Introduction

Gender dysphoria is a recognised medical condition for which gender reassignment treatment is available on the NHS in Scotland. 
 
A person with gender dysphoria may:

  • experience distress, anxiety, uncertainty and persistently uncomfortable feelings about their biological sex not fully matching their gender identity (the gender they see themselves as) 
  • have, and may act on, a gender identity which is different from their anatomical sex. For example, someone born with female sex characteristics deciding to live permanently as a man

Transsexualism

Long lasting and extreme gender dysphoria can be known as transsexualism. This is the desire to live and be accepted as a member of the opposite sex. 

It can also be accompanied by the wish to make his or her body as fitting as possible with the preferred sex through surgery and hormone treatment. 

Non-binary gender identities

People with non-binary gender identities can experience gender dysphoria and may sometimes partially transition socially, take hormones or have some surgery done. 

This includes androgyne, thirdgender and polygender people who do not feel comfortable thinking of themselves as simply either men or women. They might identify their gender as being a combination of the two, or as being neither.

Early symptoms

The symptoms of gender dysphoria may begin to appear at a very young age. For example, a child may refuse to wear typical boys' or girls' clothes, or dislike taking part in typical boys' or girls' games and activities.

In most cases, this type of behaviour is just part of growing up. However, in cases of gender dysphoria, it persists into later childhood and through to adulthood.

Causes

The exact cause of gender dysphoria is unknown. It is currently classed as a mental and behavioural disorder in the WHO International Classification of Diseases. However, many recent studies have suggested that it is more to do with biological development (relating to the body). 

Research into what causes gender dysphoria is ongoing.

How common is gender dysphoria?

Gender dysphoria is rare, but the number of people being diagnosed with it is increasing due to growing public awareness about the condition. Although awareness has increased, many people with gender dysphoria still face prejudice and misunderstanding about their condition.
 
There is no reliable information on the number of transgender and transsexual people in Scotland and there is currently no routine collection of data on gender reassignment. 

The Gender Identity Research and Education Society provides guidance on estimating the number of people experiencing gender dysphoria.

Outlook

Treatment for gender dysphoria aims to help people become content with their gender identity. This can mean different things for different people. 

  • For some, it can mean dressing and living as their preferred gender
  • For others it can mean taking hormones that change their physical appearance
  • Transsexual people may seek to have surgery to permanently alter their biological sex

See our policy guidelines section for information on legislation and the NHSScotland Gender Reassignment Protocol.  

Symptoms of gender dysphoria

In most cases, a person with gender dysphoria will begin to feel that something is wrong with their sex and gender identity during early childhood. For others, this may not happen until adulthood.

Most transsexual people who have an extreme form of gender dysphoria will have been experiencing concerns since before they were two years of age.

There are no physical symptoms of gender dysphoria, but there is specific behaviour that people may display. 

Children

It is likely that children will find it difficult to express their feelings of gender dysphoria and it can be difficult for others to identify their discomfort. 

Often the child will be the only person who is aware of their unease with the gender they were assigned at birth and their biological sex. They may not understand these feelings.

If your child has gender dysphoria, their behaviour may include:

  • insisting that they are of the opposite sex 
  • disliking or refusing to wear clothes that are typically worn by their sex 
  • wanting to wear clothes that are typically worn by the opposite sex 
  • disliking or refusing to take part in activities and games that are typically meant for their sex 
  • wanting to take part in activities and games that are typically meant for the opposite sex 
  • disliking or refusing to pass urine as their sex usually does, for example a boy may want to sit down to pass urine and a girl may want to stand up 
  • insisting or hoping that their genitals will change, for example a boy may want to be rid of his penis, and a girl may want to grow a penis 
  • feeling extreme distress at the physical changes of puberty 
  • feelings of anxiety and depression

In many cases, behaviour such as this is just a part of childhood and does not necessarily mean that your child has gender dysphoria. 

Only in rare cases does the behaviour persist into the teenage years and adulthood. 

Teenagers and adults

If the feelings of gender dysphoria are still present by the time your child is a teenager or adult, it is likely that they are not simply a phase or a stage of development.

If you are a teenager or an adult whose feelings of gender dysphoria started in childhood, you may now feel:

  • you have a much clearer sense of your gender identity and the way you want to deal with it 
  • without doubt that your gender identity is at odds with your sex 
  • comfortable only when in the gender role of your preferred gender identity 
  • a strong desire to hide or be rid of the physical signs of your sex, such as breasts, body hair and muscle definition 
  • a strong dislike for, and a strong desire to change or be rid of, the genitalia of your sex

Feeling depressed or suicidal

Certain feelings can often be very difficult to deal with. 

