the individual’s experience of their gender identity and their biological sex.
• The NHS guidance refers to the need to track biological sex for research purposes and outcome measures.
• Of note, biological sex has not been tracked by GIDS for a significant proportion of referrals in 2020-2021.

7. Reaffirms the preeminence of the DSM-5 diagnosis of “gender dysphoria” for treatment decisions

• The NHS guidance differentiates between the ICD-11 diagnosis of “gender incongruence,” which is not necessarily associated with distress, and the DSM-5 diagnosis of “gender dysphoria,” which is characterized by significant distress and/or functional impairments related to “gender incongruence."
•  The NHS guidance states that treatments should be based on the DSM-5 diagnosis of “gender dysphoria.” 
• Of note, WPATH SOC8 has made the opposite recommendation, instructing to treat based on the provision of the ICD-11 diagnosis of “gender incongruence.” “Gender incongruence” lacks clinical targets for treatment, beyond an individual’s own desire to bring their body into alignment with their internally-held view of their gender identity.

8. Clarifies the meaning of “multidisciplinary teams” as consisting of a wide range of clinicians with relevant expertise, rather than only “gender dysphoria” specialists

• The NHS guidance clarifies that a true multidisciplinary team is comprised not only of “gender dysphoria specialists,” but also of experts in pediatrics, autism, neurodisability and mental health, to enable holistic support and appropriate care for gender dysphoric youth.
• neurodevelopmental disorders such as autistic spectrum conditions
• mental health disorders including depressive conditions, anxiety and trauma
• endocrine conditions including disorders of sexual development pharmacology in the context of gender dysphoria
• risky behaviors such as deliberate self-harm and substance use
• complex family contexts including adoptions and guardianships
• a number of additional requirements for the multidisciplinary team composition and scope of activity have been articulated by the NHS.

9. Establishes primary outcome measures of “distress” and “social functioning”

• The rationale for medical interventions for gender-dysphoric minors has been a moving target, ranging from resolution of gender dysphoria to treatment satisfaction.  The NHS has articulated two main outcome measures of treatment: clinically significant distress and social functioning .
• This is an important development, as it establishes primary outcome measures that can be used by researchers to assess comparative effectiveness of various clinical interventions. 

10. Asserts that those who choose to bypass the newly-established protocol will not be supported by the NHS

• Families and youth planning to obtain hormones directly from online or another external non-NHS source will be strongly advised about the risks.
• Those choosing to take hormones outside the newly established NHS protocol will not be supported in their treatment pathway by NHS providers.
• Child safeguarding investigations may also be initiated if children and young people have obtained hormones outside the established protocols.

With the new NHS guidance, England joins Finland and Sweden as the three European countries who have explicitly deviated from WPATH guidelines and devised treatment approaches that sharply curb gender transition of minors. Psychotherapy will be provided as the first and usually only line of treatment for gender dysphoric youth.

The full text of the NHS guidance can be accessed here .

 * This is a transitional protocol as the NHS works to establish a more mature network of children’s hospitals capable of caring for special needs of gender dysphoric youth. A fuller service specification will be published in 2023-4 following the publication of the Cass Review’s final report .

Cass Review: A victory for women, children and common sense

Dr Cass’s landmark review into gender care services in England brought us one step closer to throwing the harmful delusion that is gender ideology into the dustbin of history.

In England, a landmark independent review into gender care services for young people has exposed one of the biggest medical negligence scandals of recent times and vindicated those who have been accused of engaging in malicious “culture wars” and branded as unkind bigots for opposing unnecessary medicalisation of children.

The review, conducted by respected paediatrician Hilary Cass, found that some of the most vulnerable members of society – children presenting with “gender dysphoria” which, in many cases, masks autism, sexual abuse, trauma and confusion over same-sex attraction, among other conditions – have been let down by a lack of research and “remarkably weak” evidence on medical interventions in England’s gender care clinics.

Keep reading

Ten years after chibok girls kidnapping: one woman’s struggle to move on, poland lawmakers take steps towards liberalising abortion laws, polish lawmakers debate reforming strict abortion laws, why has arizona re-enacted a 160-year-old abortion ban.

