TransPlus is an exciting new pilot of an NHS Gender Dysphoria Clinic for adults (17 and over) that is integrated into an existing sexual health and HIV service at 56 Dean Street.
56 Dean Street is an award-winning sexual health and HIV service based in Soho, the heart of London’s LGBT+ community. Set to run for 3 years, the TransPlus pilot integrates specialist gender care with a range of sexual health and wellbeing services.
TransPlus will offer flexible, tailored support options, assessment for and diagnosis of gender dysphoria, hormone therapy (including prescriptions and monitoring), voice therapy, as well as referrals to surgical providers. The service will work to NHS England’s National Service Specification for gender dysphoria services.
TransPlus doesn’t have a waiting list, as such. As a pilot service, we are seeing a limited number of service users over the course of three years. You are eligible to access TransPlus if you meet ALL of the following criteria
We are contacting eligible people directly in order to let them know about the service and invite them to join TransPlus as a service user.
If you meet all of the above criteria, please read through the rest of this Service User FAQ and decide whether or not you would like to transfer your care from your current waiting list to TransPlus at 56 Dean Street. Details about how to access the service are included in the questions below.
Please note, as a small-scale, time-limited pilot we regret we cannot accept transfers of care from people who have already had their first appointment at another NHS Gender Dysphoria Service.
You may not have heard from us for a number of reasons. For instance, we may not be aware that you are currently on a waiting list for an NHS Gender Dysphoria Clinic (i.e. we don’t know that you’re eligible for the service), or you may have changed your phone number since your last visit.
If you meet the eligibility criteria for the TransPlus service, please read through the rest of our Service User FAQs. If you think you would like to use TransPlus or you would like to ask us further questions in order to decide, please contact us via: firstname.lastname@example.org
TransPlus is the first NHS Gender Dysphoria Clinic in England to offer gender-affirming interventions alongside sexual & reproductive health services and HIV care. We are an experienced, multi-skilled team of trans and LGBQ practitioners and allies.
We offer a flexible, holistic service that supports people who are exploring their gender. We can provide assessment for (and diagnosis of) Gender Dysphoria, and subsequent access to various elements of medical transition (should people choose it). Additionally, we aim to support all our service users in optimising their sexual health and wider wellbeing.
Some of the services we offer may be familiar to you within the context of a gender dysphoria clinic:
We also offer:
If you haven’t already heard from us, but think you might be eligible to use the service please contact us via email@example.com with your name, date of birth, the date you were referred (and the name of the service), and your mobile telephone number.
Once you’ve contacted us:
This call is not an assessment and there is no right or wrong way to answer any of the questions.
We understand that choosing your gender clinic is a big decision. You don’t have to give us an answer on the spot and we want you to have all the information you need to make the best choice for you. Take some time to read through our webpages and any information we send you. We can call you back when suggest to see if you are ready to move forward with us.
In the meantime:
Booking your appointment:
We’ll call you back and ask if you’re happy to book your first appointment. If you’d like to go ahead, we’ll arrange a time and a date that’s convenient for you to come into 56 Dean Street. We’ll text you the details of your appointment, and you’ll also get another reminder message a few days before your visit too.
It doesn’t count against you in any way. If you’ve read through all of our information and decided that TransPlus isn’t right for you, we hope you’ll continue to use our other services as and when you need them.
You don’t need to give us a reason and you can keep using Dean Street Express, 56T (our weekly dedicated service for trans/non-binary people and their partners) or any of our other sexual and reproductive health services at 56 Dean Street.
Your first appointment at TransPlus is split into two stages. Each stage is an hour-long, with a short break in between. This is to maximise your time spent with us and to reduce the need for multiple appointments (and therefore multiple trips).
We’ll ask you if this is ok when we’re booking your appointment. Some people may opt to spread their first appointment over two separate days for a number of reasons (e.g. chronic health conditions, difficulty concentrating, fatigue etc). This is fine by us, and you don’t need to give a reason on the phone if you don’t want to.