See your GP as soon as possible if you have been experiencing feelings of depression or suicide. They will be able to provide help and support.

Alternatively, call:

  • Breathing Space on 0800 83 85 87. 
    Lines are open Monday to Thursday: 6pm – 2am and Friday 6pm through to Monday 6am. 
  • ChildLine on 0800 1111.
    Contact ChildLine anytime. Calls are free and confidential. 
  • Samaritans on 116 123. 
    They are available 24 hours a day to talk through any issues that you may have in confidence. 
  • NHS 24 on 111.

Our Mental Wellbeing section also provides further information about depression.

Causes of gender dysphoria

The exact cause of gender dysphoria is unknown and there is much debate over the condition’s possible causes. 

Gender dysphoria was traditionally thought to be a purely psychiatric condition, which meant that its causes were believed to originate in the mind. However, recent studies have challenged this and suggested that gender dysphoria may have biological causes associated with the development of gender identity before birth. 

More research is needed before the causes of gender dysphoria can be fully understood but it is now widely agreed that it cannot be thought of as a purely psychiatric condition.

Typical gender development

Much of the crucial gender development that determines your gender identity happens in the womb (uterus). To understand how gender identity can be affected by development in the womb, it is necessary to know how it normally works.

Your sex is determined by chromosomes. These are the parts of a cell that contain genes (units of genetic material that determine your characteristics). You have two sex chromosomes: one from your mother and one from your father.

During early pregnancy, all unborn babies are female because only the female sex chromosome (the X chromosome) that is inherited from the mother is active. At the eighth week of pregnancy, the sex chromosome that is inherited from the father becomes active. This can be either an X chromosome (female) or a Y chromosome (male).

If the sex chromosome inherited from the father is X, the unborn baby (foetus) will continue to develop as female with a surge of female hormones. The female hormones work in harmony on the brain, gonads (sex organs), genitals and reproductive organs so that the sex and gender are both female.

If the sex chromosome that is inherited from the father is Y, the foetus will go on to develop as male. The Y chromosome causes a surge of testosterone and other male hormones, which initiates the development of male characteristics, such as testes. The testosterone and other hormones work in harmony on the brain, gonads (sex organs) and genitals, so that the sex and gender are both male.

Therefore, in most cases, a female baby has XX chromosomes and a male baby has XY chromosomes.

Changes to gender development possibly resulting in gender dysphoria

Gender development is complex and there are many possible variations that can cause confusion between a person’s sex, gender identity and gender role. However, it is important to remember that these are not yet fully understood.

In rare cases, the hormones that trigger the development of sex and gender may not work properly on the brain, gonads and genitals, causing variations between them. For example, the sex (as determined physically by the gonads and genitals) could be male, while the gender (as determined by the brain) could be female.

This could be caused by additional hormones in the mother’s system or by the foetus’s insensitivity to the hormones, known as androgen insensitivity syndrome (AIS). In this way, gender dysphoria may be caused by hormones not working properly within the womb.

Other rare conditions possibly resulting in gender dysphoria

Other rare conditions, such as congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism) may also result in gender dysphoria.

In CAH, a female foetus’s adrenal glands (two small, triangular-shaped glands located above the kidneys) cause a high level of male hormones to be produced. This enlarges the female genitals. In some cases, they may be so enlarged that the baby is thought to be male when she is born.

Intersex conditions cause babies to be born with the genitalia of both sexes (or ambiguous genitalia). 

Previously in such cases, it was recommended that the child’s parents should choose which gender to bring up their child. However, it is now thought to be better to wait until the child can choose their own gender identity before any surgery is carried out to confirm it.

Diagnosing gender dysphoria

If you think that you or your child may have gender dysphoria, see your GP or one of the four gender identity clinics in Scotland. Gender identity clinics offer expert support and help, as well assessment and diagnosis, for people with gender dysphoria. 