The National Health Service (NHS England) said it commissioned the review, published on April 10, to ensure that “children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, that meets their needs, is safe, holistic and effective.”

The review’s intentions, and thus its conclusions, are of course disputed by those who insist that anyone claiming to be transgender must be instantly affirmed – and in the case of a child, given access to puberty blockers.

Puberty blockers –  hormones that stop the progress of puberty –  have long been at the centre of the dispute over whether medical interventions offered to gender-questioning children are safe and fit for purpose.

In short, Cass has found that puberty blockers do indeed have side effects and negative health implications. Her inquiry concluded that there is, at best, weak evidence that these drugs are safe and beneficial to gender-questioning children, especially in the long term.

Cass told the BBC that the use of puberty blockers to “arrest puberty” started out as a clinical trial, but has been expanded to a wider group of young people before the results of that trial were available.

“It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood, and that’s been a particular problem that we have not had the follow-up into adulthood to know what the results of this are,” she said.

To make sense of this scandal, and understand how the NHS came to offer this experimental treatment to vulnerable children without obtaining meaningful evidence for its safety and efficacy, we must examine how British institutions have been captured by “gender ideology” – the belief that an individual’s internal sense of gender, or “gender identity”, should supersede their sex in all aspects of life and under law.

In 2016, Women and Equalities Minister Maria Miller led an inquiry into transgender equality that strongly recommended that the United Kingdom legally adopt principles of gender self-declaration, which would allow any individual to decide whether they would be considered male or female according to their own “gender identity”.

Miller signed off a report advising a change to the Equality Act which would replace the protected characteristic of “gender reassignment” with “gender identity”. In so doing, she suggested that the inner feeling of “gender” should take precedence over legal sex.

Feminists complained – for us, this was a matter of protecting our hard-won sex-based rights. But Miller dismissed women’s fury about the erosion of single-sex provisions in domestic violence refuges and prisons among other aspects of life as “extraordinary” bigotry.

The feminist resistance to gender ideology and objection to harm it inflicts on women and children, however, did not start with Miller’s misguided inquiry, which ramped up institutional capture.

The first article I ever wrote on the trans issue was published in the Telegraph Magazine in November 2003. It was about those who had undergone “sex change” surgery (the popular parlance of the time).

Researching that article, I discovered that Mermaids (a charity supporting children and teenagers with “gender identity disorder”) had seen a dramatic increase in inquiries since its founding in 1995. “Sex-change” treatment, including puberty blockers, was available to children as young as 14, despite evidence (even then) from the Tavistock and Portman NHS Foundation Trust that one in four teenagers seeking “gender reassignment” would later change their minds.

Soon after, I wrote about Vancouver Rape Relief (VRR), in Canada. In August 1995, two VRR employees had asked Kimberly Nixon (a trans-identified male) to leave its counsellor training, which prepared attendees to offer face-to-face support to women traumatised as a result of male violence. The following day, Nixon filed a human rights complaint, initiating a lengthy legal battle.

The publication of this article in Guardian Weekend on January 30, 2004, headed “Gender Benders, Beware” , led directly to me being cast out by trans activists.

Invitations to prestigious events were withdrawn. I was shortlisted for awards, only to be un-shortlisted when the organisers found themselves under pressure.

Refusing to bow down to these efforts, I and a small number of other feminists continued to speak out – as did some valiant whistle-blowers. These were people working within gender clinics, horrified by the creeping normalisation of transitioning “gender-distressed” children.

In September 2017, Woman’s Place UK (WPUK) was founded by a group of feminists in response to planned new legislation by Miller, and everything changed as groups of women began to organise. Resistance to gender ideology was now driving feminist activism.

These efforts, however, did not immediately put a stop to institutional capture. There was a spike in the number of children, overwhelmingly girls, presenting with gender dysphoria and being referred to gender clinics, but this did not concern trans activists and their supporters in positions of power. More than 5,000 referrals were made to the Gender Identity Development Service (GIDS) in London in 2021-22, compared to just 500 hundred a decade earlier. Almost two-thirds of referrals in recent years were teenage girls. Still, people continued to dismiss our concerns over gender ideology and its medicalisation of children as hyperbole and bigotry.