Stage One: You’ll meet with one of the Senior Nursing Team. Stage One is an opportunity for you to explore the services we offer in more detail and to ask questions about various aspects of social or medical transition. During this initial discussion, we would also like to learn a bit more about you. This helps us to offer the most appropriate information and support.
We will most likely discuss:
Get the most out of your visit:
*Because we see people who experience domestic or sexual abuse, we will always ask service users to come into their appointments alone at first (or with a caseworker if you choose). Once we have asked some confidential questions about you and your safety, your supporter, friend or advocate is welcome to join you.
Stage Two: If you are hoping to access physical interventions such as hormone therapy or referral for surgery via TransPlus, you’ll meet a member of the nursing team for a health check. We’ll ask about your medical history (including any health conditions and/or medication you might be taking). We’ll also measure your height, weight and blood pressure, and take some blood tests. This health check does not involve a genital or chest examination.
In this part of your visit, we’ll also offer a full sexual health screen and vaccinations for some sexually transmitted infections (Hepatitis B and Human Papilloma Virus/HPV). If you have symptoms of an STI, we may offer an examination and treatment but this is separate from your pre-hormone health check (which does NOT require a genital examination). If it feels more appropriate we can arrange for you to come back on another day or see a different member of staff about your sexual health.
By undertaking the health check during your first appointment, we can be ready to start hormone therapy at your second appointment if:
At the end of your first visit, we will give you some written information about the services we offer, as well as information about hormone therapy and/or gender-affirming surgeries if required.
Please read this information before you come back for your second appointment (usually in 2-4 weeks) and highlight or make notes of any areas you would like more information about.
There’s no set way to dress ‘like a man’, ‘like a woman’ or ‘like a non-binary person’ and we strive to provide a space where all trans/non-binary people can be themselves. We recognise that gender identity is very different from gender expression, all we ask is that people dress however they feel most comfortable on the day.
For some people, Dean Street might be one of the few places they are able to dress in ways that feel authentic (whatever that might look like). By all means, bring a change of clothes (wigs, make-up etc.) to your appointment. Just make sure you dress for you, and not for us.
You’re welcome to change in any of the bathrooms on site. The toilets on the clinic floors are available but often busy as they’re used for STI screening. The bathrooms on the Lower Ground Floor are the quietest in the building and are not in constant use. Just ask our team at ground floor reception to buzz you through the door.
We are a team of professionals from a range of backgrounds and disciplines (inc. nursing, psychology, social work, sexual & reproductive medicine). You can find out more about the TransPlus team here.
As a pilot Gender Dysphoria Clinic, our team will be receiving on-going training and clinical supervision from an experienced Specialist Consultant in Gender Dysphoria.
To support the learning and development of the TransPlus team, we may ask your permission for either a colleague or a supervisor to sit-in on some of your appointments with us (either physically or via a video link). We will ask your consent when booking your appointment and you are welcome to decline.
Confidentiality is a fundamental component to the running of any sexual health service, and as TransPlus is part of 56 Dean Street we follow the same policies as the wider service. There are strict laws that we must adhere to regarding the use, sharing, disclosure, storage and transfer of patient-identifiable information. This means any personal information you provide us will be held in the strictest confidence. Your TransPlus records are stored within the sexual health clinic’s computer system and kept separate from the general medical notes that are used in the main hospital. Computerised information about our patients is coded and only staff within the clinic are able to access identifiable information (such as your name or address).
You can access a full sexual health screen anytime you visit TransPlus. This can involve blood tests for syphilis, hepatitis B and C, HIV, as well as swabs or urine samples for bacterial infections like chlamydia or gonorrhoea.
You may also need blood tests because you are already taking hormones or you’re thinking about taking them in the future. We can undertake hormone monitoring at the same time as your sexual health screen or HIV care to avoid the need for multiple blood tests.
An important part of hormone care is having regular blood tests to check your hormone levels, your liver and kidney function, and your full blood count. If and when you start taking new medications as part of your TransPlus care, we will most likely check your blood at 1 month, 3 months, and 6 months intervals. Once people are stable on their hormones, blood tests are required every 6 months to 1 year.
