Faqs
TransPlus is an NHS gender dysphoria service for adults that is integrated into an existing sexual health and HIV service at 56 Dean Street. 56 Dean Street is an award-winning sexual health and HIV service based in Soho, the heart of London’s LGBT+ community.
TransPlus offers flexible, tailored support options, assessment for and diagnosis of gender dysphoria, hormone therapy, speech and language therapy, referrals to surgical providers, as well as an extensive wellbeing programme. The service works to NHS England’s Service Specification for gender dysphoria services, and as such is able to provide the same services offered at the other gender dysphoria services in England.
We are still unable to accept direct referrals to TransPlus from patients, GP’s or other healthcare professionals.
TransPlus have been asked by NHS England to see adults who were originally referred to the Tavistock and Portman Gender Identity Clinic (GIC). This is a change from our previous eligibility criteria and aims to reduce the extensive waiting list to be seen at the Tavistock GIC.
We will see people from among those who have been waiting the longest and aim to ensure that no one we see will have waited longer than if they had remained on their original list.
If your details have been transferred to us, we will contact you as soon as possible thereafter to let you know. Those originally referred to the Tavistock GIC can of course opt out of being seen by us.
Those seen at TransPlus will also need to be registered with a GP in England and not eligible for one of the NHSE-commissioned pilot gender dysphoria services.
TransPlus is the first NHS gender dysphoria service in England to offer gender-affirming interventions alongside sexual & reproductive health services and HIV care. We are an experienced, multi-skilled team of trans and LGBQ practitioners and allies.
We offer a flexible, holistic service that supports people who are exploring their gender. We can provide assessment for (and diagnosis of) Gender Dysphoria, and subsequent access to various elements of medical transition (should people choose it), including prescribing and monitoring hormone therapy within our clinic. Additionally, we aim to support all our service users in optimising their sexual health and wider wellbeing.
If you have received an email from TransPlus informing you that your referral has been transferred to us, there is nothing you need to do unless you wish to opt out of your transfer. In this case, please follow the instructions in our email.
Once the two week opt out period has ended, we will start contacting people (usually via email and phone) to collect additional documentation before we are able to offer a first appointment. We will ask you to sign a consent form allowing us access to a summary of your medical records and ask you to send any previous gender dysphoria reports (only if you have one).
Once we have received the information from you and your GP, this will be screened and we will call you to book your initial appointment with us.
Please note that it may be a number of months before we are in touch again after the initial email due to the volume of referrals that are transferred to TransPlus at a time.
No, anyone who has already been seen by TransPlus or who has been booked for a first appointment with TransPlus will remain under our care until formal discharge from the service.
You’ll meet with one of the Senior Nursing Team or Doctors. This is an opportunity for you to explore the services we offer in more detail and to ask questions about various aspects of social or medical transition. During this initial discussion, we would also like to learn a bit more about you. This helps us to offer the most appropriate information and support.
If you feel there is anything that would make your appointment easier in terms of neurodivergence/access needs, please let the team know in advance and we can make adjustments for you.
We will most likely discuss:
We will only ask questions that are relevant to assessing gender dysphoria/keeping you safe. If you feel uncomfortable with any questions asked, please feel free to raise this with us.
Get the most out of your visit (consider):
*Because we see people who experience domestic or sexual abuse, we will always ask service users to come into their appointments alone at first (or with a caseworker if you choose). Once we have asked some confidential questions about you and your safety, your supporter, friend or advocate is welcome to join you.
If you are hoping to access physical interventions such as hormone therapy or referral for surgery via TransPlus, you’ll meet a member of the nursing team for a health check. We’ll ask about your medical history (including any health conditions and/or medication you might be taking). We’ll also measure your height, weight and blood pressure, and take some blood tests. This health check does not involve a genital or chest examination.
