There are a number of different services available through the Welsh Gender Service, tailored to your individual needs.
Patients are often at different stages in their transition process when they are referred to our service. It may be appropriate in some cases to undertake a diagnostic evaluation at the first appointment, and for some, a discussion of treatment options.
The majority of our patients will wish to access Gender Affirming Hormone Therapy (GAHT), also commonly known as Hormone Replacement Therapy, as part of their treatment pathway. Where appropriate, the Welsh Gender Service makes recommendations for GAHT to a Local Gender Team (LGT) who coordinate the prescribing and monitoring of these treatments. The Welsh Gender Service doesn’t hold information about waiting times to access LGTs so you will need to contact them directly should you have any queries once you have been referred into their care.
Some patients may have a more complex medical history or require a tailored treatment plan and will require input from our Consultant Endocrinologist.
Some of our patients will also choose to access a number of NHS commissioned gender-affirming surgeries. Depending on the planned surgical procedure you may need to see a second independent clinician for review before your referral is made; we will organise this for you. Surgery is carried out at a number of centres across England and each have different criteria and requirements for providing surgeries. Waits for procedures can vary significantly across hospitals and procedures so reading up on these to make an informed choice is essential to make the right choice for you. Once you have chosen your provider, we make a referral on your behalf.
Referrals themselves are sent to a central administrative hub called the NHS Gender Dysphoria National Referral Support Service (GDNRSS) and you will be notified once your referral has been processed. The Welsh Gender Service doesn’t hold information about waiting times for surgery, so you will need to contact the GDNRSS directly through their Single Point of Access support line on 0300 131 6775 or by email at agen.gdnrss@nhs.net. They can give you information about your referral, the status of your chosen provider, and practical information such as travel and parking details, who can accompany you, what to take with you and where to report when you get there.
All surgical referrals have criteria that a patient needs to meet which include smoking status, and BMI targets (typically having a BMI under 35 or 30 although this varies depending on the provider and the type of surgery). People who meet the requirements for ‘Level 2’ Criteria can self-refer to NHS weight-loss support. For those who meet ‘Level 3’ Criteria, they can get a referral through their GP.
Here are links to information leaflets about the key surgical options available:
More information is also available through the NHS Gender Dysphoria nurse-led support and information service.
Clinical Psychologists work within the Welsh Gender Service and you can be referred to us by your gender clinician if they and you consider this appropriate.
As Clinical Psychologists, we are trained in the assessment and treatment of a range of emotional wellbeing or mental health difficulties. We aim to reduce psychological distress and promote psychological wellbeing and resilience.
We work with you to thoroughly assess emotional wellbeing difficulties in the context of significant life events, relationships and the wider system (e.g. occupation or culture). If required, we can use this understanding to identify your needs and what further support we can offer to improve your emotional wellbeing.
At the WGS, our Clinical Psychologists specialise in working with trans and gender diverse individuals on a range of issues that may be impacting or impacted by gender.
The Psychology Team are part of the wider WGS. However, we recognise how important safety and confidentiality is in therapeutic sessions. Only the ‘headlines’ may be shared with other clinicians in very specific circumstances, such as if we are concerned about a patient’s welfare.
In your first few meetings, we will ask questions about how long you have had your problems, how they affect you and what you do to cope. We may ask you about your family and other people who have been involved in your life. You could be asked to fill in questionnaires about your circumstances and feelings or complete tasks outside of the sessions.
We will always talk to you to explain what we are asking you to do and why. Lots of people find that a shared understanding of their difficulties and the factors that led up to and maintained them is enough. Alternatively, you and your psychologist may decide that it would be helpful to complete some talking therapy together. We run a range of interventions both 1:1 and group-based where we aim to flexibly work on the gender related difficulties that are causing you distress. These use a range of evidence-based modalities. The psychologist will try to give you as clear an idea as possible of how many sessions any intervention would take.
GAHT can impact on your fertility; if you require fertility preservation you will be referred by the Welsh Gender Service to either the Wales Fertility Institute for those in Mid and South Wales or to The Hewitt Centre (in Liverpool, England) for those in North Wales. We are aware of extended waiting lists for this service.
Either the Welsh Gender Service or your GP can refer you to your local health board’s Speech and Language Therapy team. In some health boards, you can also self-refer.
The Nurse led clinic is a holistic service, which is guided by your individual needs. They assist other members of the team with patients who need additional support meeting their treatment goals. No changes to your core treatment plan will be made by the Gender Nurse, however the outcome of the appointment will be shared with your Gender Clinician to inform your future care.
If you are a patient already having appointments with the Welsh Gender Service and have completed a deed poll, we can support you in applying to the British Passport Office for a change of detail including your gender marker. If you send a copy of your deed poll to our patient email (cav.wgs_enquiries@wales.nhs.uk) and instruct us, the Welsh Gender Service admin team can provide a letter to support your passport change; we do not charge for this service. Additionally, if you were to request it, we can change the relevant information on your hospital NHS records.