We will start you on your medication and take responsibility for monitoring in the early stages. However, we will work to ensure your GP surgery feels competent and confident in carrying out your blood monitoring (and injections – if needed) in the long term.
At your first visit, we’d like for you to undertake a physical health check with our nursing team. This will include taking your medical history and a sexual health screen (if it feels necessary and appropriate). We’d also like to take your blood pressure, measure your height and weight and take a set of blood tests. These tests will look at your full blood count, hormone levels, and your kidney and liver function. We’ll also give you some information about hormone therapy to take away with you and read before your next visit.
Our clinical team will have reviewed your blood results by the time you come in for your second visit (2-4 weeks later) and will have made a recommendation for a prescription. If you receive a diagnosis of Gender Dysphoria at your second appointment, you’ll have the option of starting hormone treatment on that day. This is also the case for people who have already received a diagnosis of Gender Dysphoria from an NHS-approved practitioner elsewhere.
We understand that some people may wish to wait and/or access additional support before starting hormone therapy (if they choose to take hormones at all). We have a range of services designed to support our service users to make the best possible choices about their gender care (including peer support, clinical psychology and psychosexual therapy), and those decisions will always be led by you.
We also ask that all service users who are interested in hormone therapy read the information from the Human Fertilisation & Embryology Authority about trans/non-binary people and fertility preservation here.
Not everyone will want to have gender-affirming surgery (or surgeries) but if you do, we’re happy to discuss this with you. You will work with our clinical team to decide on the right options for you. When this happens is dependent on a number of factors. For instance, some people may be joining the TransPlus service having already received a diagnosis of Gender Dysphoria from an approved provider elsewhere. If this is the case, it may take less time for that person to be referred for surgery compared to a person who has never had any formal support around their gender.
TransPlus is not able to reduce or influence the waiting times of surgical providers and it is our understanding that a number of waiting lists currently exceed 18 months or more. The NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process and manage referrals to your chosen surgical team. The GDNRSS has a support line that you can call for information about your referral, the status and estimated waiting times of your chosen provider, as well as offering practical information about travel, parking etc.
You can call the GDNRSS support and information line on 01522 85 77 99. Their lines are open Monday to Friday from 9am until 5pm.
Also, further information is available via the National Referral Support Service patient information leaflet.
The TransPlus pilot has been commissioned for 3 years. In this time, we hope that eligible service users will be assessed for Gender Dysphoria and (if diagnosed) will subsequently have access to any gender-affirming care that is available via the NHS (including hormones, speech therapy, talking therapies and group work to reduce dysphoria, and surgery).
By the end of the pilot, we anticipate that all TransPlus users will be discharged from the service and will latterly be under the care of their GP.
TransPlus offers a safe, efficient service. The time between your first and second appointments is usually 2-4 weeks (unless you choose otherwise). Some people may choose longer periods between appointments for a number of reasons e.g. to access additional support or services or to spend more time considering the various options available to them. We’re a flexible service and we’ll be led by you.
If you are taking hormones that have not been prescribed to you by a registered medical professional, we can provide blood tests to monitor your hormone levels and the impact of the medication on your body. We have walk-in slots available for at 56T every Wednesday evening.
As you are taking medication that we did not prescribe to you, we’re not able to provide guidance about how to take it. However, we can explain what your blood test results mean and highlight any abnormalities. You can use this information to make an informed choice about how to continue with your medication. If we have serious concerns about any of your blood results, we will ask for your consent to notify your GP.
Not necessarily. We want to make sure that TransPlus is as easily accessible as possible, and we understand that many people will have been diagnosed in private services or abroad and that some may have started hormone therapy or even had some surgeries prior to being seen at TransPlus.
If you received your Gender Dysphoria diagnosis from a health professional who can evidence appropriate training and experience in assessing, diagnosing and prescribing for gender dysphoria then you will not need to receive a diagnosis from TransPlus.
Appropriate training and experience can include:
A number of people will be joining the TransPlus service at various different life stages. As long as you meet the service criteria and have not already been seen at an existing NHS Gender Dysphoria Clinic, you are eligible to use TransPlus.
