Danetre Hospital

Danetre Hospital Entrance

Gender Identity Clinic

The Northamptonshire Gender Service (NGS) is a multidisciplinary team, based at Danetre Hospital, Daventry, who aim to work closely with people to achieve good outcomes for the whole person.

Type

Gender Identity Clinic

Northamptonshire Gender Identity Clinic (GIC) is one of 7 specialist clinics currently operating in England. We provide a service for people seeking support around their gender diversity, we are commissioned to:

  • Undertake diagnostic assessments for Gender Dysphoria.
  • Offer advice on hormone treatments to GPs with whom clinical responsibility is shared.
  • Provide specialist interpretation of blood test results that are undertaken by the GP.
  • Undertake physical examinations to ensure any risks are minimised and controlled.
  • Provide second opinion assessments for other Gender Identity Clinics.
  • Undertake assessments and make recommendations for gender reassignment surgeries.
  • Provide on-going support and monitoring throughout treatment, transition, and gender reassignment.

The clinical team aims to provide a high-quality gender identity service that:

  • Follows NHS England Protocols on gender dysphoria to provide the framework for the clinical pathway through the service.
  • Is patient-centered.
  • Promotes multidisciplinary working.
  • Advocates patient and health professional collaboration in formulating individualised care plans.
  • Supports and advises our primary care colleagues in the safe and effective delivery, monitoring, and treatment of patients with gender identity needs.
  • Offers fair and equal access to the service;
  • Signposts patients and other health professionals to appropriate information and support resources;
  • Promotes positive awareness of gender issues and the legal rights of people who are transgendered, in line with the Equality Act 2010.

Who is this service for?  We are open to referrals for all people seeking support around their gender diversity and who are entitled to NHS funded care in England, when aged 17 and above. We are commissioned by NHS England (East Midlands).

How to access this service: We accept referrals from all clinicians (Psychiatrists, Social Worker, Psychologist, CPN, and other Speciality Physicians, etc.), but the GP has to be aware and in agreement due to their prominent role in providing treatment. 

To access the Joint Memorandum of Understanding (JMOU) / Gender Identity Service Referral form[docx] 159KB click here.

The current estimated wait time for new referrals (May 2020) is 43 months.

We are currently seeing patients referred in June 2017

Address

Danetre Hospital, London Road, Daventry, Northamptonshire, NN11 4DY

Map

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Contact us and opening hours

Gender Clinic
Danetre Hospital
H Block
London Road
Daventry
Northants, NN11 4DY

Email: genderclinic@nhft.nhs.uk
Telephone: 01327 708147

Mon-Fri: 09.00-17.00
(Appointment only)

How to find us

The Northamptonshire GIC is based at Danetre Hospital’s Mental Health Resource Centre in the small town of Daventry.  It is easily accessible from the M1 and M6 motorways.  There are nearby railway stations at Long Buckby and Northampton and a regular bus service from Rugby, Banbury and Northampton for those travelling by public transport.

Parking is free and the clinic enjoys access from both front and rear hospital entrances for those arriving by taxi or car.

 

The team

It is important for us to hear from our clients about the service they have received so we can continually improve the service we provide. A feedback form (code 0089) is available for your comments or any suggestions for improvement.

GIC Manager

Gian Sammarco – Team Manager

Administrative Team

Jeanette Williams – Medical Secretary
Lynne Reynolds – Data and Team Administrator

Doctors

Dr Timmins - Consultant Neuropsychiatrist
Dr Khoosal – Consultant Psychiatrist
Dr Hassitt – Consultant Psychiatrist
Dr Tickle – GP with Specialist Interest

Psychology

Dr Sue Cotton – Senior Psychologist 
Meghan Thurston – Senior Psychologist
Eileen Wood - Senior Psychology Assistant

Speech and language Therapy

Rhiannon Grebert  – Speech and Language Therapist

Nursing

Julie Cann – Gender Clinic Nurse
Sally Fisher - Gender Clinic Nurse
Rhian Daniels - Gender Clinic Nurse

Terminology

Diagnosis  

Northamptonshire Gender Clinic uses the ICD-10 classification system and you may see the term "Transsexual F64.0 - male to female" or "Transsexual F64.0 - “female to male” in the diagnosis section of clinic letters.