Referrals can be made to these clinics for patients to explore the options available to them:

  • The main NHSScotland gender identity clinic is based at the Sandyford in Glasgow and accepts referrals from across Scotland. It is also possible to self-refer to the Sandyford clinic. Visit the Sandyford website or telephone 0141 211 8130. 
  • The NHS Lothian gender clinic for patients who have, or think they may have, gender dysphoria is provided at the Chalmers Sexual Health Centre in Edinburgh. The service is for patients in Lothian and patients can refer themselves or be referred by a GP or other health care professional. The gender clinic staff can be contacted via the Chalmers Centre by calling 0131 536 1505 and asking for the secretary of the gender clinic. 
  • NHS Grampian accepts referrals from GPs of patients residing in Grampian, Orkney and Shetland. All GP referrals should be made to Dr John Callender, Royal Cornhill Hospital, Aberdeen AB25 7ZH. People cannot self-refer to this service. 
  • NHS Highland Sexual Health Clinic based at Raigmore Hospital, Inverness accepts self-referrals. The clinic can be contacted on 01463 704 202. The clinic only accepts patients from the NHS Highland area.

There are strict criteria for diagnosing gender dysphoria, which are different for children and adults. The criteria are based on the assumption that gender dysphoria is a purely psychiatric condition (relating to the mind), which is now increasingly thought not to be the case.

For this reason, and due to the fact that gender dysphoria is so complex, specialists tend to make a diagnosis based on each individual rather than just on the criteria  

Traditional criteria for diagnosing gender dysphoria in children

To be diagnosed with gender dysphoria, a child should behave in the following way for at least six months:

  • repeatedly insist that they want to be the opposite sex, or that they are the opposite sex, and behave as the opposite sex. This must not be just because they want the supposed advantages of being the opposite sex 
  • dislike or refuse to wear clothes typically worn by their sex and insist on wearing clothes typically worn by the opposite sex 
  • show dislike or unhappiness with their genitalia and insist that it will change into that of the opposite sex. For example, refuse to pass urine as members of their sex usually do 
  • not yet have reached puberty (when a child progresses into a sexually developed adult)

Traditional criteria for diagnosing gender dysphoria in teenagers and adults

To be diagnosed with gender dysphoria, a teenager or adult should:

  • feel persistently and strongly that they are the wrong sex and feel a strong identification with the opposite sex 
  • feel discomfort in their sex and its gender role and strongly dislike and wish to be rid of the physical characteristics of their sex, such as breasts, facial and body hair and genitalia 
  • not have a condition that causes them to display physical attributes of the opposite sex (although this is being increasingly questioned) 
  • experience long-term anxiety, distress and impairment in social and occupational areas of life due to their condition 

Assessment

As well as these criteria, a diagnosis of gender dysphoria will depend on an assessment of the gender identity and preferred gender role. 

Gender identity clinicians will complete an initial assessment and, if a provisional diagnosis of gender dysphoria is given, a treatment plan will be agreed jointly. This will include the completion of a 12 month preoperative experience for adults. 

After this a diagnosis will usually be confirmed as gender dysphoria or not.

Some treatments are available during the 12 month preoperative assessment. These are outlined in our treatment section.

Patients not diagnosed with transsexualism or gender dysphoria will be offered treatment appropriate to their need by the gender identity clinic or will be referred to other appropriate services.

Treating gender dysphoria

Treatment for gender dysphoria aims to help people with the condition live the way they want to in their preferred gender identity. What this means will vary from person to person, and some people will need more treatment than others. 

Gender dysphoria should be treated in line with the NHSScotland gender reassignment protocol which was issued by the Scottish Government in July 2012.

Consent to treatment

You should be a full participant in decisions about your healthcare and wellbeing and be given any information or support that you need in order to do so. 

For further information on consent, including when children and teenagers can consent to their own treatment, see consent in the NHS.

Children and young people

Children and young people should contact their local GP or gender identity clinic in the first instance and may then be referred to the NHS Greater Glasgow and Clyde Sandyford Gender Clinic.

For children and young people aged between 12 and 18 in Scotland, the Sandyford Gender Clinic has an assessment service provided through a child and adolescent psychiatrist. Paediatric endocrinology services (specialists in hormonal conditions) from Yorkhill Hospital are also involved.

A full assessment will be carried out and the patient’s family will be invited to participate in discussions, if the young person gives consent. Young people will also have the opportunity to discuss issues without their family being present. 

In some circumstances, such as consideration of pubertal suppression (where manmade hormones are used to delay the development of puberty caused by testosterone and oestrogen), young people may be referred for an opinion from a paediatric endocrinologist. 

Occasionally, young people may be referred to their local child and adolescent mental health team for further assessment or interventions.

The amount of treatment that your child has will depend on how strong and long-lasting their feelings of gender dysphoria are. However, all children and their families should be offered counselling and support through their gender identity clinic.  Details of other support services are are included in our Support Services Directory.