Choosing the right surgeon for you is a big step. Make sure you explore the types of procedures you want thoroughly, find out as much as possible about the surgeon, and review pictures of their previous results. These are often available on request from the surgical providers themselves as well as from various community websites.
Whilst we can assess people for their readiness to undergo gender-affirming surgical procedures, we are not responsible for the waiting lists for individual surgical providers. However, many providers will have cancellation lists for people who are able to undergo surgery at short notice.
Some of the factors that might cause delays to surgery include:
Getting to a healthy weight – There are a number of risks associated with procedures that require a general anaesthetic. Each surgical team will have its own guidelines about weight (both under or over-weight), as this will affect a person’s risk of surgical complications. Providers will usually set a weight range for those they consider suitable for surgery, which is often a body mass index (BMI) of 18-30. If you know your weight and height, you can calculate your BMI here, or you can use our free machines in the Level 2 and Level 3 waiting rooms at 56 Dean Street. They can tell you your weight and BMI, as well as checking your blood pressure.
We can help people achieve a number of goals in relation to their weight (both putting it on and losing it) through our workshops and activities.
Giving up smoking – Smokers are significantly more likely to experience complications during or after surgery and some surgical providers will not operate on people who are active smokers. Not only are smokers at risk of serious complications from undergoing surgery, smoking can also affect the healing process and cause tissue death where skin has been grafted. Talk to us about giving up smoking or contact your GP or local Stop Smoking service.
Hair removal – Certain surgeries might require a person to undergo hair removal procedures before the procedure. E.g. a person having phalloplasty (surgery to create a penis) might want to permanently remove the hair on their forearm if it is being used to create the penis shaft and urethra. Those having vaginoplasty or vulvoplasty (surgery to create a vagina or vulva) will require hair removal on any skin sites that will be resituated to the inside of the body in order to avoid future complications.
Other health conditions – There are a number of physical health conditions which might need to be controlled or treated before undergoing surgery e.g. genital warts if you are having genital surgery.
Optimising your psychological wellbeing is also important. Sometimes just thinking about a hospital stay or having a surgical procedure can cause some people to experience anxiety. Additionally, undergoing surgery with a general anaesthetic can have a big impact on your mood and energy levels. The recovery process can also take a lot out of you and can cause some people to feel lonely, vulnerable or scared. Particularly if you’ve never had an operation before and are unsure if you are healing as you would expect or wondering if you are taking good care of your wounds.
Getting yourself feeling as though you are well prepared for surgery and the healing process is important, as is asking questions to your surgical team if you’re unsure about something once you’re discharged home. A lot of surgical providers are happy to provide remote follow up over the phone or e-mail, including reviewing pictures of any tissue or stitches that you may be worried are not healing as they should.
The short answer is yes. 56 Dean Street has offered sexual health services to marginalised communities for over 10 years. The team has experience in working with people from all walks of life, including the trans and wider LGBTQI+ communities, and those who live with an array of wellbeing challenges.
We understand that trans/non-binary people face day-to-day adversities that can result in poor mental health, including thoughts of suicide and self-harm. These thoughts and feelings do not (in and of themselves) constitute a barrier to accessing care. We strive to provide our service users with the tools and coping strategies they need to improve their mental wellbeing and develop their resilience.
With your consent, we aim to work in partnership with any existing support services you may access (e.g. mental health teams, learning difficulty or eating disorder services) to ensure you feel safe and supported in making decisions about your care at TransPlus.
Additionally, we have specialist clinics for people who hope to make changes to their drug or alcohol use, and for people who work in the sex industry. We encourage and support TransPlus users to access these services if needed and strive to provide a judgement-free service at all times.
56 Dean Street is a specialist HIV care centre and we have provided both sexual health and HIV services to trans/non-binary people since the service opened in 2009. Research indicates that combining HIV care with gender-affirming services and hormone therapy can optimise people’s adherence to their HIV treatment, resulting in better health outcomes.