We recognise that terminology changes and classifications often lag considerably behind and that many service users object to the term "transsexualism" or "gender identity disorder". We are however obligated to use these terms until there is an official change in the classification system. Clinicians will be happy to discuss any particular wish you may have regarding how your condition is referred to in formal correspondence and wherever possible we will attempt to correspond with you in accordance with those wishes.

This service recognises that people undergoing treatment may not wish to be referred to as "patients" or "clients" and may have already had experience elsewhere in the UK or overseas and may have strong views, for example, of the role of psychiatrists as gatekeepers of service and the relevance of counselling or psychological interventions and what they regard as a normal emotional state. We welcome your views and will seek to reflect that in your individual treatment plan.

Confirming and expressing gender identity should be a positive and empowering experience for everyone.

Gender Dysphoria

In recent years the needs of individuals identifying as transgender and experiencing gender dysphoria has become increasingly highlighted, raising their profile both within the NHS and in wider society through the media. For transgender people, the sex they were assigned at birth and their own internal gender identity do not match.

This incongruence can be a source of significant distress. Indeed, the DSM-5 identifies this distress as ‘gender dysphoria’, where up to 1% of the population reportedly experience ‘Gender Variance’ (WPATH 2011). This highlights an increasing demand for support for individuals experiencing gender dysphoria.

For some individuals who experience gender dysphoria, medical interventions alone, such as hormone therapy and gender reassignment surgery, can alleviate associated distress. Others may need more in depth support around their psychological wellbeing and mental health.

Non-Binary

We recognise that there are identities other than the traditional binary identities. People who identify as non-binary may think of themselves as both man and woman (bigender, pangender, androgyne); neither man nor woman (genderless, gender neutral, neutrois, agender); moving between genders (genderfluid); or embodying a third gender.

The Northamptonshire GIC does accept referrals for people who identify as non-binary and this is in line with the guidance given to us by NHS East Midlands, who commission our service.

However, at present there are no clear diagnostic criteria recognised by the ICD-10 definitions. This lack of clarity can create challenges to treatments being offered, medical treatments and surgical procedures can create physiological changes that are irreversible, including losing the ability to have children without prior gamete (sperm/ova) storage. Therefore, we always aim to explore someone’s goals and aspirations as fully as possible.

How to get referred

We are a national service which means you can be referred to our clinic from anywhere in England.  NHS England funds all 7 of the Specialist Gender Services in the UK.

We accept referrals from all clinicians, but the GP has to be aware and in agreement due to their role in providing treatment.

The referral should include the below:

  • The referrer has completed the Service’s referral form, which can be accessed by clicking here. The referral form can be completed with the GP or this can be completed alone by the service-user and discussed with their GP
  • The service-user must be 17 years old at the time of referral or will have passed their 17th Birthday by the time they would be seen for assessment.
  • If there is a clinical history of mental health difficulties or physical conditions, the referral must clearly document this, any diagnosis, and indicate any interventions or treatments that are currently in place to manage any identified risks.
  • The GIC is not commissioned or resourced to provide Crisis Management. Therefore, where a high level of risk is identified the GIC must be satisfied that the service-user is receiving adequate support from Primary or Secondary services before accepting a referral.
  • A service user's GP must be in agreement to the referral being made and has indicated on the referral form that they are willing to collaborate with the clinic’s ‘Memorandum of Understanding’ (MOU). By doing this they are agreeing to prescribe and administer medicinal treatments that are advised by Northamptonshire’s GIC Consultants.
  •  Although the MOU is a non-binding agreement of shared clinical responsibility, Northamptonshire GIC will be unable to progress further than providing a diagnosis, as the clinic is not commissioned or funded by NHS England to prescribe or administer medicines directly.

