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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR181. Good practice guidelines for the assessment and treatment of adults with gender dysphoria

Price: £0.00

Approved: Dec 2012

Published: Oct 2013

Status: current

Number of pages: 62

Review by: 2018

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Correction: p. 41 of this document has been corrected since first publication, in respect of an error in the dose of testosterone ethanoate recommended. The document is correct as now published.

Gender variance is not uncommon, and the number of people seeking treatment in Gender Identity Clinics is increasing rapidly. A survey of 10,000 people undertaken in 2012 by the Equality and Human Rights Commission found that 1% of the population was gender variant to some extent – though this figure cannot be assumed to be representative of the whole population. Historically, more women sought treatment than men, but this difference is reducing.


People often find it difficult to confide their feelings of gender dysphoria to their GP because they fear ridicule, guilt or shame, or are concerned about delays in getting treatment on the NHS. This has led to increasing numbers of people self-medicating using hormones and hormone-blockers available via the internet. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.


This report makes a series of recommendations to ensure gender dysphoria patients get the best possible care. It covers the areas of hormone treatment, surgical interventions, speech and language therapy, and general medical care.


The provision of care for patients experiencing gender dysphoria is an excellent example of an area where multidisciplinary and interdisciplinary care is not only good practice but ensures that a wide choice of treatment pathways are offered, tailored to the needs of the individual patient. This report aims to optimise the clinical care pathways for patients who may need to access several medical and allied health professionals.


The best practice guidelines – which are endorsed by 13 separate organisations – have been drawn up by a multidisciplinary working group that included representation from psychiatry, endocrinology, gynaecology, urology, general practice, nursing, psychology, psychotherapy and speech and language therapy, as well as representation from patient groups. It is the first time that so many different groups have come together to agree a common set of guidelines.


  • Endorsements
  • Working group
  • Executive summary and recommendations
  • Introduction
  • Good practice
  • Overview of recommended procedure
  • Appendices


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