However, if you are a TransPlus service user who is living with HIV and you receive your care elsewhere, you do not have to transfer your HIV care to us. You are welcome to do so, but it is not a requirement of using TransPlus, Dean Street Express, 56T (our weekly dedicated service for trans non-binary people and their partners) or any other sexual and reproductive health services at 56 Dean Street.
We support trans/non-binary people’s right to self-determination. However, the current process for obtaining legal gender recognition in the UK requires an application for a Gender Recognition Certificate in accordance with the Gender Recognition Act 2004. See the Gov.UK website for further details.
Should you choose to apply, your application requires a report from a:
We are able to provide a medical report for these purposes, which is compliant with the following guidance.
Please request the report at one of your appointments or ask the team via firstname.lastname@example.org
We love to hear feedback about the services we provide. Whether it’s positive or negative, your views help us shape and develop our services and allows us to deliver the best possible care. If you would like to give feedback or talk to us about a problem or complaint you can do so via Chelsea & Westminster Hospital Trust’s Patient Advice and Liaison Service.
We also have paper feedback forms in all of our waiting rooms and at the reception desks. If you prefer to use these, please hand them to our clinical team or the reception staff.
TransPlus is a small-scale, time-limited pilot of an NHS Gender Dysphoria Service integrated into an existing GUM/HIV clinic. We are not accepting external referrals from primary care at this time. Your patient is eligible to use services at TransPlus if they meet the following criteria:
If your patient meets the above criteria and has not yet been contacted by the TransPlus team, please ask them to contact us via: email@example.com.
If your patient is not eligible to use TransPlus, a number of existing NHS Gender Dysphoria Clinics will be able to accept referrals from primary care providers. Ask your patient which service they would like to be referred to. Contact details and information for existing services can be found here.
TransPlus works with its service users to undertake assessment for and diagnosis of Gender Dysphoria (GD), as well as providing access to a number of NHS pathways and procedures known to alleviate GD and its related distress.
Subsequent to a diagnosis of GD, many of our service users may wish to undertake hormone therapy (and anti-androgen therapy if appropriate). TransPlus will initiate hormone treatment and its initial monitoring and titration, before making prescribing and monitoring recommendations to primary care clinicians.
If your patient has consented to information sharing between TransPlus and Primary Care, you will have access to a range of online resources, a dedicated telephone surgery for healthcare providers, and regular CPD opportunities to ensure you feel confident in supporting your trans/non-binary patients and in prescribing for Gender Dysphoria.
We also provide counselling and advice on fertility preservation, Speech & Language Therapy, and access to other gender-affirming pathways, including ‘top’ (or chest) surgeries, and ‘lower’ (or genital surgeries). As well as a varied programme of talking therapies and support options (including but not limited to psychology, social work, peer support and psychosexual therapy).
We aim to discharge patients back to primary care once they have received the gender-affirming care that is right for them. However, our clinical support services and telephone surgery for healthcare providers will remain open access to ensure general practitioners feel confident in providing on-going support to their trans/non-binary patients.
The responsibility for general practitioners supporting trans/non-binary people is largely similar to that of non-trans people. Primary care services that are of particular relevance to a person who is undergoing a medical transition may include:
Whilst TransPlus is able to support trans/non-binary people with weight management, improving psychological wellbeing, or smoking cessation, these are supplementary to local provision and are designed to complement and not replace them.
Other primary care responsibilities include:
The General Medical Council have produced clear guidance for GPs who are supporting trans/non-binary patients in primary care, including advice on how to make your practice more inclusive, as well as your responsibility to take over the prescribing and monitoring of hormone therapy once a person is discharged from an NHS Gender Dysphoria Clinic. See the GMC’s guidance on Trans Health.
Gender Dysphoria Clinics and the gender-affirming services and procedures that are accessible via their clinical pathways (e.g. speech therapy, some surgeries) are centrally funded by NHS England’s Gender Dysphoria Clinical Programme (which falls under Specialised Commissioning).
The funding of the majority of gender-affirming care via the NHS is not the responsibility of local CCGs (including assessment, diagnosis, gender-affirming surgeries, specialised talking therapies). However, when a person is discharged back to primary care after completing their pathway at a Gender Dysphoria Clinic, prescribing and monitoring of hormone therapy (and its funding) becomes the responsibility of primary care.