How to access this service: We accept referrals from all clinicians (Psychiatrists, Social Worker, Psychologist, CPN, and other Speciality Physicians, etc.), but the GP has to be aware and in agreement due to their prominent role in providing treatment. 

You can access the referral form here -  Joint Memorandum of Understanding (JMOU) / Gender Identity Service Referral form[docx] 159KB 

The current estimated wait time for new referrals (May 2020) is 43 months.

We are currently seeing patients referred in June 2017

For more information please download our FAQs: by clicking here.

Be mindful project

Appointments

It is very important that you attend your appointments at the scheduled time, we ask that you present to the Reception within the Mental Health Resource Centre so that you can be booked in. If you are not able to attend an appointment please let us know at the earliest opportunity so that we can rearrange your appointment, also your cancelled appointment can be offered to someone else who is waiting to be seen. Where appointments are canceled without notice, contact via the telephone will be made. One further appointment will be offered by the clinic, but if that second appointment is not attended then you will be discharged from the service and referred back to your GP.

Clinic Letters

Northamptonshire GIC copy all correspondence sent to primary care (GP) colleagues to the service user at their home address, unless requested not to do so. Please let the GIC know how you would like your letter addressed, for instance, gender, name, title, address. You can discuss this with your clinician at your appointment. We can also arrange for shortened versions containing just your treatment plan to be sent out if you should wish.

Prior to your first assessment with the GIC, it may be that appointment letters or similar are addressed using the details we have on record, which may differ to someone’s preference. This will be due to what is recorded on our system but can be amended following your first contact.

We recognise that postal services can be unpredictable and clients who fail to attend appointments sometimes have informed us they had not received their appointment letter. We are aware that clinic letters following appointments are not always received as quickly as would be preferred. Unfortunately, the length of time can vary due to staff capacity and number of appointments within a given period.

If you are expecting a clinic letter and have not received this within the expected time frame, please contact us via email/telephone.

GIC Emails/Telephone

The GIC can also be contacted by email (genderclinic@nhft.nhs.uk). This way of communicating with the clinic can be used for queries such as appointments, letters, emailing blood results, GP queries, etc. Emails sent to the GIC will be responded to as quickly as feasible, but due to limited administrative support, the complexity of a matter, or advice required, this may take some time.

We would ask if the matter is urgent that you communicate by telephone, and follow up with an email. If the matter is more urgent, typically this will concern prescriptions of hormones or blood results, etc, it is likely that one of staff in the clinic will ring you directly and we would be grateful if you would keep the clinic informed of your current mobile number. This also speeds up communication about appointments, which unfortunately from time to time might need to be changed.

Role of the GP

Your GP is pivotal in the provision of your treatment pathway, hormone treatment and referral to other services, including secondary care services when there are co-morbid health concerns. Typically this might include unstable diabetes or hypertension, mental health and communication difficulties.

We recognise however that GPs from the wider referral base may have no knowledge of the field and from time to time GPs are reluctant to initiate treatment as they are unfamiliar with the use of this drug in particular outside of its licensed indications. GPs can seek guidance on our website with the information and links provided or contact us by phone/email found in the contact us section.

We will provide individual support to GPs by phone if required, particularly in the use of gonadorelin analogues such as Prostap.  We would ask that any GPs with concerns get in touch directly with the clinic, by phone or email and we are able to provide copies of the National Standards of Care and reference to relevant commissioning documents.

GPs should ensure they are involved in the referral process, particularly if another clinician or healthcare provider is referring (e.g. Tavistock GIDS, CMHT). In particular, it should be checked that the GIC’s referral form (download here: Northamptonshire Memorandum of Understanding and GIC Referral Form) has been completed with GP willingness to collaborate with the clinic’s ‘Memorandum of Understanding’ (MOU).