The UK Government Department of Health has published a number of leaflets about gender identity, including one aimed at parents whose children are experiencing gender dysphoria. The leaflets are available on the Gender Identity Research and Education Society website.

Endocrine treatment

Endocrine treatment is treatment with hormones (powerful chemicals). It is the first step to developing the physical signs of your preferred gender. 

If diagnosed with gender dysphoria before reaching puberty, endocrine treatment will not be received. 

These do not recommend endocrine treatment for young children because a diagnosis of transsexualism cannot be made before a child has reached puberty. 

Gonadotrophin-releasing hormone (GnRH) 

If your child has been diagnosed with transsexualism, and they have reached puberty, they may be treated with gonadotrophin-releasing hormone (GnRH) analogues. These are synthetic (manmade) hormones that suppress the hormones naturally produced by your body.

GnRH analogues may be suitable for children who have reached Tanner stage two in puberty. This means a number of physical changes have taken place, such as pubic hair starting to grow. In girls, this is around 11 years of age and in boys it is around 12 years of age.

Some of the changes that take place during puberty are driven by hormones. For example testosterone, which is produced by the testes (testicles) in boys, helps stimulate the development of the penis. 

As GnRH analogues suppress the hormones that are produced by your child’s body, they also suppress puberty.

Cross-sex hormones

If your child has been taking GnRH analogues for several years and are diagnosed as transsexual, they may be offered cross-sex hormones. These can alter your child’s body further to fit with their gender identity. 

The effects of these hormones are only partially reversible, so they are not offered to children who are under 16 years of age.

For more information about cross-sex hormone treatment and gender reassignment surgery, see the section about treatment for adults below.

Adults 

Gender identity clinics offer ongoing assessment for people with gender dysphoria. They can also provide support and advice for you and your family about living in your preferred gender role.

For some people, support and advice from a clinic are all they need to feel comfortable in their gender identity. However, others will need more extensive treatment, such as a full transition from one sex to the other. The amount and extent of treatment you have is completely up to you.

The gender identity clinic will complete an initial assessment with you. This will usually be with the input of a psychiatrist (a doctor who treats mental and emotional health conditions). This assessment is necessary to confirm your diagnosis and, if you want to have hormone therapy, means that you can take the necessary health tests first.

Preoperative 12 month experience

The pre-operative experience must be completed before you can have gender reassignment surgery.

The social aspects of changing your gender role can be challenging. Often more so than the physical aspects. Living in your desired gender role for 12 months allows you to experience, and socially adjust in your desired gender role, before undergoing surgery that cannot be reversed. 

Twelve months allows for a range of different life experiences and events that may occur throughout the year. For example, family events, holidays, work or school experiences. You should live consistently in your desired gender role on a day-to-day basis and across all settings of your life. This includes coming out to partners, family, friends, and community members.

You should have access to the following treatments during and beyond the preoperative experience:

Transsexual women (MtF) 

  • Psychotherapy 
  • Hormone therapy
  • Facial hair removal
  • Speech therapy 

Transsexual men (FtM)

  • Psychotherapy
  • Hormone therapy
  • Mastectomy and chest reconstruction
  • Speech therapy

Once you have completed the preoperative 12 month experience, you will have a second assessment with your gender identity clinic where you will review your progress and further discuss and agree your treatment plan.

Patients who choose not to have surgery can continue on hormone therapy. 

The 12 month experience can be extended if you or your gender identity clinic feel that further time is needed. It may also be extended if your attendance at your gender identity clinic is inconsistent.     

Ongoing psychotherapy and counselling 

Your gender identity clinic should offer regular psychotherapy and counselling throughout the process. It is important that your families, partners and carers are also supported during this time. 

Your GP or gender identity clinic should be able to help with this and also make you aware of other support networks. Some of these are included in our Support Services Directory.

Hormone therapy

Hormone therapy may be all the treatment you need to live with your gender dysphoria 

Before starting hormone treatment you are encouraged to stop smoking, take regular exercise, have a sensible diet and consume no more than 14 units of alcohol per week.

With your consent, blood tests will be taken to determine your health and suitability to begin hormone therapy.

You will need to take hormones for the duration of your life and they should never be taken without your doctor’s involvement. You will be monitored to find out whether the hormone treatment is benefiting you.

You may be frustrated with how long hormone therapy takes to produce results and you will need to be realistic about the extent of changes you can expect. Hormones cannot change the shape of your skeleton, for example how wide your shoulders or your hips are. It also cannot change your height.

Some people may be unable to take hormones due to other health conditions. In this case the gender identity clinic should discuss other options with you.