In this part of your visit, we’ll also offer a full sexual health screen and vaccinations for some sexually transmitted infections (Hepatitis B and Human Papilloma Virus/HPV). If you have symptoms of an STI, we may offer an examination and treatment but this is separate from your pre-hormone health check (which does NOT require a genital examination). If it feels more appropriate we can arrange for you to come back on another day or see a different member of staff about your sexual health.
At the end of your first visit, we will give you some written information about the services we offer, as well as information about hormone therapy and/or gender-affirming surgeries if required.
There’s no set way to dress ‘like a man’, ‘like a woman’ or ‘like a non-binary person’ and we strive to provide a space where all trans/non-binary people can be themselves. We recognise that gender identity is very different from gender expression, all we ask is that people dress however they feel most comfortable on the day.
For some people, Dean Street might be one of the few places they are able to dress in ways that feel authentic (whatever that might look like). By all means, bring a change of clothes (wigs, make-up etc.) to your appointment. Just make sure you dress for you, and not for us. You’re welcome to change in any of the bathrooms on site.
We are a team of professionals from a range of backgrounds and disciplines.
First appointments are usually carried out by our Specialist Nurse Practitioners or Doctors. After that you will either meet a Senior Clinical Psychologist or Consultant Medical Doctor specialising in HIV/Sexual Health and Gender.
Follow up hormone appointments are usually carried out by the nursing team and doctors.
You may also, depending on your needs, meet some of our specialist Wellbeing Team; peer support, psychosexual therapy, psychology, GSRD counsellors and Speech and Language Therapists.
To support the learning and development of the TransPlus team, we may ask your permission for either a colleague or a trainee to sit-in on some of your appointments with us. We will ask your consent and you are welcome to decline without any prejudice to your care.
Confidentiality is a fundamental component to the running of any sexual health service, and as TransPlus is part of 56 Dean Street we follow the same policies as the wider service. There are strict laws that we must adhere to regarding the use, sharing, disclosure, storage and transfer of patient-identifiable information. This means any personal information you provide us will be held in the strictest confidence. Your TransPlus records are stored within the sexual health clinic’s computer system and kept separate from the general medical notes that are used in the main hospital. Computerised information about our service users is coded and only staff within the clinic are able to access identifiable information (such as your name or address).
Our service users come from all over the country and we know travel can be difficult and costly. We will therefore try and accommodate your needs as much as possible when arranging appointments.
We do like to meet all of our service users at least once during the assessment appointments.
After this, most appointments can be done online if this is your preference. Let us know at your visit whether you’d prefer your subsequent appointments to be online or face to face and we will do our best to accommodate you.
Yes, sometimes we may initiate or continue hormone therapy within our clinic after diagnosis of gender dysphoria. We are aware that it can sometimes be difficult to access hormone therapy from your GP, even when it has been recommended by a gender dysphoria service. As a result, we are able to prescribe and dispense hormones on site.
This is not meant to be long term solution for any service user. In order to free up capacity to see new patients we will only prescribe for a limited period until a service user is stable on their regimen, at which point we will request your GP take over long-term prescribing.
For those with GPs already prescribing, we can write to them with advice on change of dose/preparation etc. when necessary.
We are very happy to assist your GP with any questions they have after they have taken over the prescribing. If you are having difficulty in getting your hormones through your GP, please let a member of the nursing team know and they can support you with this.
You can access a full sexual health screen anytime you visit TransPlus. This can involve blood tests for syphilis, hepatitis B and C, HIV, as well as swabs or urine samples for bacterial infections like chlamydia or gonorrhoea.
You may also need blood tests because you are already taking hormones or you’re thinking about taking them in the future. We can undertake hormone monitoring at the same time as your sexual health screen or HIV care to avoid the need for multiple blood tests.
An important part of hormone care is having regular blood tests to check your hormone levels, your liver function, and sometimes full blood count and prolactin. If and when you start taking new medications as part of your TransPlus care, we will most likely check your bloods 3 months later. Once people are stable on their hormones, blood tests are only required once per year.
We will start you on your medication and take responsibility for monitoring in the early stages. However, we will work to ensure your GP surgery feels competent and confident in carrying out your blood monitoring (and injections – if needed) in the long term.
