Advocating for yourself is hard, so we're gonna do it for you

Requesting services from your GP can be tricky.Often you may not know how to phrase requests, and practice managers/administrators may not know how to process them or what information is required. The main stumbling block is often your GP lacking the confidence to provide these services without specialist oversight - this usually means a GIC, which is simply not a viable option for many trans individuals due to current waiting times.Providing a written request is preferable to discussing this on the phone/in person for a few reasonsThe request (should be) scanned into your notes meaning that it can be referred back to in future and, in the event that you need to escalate a complaint, there is a "paper-trail" that provides clear evidence of exactly what you requested and when.
You can include links to relevant policy and guidance that may help your GP feel confident enough to do X for you.You can use a more formal tone and convey information clearly and concisely.Submitting RequestsDepending on how your practice operates, you may decide to give this letter to your GP in a face to face appointment, or you may have to hand it in at the desk to be actioned by the clinician dealing with written requests. Some practices will provide an email address to send letters to: you must follow this up with a call/visit/email to ensure that the email has been received and the letter has been added to your notes to be actioned upon.Regional VariationThese should be relevant across the UK, but please note that I am only familiar with the way that primary care operates and the relevant legislation in England. Do a quick google to see if the info included is relevant to your area. The sources are all UK based, so these letters are unlikely to be useful abroad. Feel free to adapt them though!Nonbinary IDUnfortunately, the X gender marker and even the Mx. title are not currently supported by any relevant UK government department. Play this how you want to play it, but in my case (they/them, amab, undergoing hormonal and surgical feminisation) I have changed my details with my GP to Miss/Female. It sucks, but it's what we've got right now. A letter requesting an "X" marker from the passport office etc will be rejected.I hope these are helpful. There are various other things you may wish to request, for example local funding for sperm/egg storage, so please feel free to use this general tone to modify these letters to maximise your chances of success.Trans lives matter