By July 2023, the situation in schools in some parts of the country had become so urgent that concerned parents started to take matters into their own hands.

In the Brighton and Hove area, where a number of children were being allowed to “socially transition” at school, for example, concerned parents set up   PSHE Brighton to assess the delivery of Personal, Social, Health, and Economic Education (PSHE) and Relationships and Sex Education (RSE) in local schools.

So far, more than 20 local families contacted them and voiced their worry that their children may be being transitioned “from the classroom to the clinic”.

One such family was 16-year-old Catherine’s*.

Catherine is autistic and, in less than two years, has gone from being a feminist and a proud lesbian to identifying as a boy. Now fixated on medical and surgical transition, she appears to have experienced rapid onset gender dysphoria after accessing material from trans-affirming charities like Mermaids  online.

Her parents say she forced her school into making a social work referral by self-harming and reporting false information about her family. They explain that they had secured agreement from both Catherine’s headteacher and a private counselling service that social transition would be inappropriate for her before a full assessment of her needs had been carried out.  Nevertheless, her parents say that “an unholy alliance of well-meaning teachers and social workers, misguided by potentially unlawful policies, practices, procedures, and training, have led to Catherine transitioning – first socially and then medically”.

Today, Catherine is estranged from both of her parents.

There are many, many more families going through this hell, and many children like Catherine who are exposed to experimental treatments with permanent side effects, as a result of an almost blind acceptance by individuals and institutions of gender ideology.

For years, those of us who tried to put a stop to this have been accused of being bigoted, unkind, and motivated by a dislike of trans people. For years, it has been claimed that it was not feminists and concerned parents, but ideological charities like Mermaids who were doing what is best for “trans children”. Women lost their jobs, reputations and, often, sanity for speaking up against gender ideology, and its medicalisation of vulnerable children. Thankfully, Hilary Cass has finally exposed the truth, proved that it was not us who were being “unkind” but those unnecessarily medicalising children, and brought us one step closer to throwing the harmful delusion that is gender ideology into the dustbin of history.

* Name has been changed to protect her identity

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.

What is it and will it make fares cheaper?

Yorkshire mum raising money for 'amazing' daughter's gender reassignment surgery.

A mum is raising money to help pay for her "amazing" daughter's gender reassignment surgery following massive waiting lists for treatment on the NHS.

Dawn Womack, from Wakefield , is raising the money to help her daughter Zoey, who has been transitioning since she was 16. Now 19, she faces long waiting lists on the NHS before she can get the treatment she so desperately needs.

Due to these long delays, Zoey has been suffering with her mental health and so Dawn has decided to instead raise money to pay for the surgery. Due to it being cheaper abroad, she has now booked the surgery in Madrid, Spain.

Read More: Life in Yorkshire 'takeaway town' where two key gripes always annoy locals

Dawn said: "She's been transitioning since she was 16 and there's been no medical support whatsoever for that. So it's meant that we've had to fund hormones ourselves.

"She has not even been able to get anything for her mental health through the GP, there's just no support whatsoever for it. So we've been funding the hormone treatment ourselves and so this has led to doing it online because it's so expensive to do it the right way."

Dawn added: "The reason for the GoFundMe is for gender reassignment surgery. So the waiting list currently in the UK, it'll take you five years but that increases every time I look at the waiting list, it's increased even more. Once they're at the top of the waiting list then waiting for an appointment and having to have hormone treatments through the NHS for two years before they will even consider surgery.

"That means she could be looking at eight to ten years before she could get gender reassignment surgery here in the UK."

Sadly, due to Zoey's mental health, Dawn doesn't believe she can wait that long. Dawn said: "Her mental health is so bad, living in the wrong body, she just wouldn't be here by then."

Get all the latest and breaking news in Yorkshire by signing up to our newsletter here.

Dawn has also paid tribute to Zoey's bravery, saying: "She has a very dry sense of humour, she's very funny and she's currently at university studying animal behaviour.

