Coventry Health Authority
Policy for Gender Dysphoria
SUMMARY GUIDANCE
FOR THE TREATMENT OF PEOPLE
WITH
GENDER DYSPHORIA
December 1999
1.INTRODUCTION
1.1This is a summary version of Coventry Health Authority’s Commissioning Guidance for people with gender dysphoria.
1.2People with gender dysphoria have the right to receive treatment.
1.3The care pathway and approval process is set out below in a brief descriptive format and diagrammatically.
2.CARE PATHWAY AND APPROVAL PROCESSES
2.1The following gives a brief description of the pathway and approval processes throughout.
2.2At the GP Surgery
2.2.1Initial referral to a Specialist
2.2.2GPs will need to decide whether there are any coexisting conditions or whether any mental health factors need to be determined. A referral to a consultant psychiatrist may be considered for this purpose. Where this is not the case then a referral to a designated specialist in gender dysphoria will be needed. An individual will need two separate independent assessments as part of diagnostic process.
2.3Local PCT Approval
2.3.1The local specialist will be expected to advise the Health Authority whether a referral to the Gender Identity Service is advisable. If the Health Authority decide to approve the referral this will be an agreement to commission the complete care pathway (if appropriate and medically supported by the specialist providers), including any referral that may eventually be made for gender reassignment surgery.
2.3.2Following approval the Health Authority will request their local specialist to proceed with the referral to the Gender Identity Service.
2.4Gender Identity Service Actions
2.4.1On receipt of the referral the Gender Identity Service will seek formal approval from the Health Authority to proceed with the assessment.
2.5Initial Assessment and Progress to the Real Life Test
2.5.1The initial assessment period of three to six months at the tertiary centre involves diagnostic assessment of the person (including the patient’s history of and current experience of gender dysphoria), counselling, general medical examination and psychological measurements and blood tests.
2.5.2Once this has been completed and where it has been resolved that the person wishes to continue with a change of gender they will progress to the ‘reallife test and experience’ (RLTE).
2.5.3Real Life Test Experience (RLTE)
The RLTE will be a minimum of 2 years living continuously in the gender role with which the individual identifies. The aim is to assist the patient and the professionals in decisions about how to proceed. There will be circumstances where the RLTE may need to be extended. The reasons for this must be discussed with the individual.
2.5.4The quality of the RLTE is assessed through discussions about the patient’s ability to consolidate their gender role in areas such as employment, voluntary work, education or training, or some other stable social and domestic lifestyle; formally adopt a gender appropriate first name and to demonstrate that society is aware that they are living in their new role. There may be occasions when clinicians request verifiable documentation or evidence of the gender change.
2.5.5Treatments provided by the Gender Identity Service
The Gender Identity Service will provide psychological support and the services of an endocrinologist to advise on hormone treatment. Hormone treatment will generally start 3 months after the Real Life Test and Experience (see section below on treatments) has commenced.
2.5.6Completion of the RLTE and Possible referral for gender Reassignment Surgery
Some individuals may not wish to progress all the way to complete surgical reassignment and there should be some flexibility in the progression from one stage to another. Some individuals may prefer lifelong hormone therapy unless contraindicated.
2.5.7If gender reassignment surgery is recommended then the Gender Identity Service will ensure that it is recommended by two consultant psychiatrists.
2.5.8The Gender Identity Service will refer an individual to a specialist centre for reassignment surgery.
2.5.9Following receipt of the referral from the Gender Identity Service the specialist centre for reassignment surgery will seek approval from The Health Authority to proceed with the surgery.
2.5.10Following surgery the individual will normally be referred back to local acute and/or mental health services.
Care Pathway Diagram
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