Helpful things

Requesting a Bridging Prescription

This is typically the tricky one.I'll paste the relevant guidance and policy in the actual letter, but the long and short of it is that your GP can provide bridging prescriptions but is not under any obligation to.The justification is harm reduction: if you're committed to taking hormones, it's better to get them from an NHS pharmacy with appropriate monitoring than buying them off the internet. Likewise, waiting years or more for hormones is known to negatively impact a person's mental health (this is obvious anecdotally, but is also backed up by actual data).If your GP refuses, you can escalate it first to your practice manager and then to your CCG (Eng) or other primary care authority (Sco/NI/Wal). Again, your GP is not under any professional obligation to provide a BP, so there's only so far you can take it. You may find that asking for a different GP/ACP at your practice or moving practice helps. You're entitled to do this for any or no reason and it is a serious breach of law and medical practice guidelines if you are treated differently for changing, or asking to change, GP.Other tips for success:
- Change your name and gender with your GP first.
- Ask your GP to refer you to a GIC first. The guidelines on BPs state that the GP must refer to a specialist for ongoing guidance - in reality, this is almost always a GIC.
- Some people find more success if they are already taking DIY hormones. This is a terrible situation, as it requires (potential) harm to take place before harm reduction can happen. I've included an optional paragraph about how you're either already taking DIY HRT and another for if you're considering it if you don't get a BP. This is not me recommending DIY HRT: it is a personal decision that carries real risk of both medical harm and legal consequences.
- You will need to see someone in person at some point. Consider booking an appointment early, and handing this letter in prior to or at that appointment.Please be aware that some forms of HRT (injectable estradiol) simply are not available in the UK and therefore your GP cannot, even if willing, prescribe them. Medications such as progesterone are not part of most GIC hormone regimes and therefore may also not be prescribed. Lastly, testosterone is a controlled drug. It is therefore illegal to use and/or share it in the UK, although it is somewhat decriminalised for personal use (the law is complex around this, do not take this as advice or endorsement and refer to other, qualified sources of information). You should not be worried about admitting potential criminality to a healthcare provider: we are only allowed to pass information on to police if we suspect violent harm has been or will be committed. It is therefore a serious breach of both law and of codes of practice to report drug use that has been discussed with us. If your GP does this, or intimates doing this, report it immediately. I have never heard of this happening, but it's something to bear in mind.https://www.transactual.org.uk/bridging-prescriptions is a great page on bridging prescriptions for additional info on all this and more.Dear Named GP or Practice,I am writing to request a bridging prescription of cross-sex hormones.Option A already DIY
I am currently sourcing name of medication/medications from an unlicensed non-UK provider (delete or amend if appropriate). In the interests of harm reduction and in accordance with GMC and RCGP guidance, I would prefer to access treatment via NHS services. To this end, I would be grateful to discuss an ongoing prescription of this medication from yourself whilst I wait for a Gender Identity Clinic Appointment (it may be beneficial to state your estimated GIC wait time here if you know it).Option B considering DIY
I am transgender/nonbinary/own terminology and would like to access feminising/masculinising hormone therapy. In view of a protracted waiting period (state if known) for a Gender Identity Clinic appointment, I am strongly considering commencing hormone replacement therapy sourced from abroad. I understand that unlicensed and unmonitored hormones pose a risk to myself, and therefore in the interests of harm reduction and in accordance with GMC and RCGP guidance, I would prefer to access treatment via NHS services. To this end, I would be grateful to discuss an ongoing prescription of this medication from yourself.Option C not considering DIY (mental health justification)I am transgender/nonbinary/own terminology and would like to access feminising/masculinising hormone therapy. In view of a protracted waiting period (state if known) for a Gender Identity Clinic appointment, I am concerned that continuing under the effects of my endogenous hormones for such a time will have an increasingly negative effect on my mental health and wellbeing. Therefore in the interests of harm reduction and in accordance with GMC and RCGP guidance, I would prefer to access treatment via NHS services. To this end, I would be grateful to discuss an ongoing prescription of this medication from yourself.End of optional section.For your convenience, I have included the following relevant sections of guidance:"It may be that the risk of harm to your patient of self-medicating with hormones bought from an unregulated source is greater than the risk of initiating hormone therapy before the patient is assessed by a specialist.A harm reduction approach is advocated by the Royal College of Psychiatrist’s current guidelines and it would be in line with our guidance if judged it to be of overall benefit to your patient."General Medical Council https://www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#Mental%20health%20and%20bridging%20prescriptions"The clinician should assist patients in obtaining hormones from properly authorised sources. A harm-reduction approach should be taken. Accordingly, hormones should not be stopped. A bridging prescription may be appropriate, and blood tests and health checks are undertaken to screen for contraindications."Royal College of Psychiatrists
https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/cr181-good-practice-guidelines-for-the-assessment-and-treatment-of-adults-with-gender-dysphoria.pdf?sfvrsn=84743f94_4In accordance with the same harm reduction principles, I would be grateful if you could kindly start regular monitoring of my hormone levels and physiological health in order to minimise the risks associated with hormone replacement therapy. I am willing to come in for regular thrombosis screening and circulatory observations, or provide these remotely. The Nottingham Centre for Transgender Health provides a list of recommended blood tests: this is under the "Information for Healthcare Professionals" on the following website.
https://www.nottinghamshirehealthcare.nhs.uk/nottingham-centre-for-transgender-health (Substitute this with your GIC if you are able to find a similar resource -the other bit is medical speak for DVT checkups, especially important for feminising HRT, and blood pressure/pulse checks, which you can also do at a pharmacy or with a BP machine bought online)I look forward to discussing this with you further and thank you for your time and patience.Kind regards,Name, Date of Birth

Gender marker GP request

Dear Named GP or Practice,I am writing to request a letter that may be used to change my gender marker with HM Passport Office, the DVLA, and other forms of government-issued ID.As detailed in the link below, a single letter in conjunction with my deed poll is sufficient for this purpose and can be written without any additional evidence by my named primary care physician, or by another GP/advanced practitioner at my registered practice with access to my record.
https://www.networks.nhs.uk/news/transgender-patients-and-passportsFor your convenience, I have pasted a template letter below that can be adapted for this purpose. This template is available at https://www.umbrellacymru.co.uk/wp-content/uploads/2018/06/Sample-GP-Supporting-Letter.pdf"To Whom It May Concern:This is to confirm that my patient [Full name] is currently undergoing gender reassignment.As part of this process they have changed their name from [Previous Full Name] to [Full Name] and lives as [gender]. This is intended to be permanent.Your assistance in making the relevant changes to your records, and in preserving full confidentiality, would be appreciated.Yours Faithfully[GP Name and Signature]"I would be grateful if you could provide me with a copy of this letter, on headed paper, that I can send to the relevant agencies.Kind regards,Name, Date of Birth

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