"She's into music, very much into films and photography, she's a really good photographer. She loves getting out and taking photographs and she models herself and takes photographs of herself which I think is really brave and helps her to feel confident in herself.

"She's a great big sister to her little brother, who absolutely adores her. She's my world, she's just amazing and she's the bravest person I ever met."

So far the campaign has raise £1,000, with a target of £5,000 at the current time, and the money needs to be raised by July 15, 2024. You can donate to the campaign here.

Latest stories

Teen rapist uses spoon to chip through cell wall to attack murderer at wetherby young offenders institute.

A source said the offender broke into the cell next door using a sharpened sppon

11-hour airport queues ruin pals' £6,000 birthday trip to Bali

Karen McArthur and her two friends were looking forward to spending 17 days in the holiday hotspot after flying out from Gatwick on April 18 - but their trip was ruined by delays

Cause of fire at former Labour club confirmed

Five fire engines were sent to the scene

Headteacher calls for 7am to 7pm school days to tackle phone addictions

Headteacher Andrew O’Neill has called for a 7am to 7pm school day in the UK in a bid to tackle phone addiction among children.

WASPI women given compensation update and told 'as soon as possible'

WASPI women have been writing to their MPs urging for action since an Ombudsman's report came out calling for compensation last month, with payouts around £2k predicted.

Dr Michael Mosley says a teaspoon of 'nutritional powerhouse' food can reduce blood pressure and improve skin

They contain a triple whammy of alpha linolenic acid, fibre and lignans which help protect against heart disease, high blood pressure and high cholesterol

People over State Pension age with eyesight issues could be due up to £434 each month

Attendance Allowance could help people who are severely short-sighted or have eye conditions including cataract, glaucoma or macular degeneration.

BBC Strictly Come Dancing's Shirley Ballas supported by Amy Dowden as she shares worrying health news

The dance show's judge shared a photo of herself to social media after undergoing a biopsy

Five reasons it’s good to have a firm and shapely bottom

For most women in their 40s and 50s there has been a lifetime of wishing their bottom was smaller. “Does my bum look big in this?” became the butt of a joke for years in the late 1990s.

Amy Dowden reveals Kate Middleton’s nine-word message to her during cancer fight

Amy Dowden appeared on ITV's Loose Women on Wednesday lunchtime and shared a message that Kate Middleton, Princess of Wales, gave to her while she was receiving her cancer treatment. The royal was diagnosed with cancer herself earlier this year

Princess Kate's incredibly generous offer to Amy Dowden during chemotherapy revealed

The Princess of Wales made Strictly Come Dancing star Amy Dowden the sweetest offer following the dancer's cancer diagnosis, saying 'let us know if there's anything we can do,' Amy revealed on Wednesday.

Little boy who lost his foot at 18 months now models for Primark, Amazon and Schuh

A little boy who lost his foot at 18 months has become a model and now he travels the world posing for famous brands including Primark, Amazon and Schuh. Arlo Tate, nine, was diagnosed with fibular hemimelia - a missing fibula - at birth. An "abnormality" was picked up at his 20-week scan - but doctors were unsure what his condition was at the time. His right foot was bent inwards so doctors suggested his parents allow them amputate his foot so he could learn to walk with a prosthetic leg. Mum Naomi, 38, says walking with prosthesis was incredibly easy and Arlo hasn't let his disability hold him back. Naomi says his friends weren’t aware Arlo even had a disability - as he plays football, basketball and rugby with them. In March 2020, Arlo was scouted by a diverse modelling agency who wanted to sign him up and he has since travelled to Prague, London and Manchester - being paid £500 a shoot for brands like Primark, Amazon and Schuh.

Dr Michael Mosley says 'two minute' action will improve your life

Health guru Michael Mosley believes simple things can help completely overhaul our lifestyles

Woman in hospital and man arrested after three-car crash on Scots road

A 64-year-old man was arrested in connection with road traffic offences following the incident.

PIP payments could stop for more than one million people under new plans to reform the DWP benefit

A consultation will look at changes to the eligibility criteria, assessment process and types of support that can be offered through PIP.

Instagram's Worst Con Artist: Where is cancer faker Belle Gibson now?