Why we require GP involvement

NHS England commissioned Specialist Gender Services are only commissioned and resourced to provide specialist assessment of gender related distress, some specific interventions and advice or onward referral for medical treatment of Gender Dysphoria.  These services and responsibilities are detailed in the NHS Interim Gender Dysphoria Protocol and Service Guideline 2013/2014.

Nationally, Gender Services successfully rely on cooperation with GP colleagues to provide prescribing and phlebotomy services as advised by the Gender Service – which is the case for all patients under our care.  This arrangement benefits the patient as it is convenient and maintains continuity of care with their local GP.  NHS England have made clear that GP or local CCG have the responsibility to ensure that patients have access to the treatments and monitoring that are advised by the Gender Service.  The prescription and phlebotomy advised can usually be undertaken by the GP, but otherwise they can be arranged by the local CCG to be provided between a local hospital and endocrinology service.  The Gender Service do not initiate nor co-ordinate these arrangements and they need to be arranged and managed locally.

The treatments advised are usually familiar to primary care practice, and specific prescribing and monitoring advice is available for the treatment of Transgender patients.  The prescription of medications ‘off licence’, particularly where there are no other suitable medications available for treatment, is common to other areas of medicine.  These roles and expectations are detailed in the Advice to Doctors Treating Transgender Patients.  Where colleagues are concerned about their knowledge and experience in prescribing and monitoring hormone interventions for Transgender patents, we are able to advise on each case individually and we are accessible Monday-Friday by phone and email.  CPD resources related to Transgender Care specifically for GP and primary care colleagues can be accessed here.

As we are unable to prescribe hormone treatments and provide phlebotomy services, we seek agreement with GP colleagues that they will do this prior to accepting the referral.  Given that a high proportion of patients who are assessed seek and are advised hormone therapy as an effective way to address Gender Dysphoria, a diagnosis without treatment is unhelpful and damaging.  Failure to provide the necessary treatment is the responsibility of the GP and local CCG, and if not provided may be discriminatory under the Equalities Act 2010 and will increase distress and harm to the patient.

Therefore we will not be able to accept the referral unless there is agreement in principal regarding the provision of advised treatment and phlebotomy services as outlined in the Memorandum of Understanding, or a detailed account of why it is in the best interest of the patient to be seen for assessment only. 

 

Assessment

A diagnosis of gender dysphoria can usually be made after two in-depth assessments carried out by two or more GIC specialist clinicians. However, each person is different and treatment plans vary according to the individual’s needs and circumstances.

Assessment can include:

  • Personal history and background
  • Exploration of gender identity and gender dysphoria
  • History and development of gender dysphoric feelings
  • Impact of stigma on mental health
  • Availability of support from family, friends, and peers
  • Physical health and a physical examination.

The assessment helps determine how someone experiences gender dysphoria and what their needs might be which could include:

  • Whether someone has a strong desire to change physical characteristics as a result of gender dysphoria
  • How someone manages any difficulties they experience
  • How feelings and behaviours have developed over time
  • What individualised support and treatment people require.

We recognise that individuals are unique and we would not seek to put service users under pressure to achieve particular arbitrary goals. 

However, we do ask that individuals explore with the clinician they are seeing any barriers to their living in role (typically these would be occupational or relationships with families) so that we may work out an appropriate treatment path and help identify resources for individuals who are experiencing difficulty. 

We generally find clients of this service are living fully in role within a year of presentation, comfortable and able to explore their emotional reaction to change in their appearance and the impact that has on who they meet and whether they feel safe and effective in their new identity. 

If needed we can advise you in applying for changes in your personal details and health service records and there is generally no charge for supporting letters to banks, licensing authorities, passport office etc. Links for further information can be found on on resource and guidance tab.

We also offer a ‘Welcome Workshop’ for people with upcoming initial assessment appointments. The workshop is run on a monthly basis, which people are automatically invited to attend. It is an opportunity to find out more about the gender clinic and to meet others involved. The workshop will include an overview of our service, physical health, and looking after ourselves.