It is our responsibility to discuss fertility and reproductive health as part of the TransPlus pathway, particularly if people are interested in hormone treatments or surgical procedures that will impact their fertility. However, we do not provide fertility preservation, gamete storage or fertility treatments at TransPlus.
Funding decisions about storage and fertility treatments are made locally by CCGs (some will fund these procedures whilst others do not). For more information about fertility preservation and treatment for trans/non-binary people, see the information for patients provided by the Human Fertilisation & Embryology Authority.
Waiting times for existing NHS Gender Dysphoria services can be in excess of two years, from referral to the first appointment. In that time, nearly 25% of those waiting may decide to access unprescribed hormone therapy from various sources. There are a number of ways in which GPs can minimise the harm posed by long waiting times and self-medication, as advised by the GMC and the Royal College of Psychiatrists:
Click to view the GMC’s full guidance on Bridging Prescriptions.
All patients are entitled to change the gender marker on their patient record by request at any time. They are not required to provide documentation (e.g. a deed poll or Gender Recognition Certificate), nor do they need to undergo any form of assessment, diagnosis, or medical procedures in order to do so.
It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t any impact on your practice payments.
Trans patients have a legal right to change their name and gender on their NHS records at any time and may bring a civil suit against practices that do not accede their request.
If you have questions about the care of a specific service user you can contact the TransPlus team via firstname.lastname@example.org (as long as we have their consent to share information). If a member of our clinical team is not immediately available, we aim to respond to your query within 24-48 hours.
For more general learning and support, we offer a package of free and low-cost digital resources, online training modules, and face-to-face learning opportunities. Please contact us via the e-mail address above with “TransPlus Learning” in the e-mail subject line if you (or your practice) would like to receive updates about our training opportunities.
We have various volunteer opportunities available for people who are interested in supporting trans/non-binary people and the wider LGBTQ+ communities within 56 Dean Street and Dean Street Express. There are also chances to volunteer across the Chelsea & Westminster Hospital Trust in a range of other settings. Please see ChelWest’s volunteer pages for further details.
Unfortunately, we’re not able to offer work experience placements within the TransPlus service. However, placements are available throughout the Chelsea & Westminster Hospital Trust.
Chelsea and Westminster Hospital NHS Foundation Trust has an established education and research partnership with the Florence Nightingale School of Nursing and Midwifery at King’s College London. Students from KCL may undertake placements within the wider Dean Street service. We may struggle to accommodate requests for placements if you are a student nurse or student midwife studying on another programme.
We receive a high volume of requests from students and academics who are keen to undertake research with people from trans/non-binary communities. Whilst we are happy to discuss your project with you, we are unable to promote any studies that have not received NHS ethics approval.
Our wider service welcomes potential collaborations with trans/non-binary researchers, and you are welcome to contact us via email@example.com.
The Chelsea and Westminster Hospital NHS Foundation Trust press office is open for enquiries from members of the press and media 24 hours a day, 7 days a week.
Communications team (Mon–Fri, 9 am–5 pm)
T: 020 3315 6828
Press office – Out-of-hours (and bank holidays)
Communications team Out-of-hours (and bank holidays)
We are contactable for urgent, time-sensitive media enquiries. In the first instance, please text or email, then call.
M: 07775 016 333
We review each request individually. We will only passively promote (i.e. put flyers in our waiting room or share on social media) projects that are trans-affirmative and provide a clear benefit to the communities. Ideally, these projects will be led by trans/non-binary people themselves.
You are welcome to send any flyers or information for us to review at:
Twitter & Facebook: @56TSoho
Post: TransPlus, 56 Dean Street, Soho, London, W1D 6AQ
We are happy to share flyers or social media posts about trans-affirmative events and activities. Ideally, events will be in or around London and will be led by trans/non-binary people themselves.
You are welcome to send any flyers or information for us to review at:
Twitter & Facebook: @56TSoho
Post: TransPlus, 56 Dean Street, Soho, London, W1D 6AQ