NHS and private hormone (endocrine) clinic appointments and endocrinologists
Interventions such as hormone blockers or gender affirming hormones require initial psychological assessment from gender specialist services before being referred to a paediatric endocrinologist, or endocrinologist. In certain circumstances, GPs have undertaken these treatments, without these requirements, due to the exceptionally long waiting times for NHS treatment. Whilst many parents and carers we spoke to preferred for their child's trans healthcare to take place within the NHS, the waiting times at the gender identity services for both children and adults, meant that some opted to pay for it privately. For example, E and D were able to pay privately for their adult son's appointments with a gender identity specialist and endocrinologist. This allowed their son to avoid waiting a long time to be seen on the NHS and get hormones prescribed, which as E observed 'did seem to help a lot' with how he felt about himself.
Leigh said there were ‘many, many conversations’ in the family and with her foster son’s therapist and social worker about what would be involved in taking hormone blockers.
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When he attended the [Gender Identity Development Service] he went monthly for assessment with his therapist who has remained his therapist throughout. So he has had that constant and he’s managed to build up a really good relationship with his therapist at the [Gender Identity Development Service]. And finally, maybe a year or so ago, started opening up about other stuff. So, in that way, he’s been supported with them. That’s been quite good. In referral in regards to the hormone blockers, with his therapist, we, as a family with his social worker had many, many, many conversations about hormone blockers. The process. What it involves. What it could lead to. Even the fact, you know, having an injection monthly is a major thing for a 11 year old to start. I think maybe three or four months after we started the conversation he was referred to the endocrinology at the [hospital] in [name of city]. That was maybe six to eight weeks. From being referred to getting the appointment. We saw one of the lead clinicians at the [hospital]. Had blood tests done. Had bone density scans done. It all seemed to go pretty smoothly. Once wed got to the [hospital] it was like not much questions, not many questions. Not much assessing. Not much, not much anything really. It was just a case of, right, youve been referred for blockers, that’s what you’re here for. Here you go. You know, so that was kinda, I didnt expect that. I expected that to be a bit more, this is our realm, let’s delve a little deeper and let’s take it a little bit slower. It wasnt.
This section is mostly about seeing the endocrinologist on the NHS. Below, you can find out more about the parents' and carers' experiences of going to the specialist hormone (endocrine) clinic with their child, to get their child assessed for hormones, hormone blockers or to get their stage of puberty assessed.
Within the NHS, the referral to the specialist endocrinologist is always done by the Gender Identity Development Service (GIDS) after the young person has been assessed by the therapists within the service. Some parents also spoke about getting a local endocrinologist involved in their child's care via their local GP practice or getting more 'joined up' or 'collaborative' care where appointments would be attended by professionals from both GIDS and the endocrinologist. Being referred could involve several visits and include blood tests, scans and filling out consent forms.
Richard felt talking to the specialists at the hospital about hormone blockers and future medical interventions was a very positive experience.
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So, you have been in the care of that service for two and a half years now?
Mmm
How often do you go and see them?
Initially, it was quite regular and perhaps even once a month and then it becomes less regular. I think it’s perhaps once every three months. We’ve been to the hospital in [city] as well to speak to the specialists about blockers and physical reassignment and get an understanding of sort of the scientific and also the medical aspects of if someone wants to have the transition medically.
How did you find that experiences talking about these more medical interventions?
The doctor was really incredible, really amazing. Spoke in a really understanding way. On the second or third visit, we spoke to a different doctor and she spoke in a way that was quite awkward in comparison to the doctor who, I was really, really impressed with. So, the other person spoke in a way where English wasn’t their first language and how they described a couple of things was a bit awkward, whereas the gentleman, he had obviously had a good experience of really reassuring people and making them feel really comfortable to discuss really potentially awkward things and he would say, Oh, you might find this embarrassing to talk about this subject, but these are some questions that you will get asked’ and deliver the situation in a really, really good way. To sort of prepare the person for what might be a bit awkward and embarrassing. Give them the option of not answering the question if they didn’t want to which I thought was excellent.
For parents, whose children are waiting to start hormone blockers, seeing an endocrinologist and other specialists who can explain aspects of medical transition can be informative and reassuring. This was the case for Richard, who felt the visits to the specialist clinic 'were excellent.' He particularly appreciated the tactful manner of one of the specialists and his ability to make him and his daughter 'feel really comfortable' discussing potentially embarrassing issues.
Lisa's son was on hormone blockers prescribed by a private provider. In order to be able to access hormone blockers on the NHS he was required to stop taking the privately prescribed blockers and have his pubertal development assessed by an NHS endocrinologist. Lisa then requested joined up appointments between the Gender Identity Development Services and the NHS endocrinology team. She said: 'we've started now to have joint meetings with endocrinology and the [Gender Identity Development Service]. They have been more helpful, because we can agree a process and then everybody knows.' Lisa emphasised that such 'multidisciplinary team meetings are really useful in circumstances where there are different types of support that are needed, especially for a child.'
Getting an endocrinologist involved in her daughter's care was something that Jan saw as a very positive outcome of her efforts to ensure that her daughter's specific healthcare needs were met locally. She felt it was 'great to have somebody in our local practice, we feel like [her], her trans care is a part of her overall medical care.'
Find out more about hormone blockers and hormone therapy.