Hormones

Hormone therapy can be part of the process of changing the body, depending on someone’s gender identity and needs. Hormones usually need to be taken indefinitely, even if surgery is undertaken. The aim of hormone therapy is ultimately for someone to feel more comfortable with themselves. Possible changes from taking hormones are listed below.

Hormone treatments to assist with gender transition can only be commenced after two documented diagnoses of Gender Dysphoria/Transsexualism, alongside a satisfactory physical exam and blood results, as per our GIC guidelines.

Each person's treatment is individually tailored to achieve a safe and effective feminisation or masculinisation and is in keeping with national and WPATH guidelines.

Effects of Taking Oestrogen

  • Penis and testicles getting smaller
  • Less muscle
  • More fat on hips
  • Breasts becoming lumpy and increasing in size slightly
  • Less facial and body hair

Effects of Taking Testosterone

  • More body and facial hair
  • More muscle
  • Clitoris gets bigger
  • Periods stop
  • Increased sex drive (libido)
  • Voice may get slightly deeper, but may not be as deep as other men’s voices.

Most physical changes, whether feminising or masculinising, occur over the course of two years. The amount of physical change and the exact timeline of effects can be highly variable.

 

Surgery

We will discuss the surgical pathway relevant to your individual needs in a very early stage in your attending this service and will be sensitive to someone’s changing ambitions and do not expect or require service users to undergo surgery until they are ready for it, or if not part of their treatment goals.

The Northamptonshire GIC will make referrals endorsing and recommending surgical procedures to appropriately qualified physicians on the basis that it is their clinical opinion that the patient is both eligible and ready to undertake such procedures.

Whilst individual time spans can vary, the following guidelines apply:

  • Upper body surgery (Bilateral mastectomy/Breast reconstruction) - Upper body surgery requires one documented clinical recommendation from a GIC Specialists who know the patient. This must be no sooner than 6 months after assessment with Northamptonshire GIC
  • Lower Body surgery – Lower body surgery requires two recommendations from a GIC Specialist. This must be no sooner than 12 months after assessment with Northamptonshire GIC.

Not everyone experiencing gender dysphoria will feel they need surgery, or may only require very specific procedures. Individual needs are discussed throughout contact with the clinic.

The aim is to increase someone’s comfort with themselves and reduce gender dysphoria through surgery.

Masculinising surgery may involve:

  • Bilateral mastectomy (removal of both breasts)
  • Hysterectomy (removal of the womb)
  • Salpingo-oophorectomy (removal of the fallopian tubes & ovaries)
  • Phalloplasty or Metoidioplasty (construction of a penis)
  • Scrotoplasty (construction of a scrotum) and testicular implants
  • Penile implant.

Feminising surgery may involve:

  • Orchidectomy (removal of the testes)
  • Penectomy (removal of the penis)
  • Vaginoplasty (construction of a vagina)
  • Vulvoplasty (construction of the vulva)
  • Clitoroplasty (construction of a clitoris with sensation).

 

Psychology

Meetings with a Clinical Psychologist may help to explore and clarify ideas and feelings, improve relationships, develop strategies to manage health pre- and post-operatively, as well as resolve or manage distress.

This could be for purposes such as:

  • Exploring gender identity, role, and expression
  • Addressing the negative impact of gender dysphoria and stigma on mental health
  • Alleviating internalised transphobia
  • Enhancing social and peer support
  • Improving body image
  • Promoting resilience.

These could be addressed through individual or group work as agreed during consultation.

Speech and Language Therapy

We have a Speech & Language Therapist (SaLT) based within our hospital sites in Northampton and Daventry who can provide sessions for people if required.

The methods used are likely to vary depending on your needs but may involve moderating pitch, intonation, resonance, and articulation as well as non-verbal aspects such as posture and breathing.

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