Not necessarily. We want to make sure that TransPlus is as easily accessible as possible, and we understand that many people will have been diagnosed in private services or abroad and that some may have started hormone therapy or even had some surgeries prior to being seen at TransPlus.
If you received your gender dysphoria diagnosis from a health professional who can evidence appropriate training and experience in assessing, diagnosing and prescribing for gender dysphoria then you will not need to receive a diagnosis from TransPlus.
Appropriate training and experience can include:
Not everyone will want to have gender-affirming surgery (or surgeries) but if you do, we’re happy to discuss this with you. You will work with our clinical team to decide on the right options for you. When this happens is dependent on a number of factors. For instance, some people may be joining the TransPlus service having already received a diagnosis of Gender Dysphoria from an approved provider elsewhere. If this is the case, it may take less time for that person to be referred for surgery compared to a person who has never had any formal support around their gender.
TransPlus is not able to reduce or influence the waiting times of surgical providers and it is our understanding that a number of waiting lists currently exceed 18 months or more. The NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process and manage referrals to your chosen surgical team. The GDNRSS has a support line that you can call for information about your referral, the status and estimated waiting times of your chosen provider, as well as offering practical information about travel, parking etc.
You can call the GDNRSS support and information line on 01522 85 77 99. Their lines are open Monday to Friday from 9am until 5pm.
Also, further information is available via the National Referral Support Service patient information leaflet.
TransPlus are able to refer, where appropriate, for all surgeries routinely commissioned by NHS England. This includes;
For those Assigned Male at Birth – feminising genital reconstructive surgery (referrals for vaginoplasty/vulvoplasty)
For those Assigned Female at Birth – masculinising chest reconstructive surgery and masculinising genital reconstruction surgery (metoidioplasty/phalloplasty)
We cannot offer referrals for any other surgeries such as breast augmentation, facial feminisation surgery and tracheal shave as they are not commissioned by NHSE on the gender dysphoria pathway. However, if you do decide to pursue these privately we may be able to support you.
We will not complete Individual Funding Requests (IFR’s) for our service users, as this needs to be done through your GP. However, we may be able to provide written supporting documentation if required.
Choosing the right surgeon for you is a big step. Make sure you explore the types of procedures you want thoroughly, find out as much as possible about the surgeon, and review pictures of their previous results. These are often available on request from the surgical providers themselves as well as from various community websites.
Whilst we can assess people for their readiness to undergo gender-affirming surgical procedures, we are not responsible for the waiting lists for individual surgical providers. However, many providers will have cancellation lists for people who are able to undergo surgery at short notice.
Some of the factors that might cause delays to surgery include:
Getting to a healthy weight – There are a number of risks associated with procedures that require a general anaesthetic. Each surgical team will have its own guidelines about weight (both under or over-weight), as this will affect a person’s risk of surgical complications. Providers will usually set a weight range for those they consider suitable for surgery, which is often a body mass index (BMI) of 18-30. If you know your weight and height, you can calculate your BMI here, or you can use our free machines in the Level 2 and Level 3 waiting rooms at 56 Dean Street. They can tell you your weight and BMI, as well as checking your blood pressure.
We can help people achieve a number of goals in relation to their weight (both putting it on and losing it) through our workshops and activities.
Giving up smoking – Smokers are significantly more likely to experience complications during or after surgery and some surgical providers will not operate on people who are active smokers. Not only are smokers at risk of serious complications from undergoing surgery, smoking can also affect the healing process and cause tissue death where skin has been grafted. Talk to us about giving up smoking or contact your GP or local Stop Smoking service.
Hair removal – Certain surgeries might require a person to undergo hair removal procedures before the procedure. E.g. a person having phalloplasty (surgery to create a penis) might want to permanently remove the hair on their forearm if it is being used to create the penis shaft and urethra. Those having vaginoplasty or vulvoplasty (surgery to create a vagina or vulva) will require hair removal on any skin sites that will be resituated to the inside of the body in order to avoid future complications.