Transsexual women (MtF)

Oestrogen will be prescribed for transsexual women and will be helpful in making your appearance more feminine.

Some changes you may notice include:

  • your penis and testicles may get smaller 
  • your body may redistribute body fat into a more female shape 
  • you may have less muscle 
  • you may have some breast development

There may be side effects, such as mood swings, tiredness and breast tenderness, although some transsexual women report feelings of calm and wellbeing after starting on hormone treatment. 

Hormones can also increase the risk of breast cancer and high blood pressure, so it is important to have regular medical check-ups.

Transsexual men (FtM)

Testosterone will be prescribed for transsexual men and will be helpful in making your appearance more masculine.

Some changes you may notice include:

  • your voice may get deeper 
  • your body may redistribute body fat into a more male shape 
  • you may have more muscle tone 
  • you may develop male pattern body and facial hair growth 
  • you may have an increased sex drive 
  • your clitoris (a small, sensitive part of the female genitals) may get bigger 
  • your periods may stop

There can be a slightly increased risk of liver complications and there may be side effects such as acne and male pattern baldness, depending on your hereditary factors. 

Regular exercise will increase muscle bulk and give maximum impact to the masculinising effects of testosterone.

Facial hair removal

Facial hair removal is a recommended treatment for transsexual women and can begin prior to the preoperative 12 month experience as the beard must grow to visible lengths to be removed. 

Electrolysis is the most safe, effective way of removing facial hair and may require between 200 and 400 hours of treatment.

Laser and Intense Pulse Light (IPL) treatment for facial hair removal may require up to 15 sessions. It is most effective if you have dark hair and fair skin but is unsuitable for treating non-pigmented hairs such as grey, white, blonde and red.

Donor site hair removal 

Transsexual men will require hair removal prior to radial artery phalloplasty or radial artery urethroplasty; otherwise there will be hair-bearing skin on the inside of the neourethra.  Transsexual women will require hair removal prior to vaginoplasty and labiaplasty.

Electrolysis may require 32 sessions over a period of 6 months (ensuring no re-growth).  An alternative and more cost effective approach is for hair follicles to be removed during surgery, this would have to be discussed and agreed with the surgeon performing the procedure.

Hair removal from the donor site can be performed with a surgeon’s recommendation prior to completion of the preoperative 12 month experience in order to reduce delays in surgery.

Bi-lateral mastectomy (removal of the breasts) and chest reconstruction 

If you are a transsexual man this procedure is usually the first surgery performed and for some it is the only surgery undertaken. 

The procedure can take place during the preoperative 12 month experience if you have agreed it in your treatment plan with your gender identity clinic and an appropriately qualified professional has recommended it. 

A bi-lateral mastectomy cannot be reversed, and timescales for when the surgery should take place should be agreed in discussions between you and your gender identity clinic.

Speech therapy

Hormone therapy will not affect the voice of a transsexual woman. To make the voice higher, you will need speech therapy, which your gender identity clinic can refer you to. 

Some transsexual women may require vocal cord or trachea (windpipe) surgery.

Transsexual men’s voices will deepen through hormone therapy but it may not be as deep as other men’s voices. 

You may benefit from speech therapy, which your gender identity clinic can refer you to if needed.

Genital surgery

To undergo such major irreversible procedures you must be physically fit and meet the criteria listed in the NHSScotland gender reassignment protocol.  

Specialist surgery for gender reassignment is not available in Scotland. You may be referred to services in England for this part of your treatment. 

Surgery may involve:

Transsexual women (MtF) 

  • Penectomy (removal of the penis)
  • Orchiectomy (removal of the testes)
  • Vaginoplasty (creation of the vagina)
  • Clitoroplasty and labiaplasty (creation of clitoris and labia) 

Transsexual men (FtM)

  • Hysterectomy (removal of uterus)
  • Vaginectomy (removal of vagina)
  • Salpingo-oophorectomy (removal of ovaries and fallopian tubes)
  • Metoidoplasty (creation of micropenis)
  • Phalloplasty (creation of penis from using skin and muscle tissue from another site, eg forearm or thigh) 
  • Urethoplasty (creation of urethra)
  • Scrotoplasty (creation of scrotum)
  • Placement of testicular prostheses 

See the Gender Identity Research and Education Society guides to lower surgery for more information on specialist surgery.

Other treatments

You may need further treatments as part of the process of matching your body to your gender. This should be part of your ongoing discussions with your gender identity clinic.

These treatments are accessed by referral from your gender clinic to plastic surgery. You can find further information on the referral process in the NHSScotland gender reassignment protocol.

