Gender dysphoria or incongruence
The Chalmers Gender Identity Clinic (GIC) based in NHS Lothian follows the national gender reassignment protocol guidelines for Scotland 2012 (currently under review).
National Gender Identity Clinical Network CEL 26 (2012) - Gender Reassignment Protocol Gender reassignment protocol (update July 2021)
As per specialist.
As per specialist.
As per specialist.
Refer to product literature, dose as per specialist.
Prescribing Notes:
- This treatment pathway covers formulary recommendations for people assigned female at birth wishing masulinising hormone treatment in connection with gender dysphoria or incongruence.
- Further information is available via NHS Lothian RefHelp resources.
- Sustanon is licensed for administration for supportive therapy for female-to-male transsexuals.
- Occasional estradiol suppression is required in addition to testosterone. Only a gonadorelin analogue is used and doses are identical to the feminising endocrine treatment pathway.
- Testosterone dose may need to be re-titrated following gonadectomy.
History Notes
23/01/2024
New condition pathway for Gender dysphoria or incongruence, ERFC Aug 23.
Step 1 estradiol. Transdermal patches, gel, spray, or oral tablets. See prescribing notes.
Prescribe estradiol transdermal patches generically with frequency of administration specified in accordance with known patient preference. Patches are available in a range of strengths and dosage schedules.
As per specialist, 1 patch twice weekly.
As per specialist, 1 patch twice weekly.
As per specialist, 1 patch twice weekly.
As per specialist, 1 patch twice weekly.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
Step 2 With or without androgen suppression. Gonadorelin analogues (leuprorelin, triptorelin or goserelin) are preferred over cyproterone acetate when androgen suppression is indicated.
3.75mg every month.
11.25mg every three months.
3mg 4 weekly.
11.25mg 3 monthly.
22.5mg 6 monthly.
Cyproterone acetate is rarely used for androgen suppression.
As per specialist.
Prescribing Notes:
- This treatment pathway covers formulary recommendations for people assigned male at birth wishing feminising hormone treatment in connection with gender dysphoria or incongruence.
- Further information is available via NHS Lothian RefHelp resources.
- Transdermal estradiol preparations are recommended for individuals over 40 and in patients with cardiovascular risk factors, high BMI, liver disease.
- For androgen suppression gonadorelin analogues (leuprorelin, goserelin or triptorelin) are preferred over cyproterone acetate. The three-monthly preparations are more commonly used.
- Cyproterone acetate is rarely used for androgen suppression due to reports of hepatotoxicity and increased risk of meningioma.
- Patients may require re-titration of estradiol following gonadectomy, when androgen suppression therapy can be stopped. All should re-engage with the GIC during this period, and the GIC will carry out this titration if indicated.
- For prescribing Gonadotrophin-releasing hormone (GnRH) analogue (any medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin), please refer to Scottish Drug Tariff part 12 Schedule 2 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’.
History Notes
06/02/2025
Updated prescribing information gonadorelin analogues, ERWG Jan 2025
23/01/2024
East Region Formulary content agreed, ERFC Aug 23.