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Gender Variance

Adults​

Female to Male​

Pharmacotherapy​

Purpose: relief of dysphoria, physical virilisation

  • Testosterone
    • WPATH guidelines recommend transvaginal USS q2years as testosterone increases risk of endometrial cancer
  • Prevent menstruation: IUS, POP, implant, GnRH analogue
  • Require contraception

Screening​

Need to ensure patient is referred for cervical screening, breast screening

Male to Female​

Pharmacotherapy​

  • Oestradiol
  • Testosterone Blockade (GnRH analogue or alternative antiandrogen)

Screening​

  • Prostate and PSA
  • Mammography (hormonal treatment increased breast cancer risk)

Bridging Prescriptions​

Definition: Monitoring and prescribing pharmacotherapy whilst patient awaits services of a GIC (Gender Identity Clinic)

Doctor's should act within their competence: refer to GIC, monitor mental health

GMC has specific guidelines related to this:

But you should only consider issuing a bridging prescription in cases where all the following criteria are met:

  • the patient is already self-prescribing or seems highly likely to self-prescribe from an unregulated source (over the internet or otherwise on the black market)
  • the bridging prescription is intended to mitigate a risk of self-harm or suicide, and
  • the doctor has sought the advice of an experienced gender specialist* and prescribes the lowest acceptable dose in the circumstances.

The BMA has guidelines and a letter to the GMC

Reference​