Some of the treatments referrals may be made for are:

  • Facial feminisation surgery – such as thyroid chondroplasty/tracheal shave (reducing the size of your Adams Apple), rhinoplasty (nose surgery), facial bone reduction (reducing the jaw line) and blepharoplasty (eyelid surgery)/facelift. 
  • Breast augmentation – you should wait between 18 and 24 months to give hormone treatment a chance to fully develop your breasts before seeking additional surgery.

Follow up care

If you have surgery you should have an appointment with your gender identity clinic within six months of surgery to discuss any issues and be provided with a post-operative plan.

You can find further information in our follow up care section.

Follow up care

After surgery, the majority of transsexual people are happy with their new sex and feel comfortable with their gender identity. 

If you have surgery you should have an appointment with your gender identity clinic within six months of surgery to discuss any issues and be provided with a post-operative plan. 

You may need further treatments and this can be discussed with your gender identity clinic.

You will be discharged to the appropriate health professional for ongoing hormone therapy and monitoring. This may be your GP.

Screening services

It is important that you continue engage with health services and go to relevant screening services.

Whether you are a trans man or trans woman who has or has not changed their Community Health Index (CHI) number (NHS patient identifier) it is important that you are aware of screening services that apply to you. 

Your CHI number identifies you as male or female, which may mean that you are not automatically invited to relevant screening services. 

Services that you might not be automatically called for include:

  • Abdominal aortic aneurysm (AAA) screening
  • Breast screening
  • Cervical screening

More information on screening programmes can be found in our Screening section.

Self-check

Your post-operative plan should let you know how to care for your body following surgery. You should also be aware of other self-checks you should do.

Prostate cancer

The chances of developing prostate cancer increase as you get older. It is the most common cancer in men and most cases develop in men aged 65 or older.

If you are a transsexual woman you are still at risk of developing prostate cancer. 

See our article on prostate cancer for further information.

Testicular cancer

Testicular cancer is an uncommon type of cancer that primarily affects younger men.

If you are a transsexual woman and have not had gender confirmation surgery you may be at risk of developing testicular cancer. 

See our article on testicular cancer for further information.

Prejudice or discrimination

You may face prejudice or discrimination during and or after you have completed gender reassignment. Treatment can sometimes leave people feeling:

  • isolated if they are not with people who understand what they are going through 
  • stressed about or afraid of not being accepted socially 
  • discriminated against at work 

There are legal safeguards to protect against discrimination (see Gender dysphoria - guidelines), but other types of prejudice may be harder to deal with. 

If you are feeling anxious or depressed since having your treatment, speak to your GP or a healthcare professional at your clinic. 

Our Mental Wellbeing section may also be of assistance.

Policy guidelines

NHSScotland Gender Reassignment Protocol

The Gender Reassignment Protocol was issued to NHS Boards on July 11 2012. 

The Gender Reassignment Protocol contains a number of therapies and surgical procedures, which the patient and their gender clinician should discuss in detail to find the most appropriate treatment pathway. 

The protocol sets out the treatment pathway from initial enquiry to completion and enables the patient to have a say in decisions about their healthcare.

Any treatment for gender dysphoria in Scotland should follow the protocol.

The Equality Act 2010

The Equality Act, 2010 protects transsexual people from discrimination and harassment in various areas, such as work or the provision of goods and services.

The Act does not require a person to be under medical supervision to be protected. For  example someone born with male sex characteristics who decides to live permanently as a woman, but does not consult a doctor or undergo any medical procedures, would be protected.

The Act also protects people associated with them, such as family members, as well as others who are perceived to be transsexual. 

Gender Recognition Act 2004

Under the Gender Recognition Act of 2004, transsexual men and women can:

To apply for a Gender Recognition Certificate you must be over 18 years of age. The application process requires you to prove that:

  • you have or have had gender dysphoria 
  • you have lived as your preferred gender for the last two years 
  • you intend to live permanently in your preferred gender.

Patient Advice and Support Service

The Patient Advice and Support Service is an independent service which provides free, accessible and confidential information, advice and support to patients, their carers and families about NHS healthcare.  

The service:

  • can provide you with information, advice and support if you want to give feedback or comments, or raise concerns or complaints, about healthcare provided by NHS Scotland
  • helps you understand your rights and responsibilities as a patient
  • works with the NHS in Scotland to improve healthcare provision 

The Patient Advice and Support Service can be accessed from any Citizens Advice Bureau in Scotland.