Thousands were fooled the wellness influencer who pretended to have terminal brain cancer. But how did she do it?

Man who tipped the scales at 22 stone and binged on takeaways and chocolate sheds six stone after holiday realisation

Charlie Murphy knew he needed to change his lifestyle after feeling unhealthy and self-conscious while on holiday

UK health officials warn of highest level in 20 years of disease being brought back from holiday

Cases were confirmed in individuals who had recently been abroad the UK Health Security Agency said

New 'targeted' cancer treatment hailed as 'real progress'

The new drug therapy has been approved by the National Institute for Health and Care Excellence (Nice) after studies showed it lessened chemotherapy side-effects

Schoolgirl endured years of agony and hospital visits after chipping tooth on recorder aged 6

Emily Smith spent four days on a hospital ward

• International edition
• Australia edition
• Europe edition

Five thousand children with gender-related distress awaiting NHS care in England

New gender clinics looking at ‘creative ways’ of reducing waiting lists amid shortage of clinicians

Five thousand children and adolescents with gender-related distress are awaiting NHS treatment – yet a shortage of clinicians meant only 12 had been seen at a new London-based gender clinic by the start of this week.

Two newly opened gender centres, in London and Liverpool, are looking at “creative ways” of reducing the waiting lists, such as running group sessions with therapists, according to Hilary Cass, the consultant paediatrician who has devised the new, more holistic treatment model for children and adolescents questioning their gender identity.

Only half of the required 45 members of staff have been hired to work in a London clinic that does not yet have a building, leaving patients to be seen online, according to a spokesperson for Great Ormond Street hospital, which is responsible for setting up the London clinic which opened on 2 April.

The Cass review states that there have been “considerable challenges” in setting up these clinics within a “highly emotive and politicised arena”.

About 250 children and adolescents have been transferred to the care of the new London hub – which will be called the Children and Young People’s Gender Service, London – and the second clinic in the north-west. Only a handful of patients are understood to have been seen so far in the north-west clinic.

Cass acknowledged that it would “take a while to resolve” the long waiting list, but said child and adolescent mental health services (Camhs) were screening children on the list to flag “urgent problems and urgent risks”.

She said there was “no magic fix” for getting the waiting list down, other than investment in Camhs and recruiting more staff into mental health services. Waiting lists would come down when more children and young people were seen by generalist practitioners locally, rather than being placed on a waiting list for specialist gender services, she said.

Clinicians’ nervousness about working in this area has made recruitment to the new services very challenging, Cass said, describing how some healthcare staff were “fearful” of working in this field, partly because of uncertainties about the correct treatment model and partly because they feared “being called transphobic if you take a more cautious approach”.

NHS England said helping the new clinics to “overcome challenges around staff recruitment will be a top priority as this will determine the pace at which they will be able to see new patients from the waiting list”.

The Great Ormond Street hospital spokesperson said a consultant paediatrician and consultant psychologist were already leading the hub’s multidisciplinary team. “We have been actively recruiting since November 2023. Building a workforce is taking time as we are recruiting into disciplines where there are known shortages, such as doctors and psychologists,” he said.

No staff members who worked at the Tavistock’s now-closed gender identity development service had been hired for the new clinics, he said. The Cass review sets out that when the hubs are operating at full capacity they should be staffed by clinicians from mental health services and services for children and young people with autism and other neurodiverse presentations. There should also be support for looked-after children and children who have experienced trauma.

Cass’s new model aims to move services away from having a very specialist focus; she said no one in the team “should have a tunnel vision on gender” and that clinicians should continue to work in parallel in other parts of the NHS outside the gender hubs.

“The more we can bring this back into normal adolescent care the better,” she said.

“It is about seeing people as whole people; if they need to go on a hormone pathway, then that’s fine and that should be still available embedded in the services,” Cass said this week. Access to endocrinology services and fertility services should be available for the minority of patients whom Cass expects to go on to seek a medical intervention.

after newsletter promotion

Cass said she had an encouraging conversation with the clinical lead for the new London hub last weekend, who said a “very diverse range of young people” had been seen, and that the patients had been “very pleased” that they would have access to a broad range of services.