Other health conditions – There are a number of physical health conditions which might need to be controlled or treated before undergoing surgery e.g. genital warts if you are having genital surgery.
Optimising your psychological wellbeing is also important. Sometimes just thinking about a hospital stay or having a surgical procedure can cause some people to experience anxiety. Additionally, undergoing surgery with a general anaesthetic can have a big impact on your mood and energy levels. The recovery process can also take a lot out of you and can cause some people to feel lonely, vulnerable or scared. Particularly if you’ve never had an operation before and are unsure if you are healing as you would expect or wondering if you are taking good care of your wounds.
Getting yourself feeling as though you are well prepared for surgery and the healing process is important, as is asking questions to your surgical team if you’re unsure about something once you’re discharged home. A lot of surgical providers are happy to provide remote follow up over the phone or e-mail, including reviewing pictures of any tissue or stitches that you may be worried are not healing as they should.
Please do. The best way for us to help you is for you to be honest.
56 Dean Street has offered sexual health services to marginalised communities for over 10 years. The team has experience in working with people from all walks of life, including the trans and wider LGBTQI+ communities, and those who live with an array of wellbeing challenges.
We understand that trans/non-binary people face day-to-day adversities that can result in poor mental health, including thoughts of suicide and self-harm. These thoughts and feelings do not (in and of themselves) constitute a barrier to accessing care. We strive to provide our service users with the tools and coping strategies they need to improve their mental wellbeing and develop their resilience.
With your consent, we aim to work in partnership with any existing support services you may access (e.g. mental health teams, learning difficulty or eating disorder services) to ensure you feel safe and supported in making decisions about your care at TransPlus.
Additionally, we have specialist clinics for people who hope to make changes to their drug or alcohol use, and for people who work in the sex industry. We encourage and support TransPlus users to access these services if needed and strive to provide a judgement-free service at all times.
56 Dean Street is a specialist HIV care centre and we have provided both sexual health and HIV services to trans/non-binary people since the service opened in 2009. Research indicates that combining HIV care with gender-affirming services and hormone therapy can optimise people’s adherence to their HIV treatment, resulting in better health outcomes.
However, if you are a TransPlus service user who is living with HIV and you receive your care elsewhere, you do not have to transfer your HIV care to us. You are welcome to do so, but it is not a requirement of using TransPlus, Dean Street Express, 56T (our weekly dedicated service for trans non-binary people and their partners) or any other sexual and reproductive health services at 56 Dean Street.
TransPlus offers a safe, efficient service. The time between your first and second appointments is usually 4-6 weeks (unless you choose otherwise). Some people may choose longer periods between appointments for a number of reasons e.g. to access additional support or services or to spend more time considering the various options available to them. We’re a flexible service and we’ll be led by you.
We support trans/non-binary people’s right to self-determination. However, the current process for obtaining legal gender recognition in the UK requires an application for a Gender Recognition Certificate in accordance with the Gender Recognition Act 2004. See the Gov.UK website for further details.
Should you choose to apply, your application requires a report from a:
If you wish to apply for a GRC we can support by providing clinical reports.
Please request the report at one of your appointments or ask the team via chelwest.transplusinfo@nhs.net
Yes. However, there are strict criteria that have to be met in order to be eligible for financial support for travel.
Please speak with or email one of the admin team BEFORE you book any travel to ensure you are eligible and to understand the process. TransPlus cannot be liable for any costs incurred if this process is not followed.
We love to hear feedback about the services we provide. Whether it’s positive or negative, your views help us shape and develop our services and allows us to deliver the best possible care. If you would like to give feedback or talk to us about a problem or complaint you can do so via Chelsea & Westminster Hospital Trust’s Patient Advice and Liaison Service.
We also have paper feedback forms in all of our waiting rooms and at the reception desks. If you prefer to use these, please hand them to our clinical team or the reception staff.