Great Ormond Street’s spokesperson said: “We are working swiftly on recruiting the right skill mix of people … We aim to settle into a permanent community base as soon as possible so we can provide the best possible service.”

He said the group sessions were not specifically designed to reduce waiting lists, adding that “group sessions and workshops have additional benefits in decreasing isolation and increasing a sense of social support for isolated young people and their families”.

“Families we have spoken to have expressed their appreciation for this opportunity. These will not be the only interventions offered and will be part of a bespoke package of care tailored to the individual needs of young people and their families,” he said, adding that there would be some one-to-one options for those children unable to access group interventions.

The central aim of the new services is “to help young people to thrive and achieve their life goals”, the Cass review states.

Mermaids, a transgender youth support charity, said it was “pleased the voices and experiences of trans young people appear to have been heard and respected” in the review, but added that the NHS was “failing trans youth, with appalling waiting lists” amid “increased politicisation of the support offered to children and young people”.

The mother of one teenager who referred herself on to the waiting list for care at the Tavistock gender clinic but who never progressed close enough to the top of the list to receive an appointment said she thought her daughter would benefit from the new approach.

“This looks like normal healthcare,” she said. “Sometimes it has felt like trans-identifying children have been exempted from all normal rules – in schools, and in healthcare. I just want her to receive standard NHS healthcare, with a strong mental health element.”

• Transgender
• Health policy
• Public services policy

More on this story

Hilary Cass warned of threats to safety after ‘vile’ abuse over NHS gender services review

Scottish gender clinic pauses prescribing puberty blockers to under-18s

No case for closing Scotland’s only NHS gender services clinic, says first minister

Veteran trans campaigner: ‘Cass review has potential for positive change’

Cass review must be used as ‘watershed moment’ for NHS gender services, says Streeting

‘This isn’t how good scientific debate happens’: academics on culture of fear in gender medicine research

Ban on children’s puberty blockers to be enforced in private sector in England

What Cass review says about surge in children seeking gender services

Adult transgender clinics in England face inquiry into patient care

Most viewed.

• Entertainment
• London / Europe
• Border / Cartel Chronicles
• Israel / Middle East
• Latin America
• On the Hill Articles
• On The Hill Exclusive Video
• Breitbart News Daily
• Newsletters
• Trump Trial
• Anti-Israel Campus Protests
• Ukraine Funding Betrayal
• Wide Open Border
• Bidenomics Bust

Illinois Library Hosting ‘Pronoun’ Seminar for Children Considering Cross-Dressing, Sex-Change Surgery

A public library in Illinois will be hosting a “pronoun” seminar for children considering cross-dressing and sex-change surgeries.

North Cook News reported :

The Wilmette Public Library and the parent-teacher organization at McKenzie Elementary School are co-hosting a seminar to teach children considering cross-dressing or “sex change surgery” how to lobby their fellow students to refer to them with different “pronouns.”

The seminar will feature Dr. Courtney Wells and Lee Wells, co-authors of A Kids Book About Pronouns . An announcement from the library describes Courtney and Lee as a married lesbian couple from Chicago who are “committed to justice and inclusivity for their own and all kids.” Courtney prefers the pronouns “they/them,” while Lee prefers “she/her.”

“Courtney is an award-winning trauma psychologist with a super cool TEDx talk on dismantling the gender binary. Lee is a therapist working with LGBTQ+ kids and families and co-founder of Mind Chicago,” the announcement said.

Lee Wells advises parents on how to properly address children experiencing gender dysphoria without offending them in her Basic Parent Guide to Gender-Inclusive Language , including the elimination of the words “boys” and “girls.” She also offers “‘parent coaching’ and ‘therapy’ to ‘young people ages 6 to 26 struggling with big emotions, worry (and) sadness,'” per North Cook News.

As Breitbart News reported , a cultural shift has been occurring regarding the treatment of children identifying as transgender, with established institutions like England’s National Health Service (NHS) banning puberty blockers on minors.

NHS England based its decision to ban puberty blockers for children on there not being enough evidence about the procedure’s safety or clinical effectiveness. The U.K. government also endorsed the “landmark decision,” hailing it as being in the “best interests of children.” NHS England proposed a ban on the procedure in June and issued the definitive decision following a review from the National Institute for Health and Care Excellence (NICE).

Paul Roland Bois directed the  award-winning Christian tech thriller ,  EXEMPLUM , which can be viewed for FREE on  YouTube  or  Tubi . “Better than Killers of the Flower Moon,”  wrote Mark Judge . “You haven’t seen a story like this before,”  wrote Christian Toto . A high-quality, ad-free rental can also be streamed on  Google Play ,  Vimeo on Demand ,  or  YouTube Movies . Follow on X  @prolandfilms  or Instagram  @prolandfilms .

Please let us know if you're having issues with commenting.

Cookies on the NHS England website

We’ve put some small files called cookies on your device to make our site work.

We’d also like to use analytics cookies. These send information about how our site is used to a service called Google Analytics. We use this information to improve our site.

Let us know if this is OK. We’ll use a cookie to save your choice. You can  read more about our cookies before you choose.

Change my preferences I'm OK with analytics cookies

Millions more GP appointments in March than before pandemic

• General practice

GP teams delivered almost 30 million appointments for patients last month (March 2024), up almost a quarter on the same period before the pandemic, new data shows today.

New NHS data published today shows there were around 29.8 million appointments delivered by GPs and their teams in just one month, compared with 24.2 million in March 2019 – an increase of 5.6 million (23.1%).

And on average, thanks to the primary care recovery plan , the NHS is now offering more than 1.4 million GP appointments every working day.

NHS staff continue to exceed ambitions to provide 50 million more appointments by March 2024 with the figures showing that GPs and their teams have delivered an extra 56.3 million appointments (363.6 million excluding Covid vaccinations) or 63.4 million (370.7 million including Covid vaccinations) over the last year compared to 2018/19.

More than nine in ten (95%) of GP practices in England have now upgraded their phone tech thanks to the ambitious blueprint with the move meaning that phone lines can be expanded and won’t ever be engaged. The remaining practices are agreeing dates within the next month for upgrades to happen with tech suppliers.

Every GP practice must offer face to face appointments as well as telephone and online consultations, with some patients choosing remote appointments where it is clinically appropriate and more convenient for them. Today’s data shows almost two-thirds of appointments took place face-to-face (65.4%) in March.

Dr Amanda Doyle, national director for primary care, NHS England said : “Thanks to GPs and their hardworking teams, millions more appointments are being delivered every month compared to before the pandemic with plans in place to improve access even further.

“Every GP practice is upgrading their telephone systems to make it easier for patients to contact their surgery, while patients can use the NHS app to order repeat prescriptions and view their test results without needing to contact their family doctor.

“We know there is more to do to make it easier for patients to access GP services, which is why, building on the successes so far of the primary care access recovery plan we will continue to modernise general practice, expand pharmacy services, and offer patients more choice in how they access care.”

Primary Care Minister Andrea Leadsom said : “Today’s figures clearly demonstrate that more people are getting the care they need, when they need it, thanks to the hard work of our GPs and their teams.

“GPs and their staff have already delivered on a number of pledges – including exceeding the target of 50 million additional general practice appointments per year, several months ahead of schedule – and through the measures in the Primary Care Recovery Plan, the NHS and primary care staff are freeing up millions of extra appointments per year and making it easier for patients to access the care they need.

“We remain committed to making our healthcare system faster, simpler and fairer for all patients so that everyone who needs an appointment is able to get one.”

Hundreds of thousands more people a month will have the option to refer themselves for key services such as help with incontinence, podiatry, or hearing tests without needing to see a GP, as part of the NHS primary care access recovery plan.

Around 180,000 more people a month will be able to self-refer for additional services such as incontinence support or community nursing without seeing their GP, so family doctors’ time can be freed up to focus on delivering care to people who need it most.

Across NHS services, around 200,000 people a month already self-refer themselves for treatment for podiatry, audiology, and physiotherapy but local services will now be able to expand the option of self-referral to other key services based on the needs of their population.

All data can be found here: Appointments in General Practice – NHS England Digital