Q&A session
Parents and Adults join Gender Plus for a Questions and Answers session - Wed 6th December 2023
The Gender Plus senior leadership team recently held a Q&A with parents and adults keen to find out more about what is on offer in terms of support to prospective service users.
The video of the session is available to watch in full here.
Participants:
Dr Aidan Kelly, Consultant Clinical Psychologist, Director of Gender Plus
Dr Claudia Zitz, Consultant Clinical Psychologist and Systemic Family Psychotherapist, Gender Plus
Paul Carruthers, Nurse Consultant, Gender Plus Hormone Clinic
What is on offer at Gender Plus?
We offer the full array of services that you would expect from a gender identity clinic including psychological assessment and psychological support. We provide recommendations around hormonal treatments and, for our adult patients, referrals for gender-affirming surgeries. We also run a hormone clinic which enables us to provide a fully integrated gender service. In addition, we offer LGBTQ+-informed mental health assessment and treatment services, as well as neurodevelopmental assessment and support services for those up to 18 years of age.
Many of the practitioners behind Gender Plus were previously at the Tavistock, how will the two approaches differ?
As a private service, Gender Plus is able to provide a more timely, more responsive approach to its service users. We work with a team of multidisciplinary practitioners in-house who are trained in managing the needs of those in our care, from mental health and neuro-developmental disciplines to endocrine specialists. Our team has a great deal of experience in managing gender diversity, we follow a developmental approach, listening to young people and creating a care pathway which addresses their needs. We also engage with local agencies to ensure we deliver an integrated holistic assessment for every individual.
Does Gender Plus take a gender-affirmative approach to healthcare?
At Gender Plus we start from the position that all gender Identities are valid, we do not promote one gender identity outcome over another. Our aim is to support our patients in being able to explore all facets of their identity. To work with anyone psychologically it is important to be respectful, compassionate, curious and open-minded. We believe in meeting the individual where they are at and helping them to move forward. In order to do that, our approach must be inherently affirmative which essentially means accepting the individual for who they are and believing that their experiences are real. However, we also believe it is important to maintain a level of curiosity to ensure the individual is able to explore their identity in a developmentally appropriate way, and without fear of this information being used to invalidate them.
What’s the step by step process when someone comes to Gender Plus?
An individual comes to the website
They fill out a referral form and book an appointment
The form is reviewed by a clinician
Questionnaires are sent out to help gather a picture of the individual
We establish a plan which takes place over a minimum of six sessions over a six-month period for those under 18. Those 18 years plus would typically be seen for fewer sessions.
During that time, for those under 18 we meet with the individual as well as family, parents or carers, to discuss the patient’s experiences and explore the understanding of their support network. For those aged 18 years plus the process is more focussed on the individual however, where clinically indicated, their family and support network are included.
As appropriate, we link with other professionals e.g. schools, other mental health professionals to gather a holistic view of the individual.
We continue to explore with the individual, posing questions in an age-appropriate way and exploring some of the uncertainties that exist
This leads to us making a shared decision with the individual and in the case of a young person their parents/carers on the safest way for them to progress in terms of next steps.
How is Gender Plus different from other providers on the market?
We have come together as a group of clinicians with a shared set of values. We believe that it's right and fair that young people and adults should have an accessible gender service which is kind, respectful and compassionate and offers a holistic approach to transgender healthcare. All Gender Plus clinicians are UK based and registered with their governing body. We currently have offices in London and Birmingham as well as Dublin. Many of us have worked in NHS gender services and we have decades of cumulative experience. Crucially, we have recently completed a six-month application process for CQC registration which we hope to have approval on by the end of this year. This will make us the only independent gender service supporting young people and adults with the seal of approval from the CQC regulatory body.
Are Gender Plus prescriptions written by GMC registered doctors?
Paul Carruthers heads up the Gender Plus Hormone Clinic. He is an NMC registered prescribing nurse consultant with more than eight years’ experience working as a nurse prescriber in the NHS adolescent gender service based in Leeds. In Ireland, Dr Tomás Ahern runs the Dublin Gender Plus Hormone Clinic. He has provided gender affirming transgender healthcare since 2016 and is registered with the Irish Medical Council.
Will you be prescribing puberty blockers?
We will not be providing blockers as a standalone medication. We have taken the decision as a service to provide medical support for those over the age of 16 by which time the overwhelming majority have already completed puberty, making the act of blocking its progress unnecessary. We will be prescribing blocking medication to suppress natural hormone production in tandem with cross-sex hormones, in line with standard NHS practice for adolescents attending gender hormone clinics.
If someone came to Gender Plus who is already on hormone treatment and blockers through another service, with partial shared care with their GP, would they need the full six sessions of assessment with Gender Plus?
Every individual who comes to use our services would have their own assessment by the Gender Plus Multidisciplinary Team, but the number of sessions needed would be decided on a case by case basis in line with the individual’s needs.
Is shared care an option with Gender Plus?
Our pathway is designed to cover a two-year period, during which the holistic needs of the individual are established including any requirements from a medical perspective. Where hormone therapy is appropriate, we will support the individual to ensure their hormone levels are stabilised. After 24 months we will look to transfer this care over to the individual’s GP, providing ongoing support in the management of blood tests and medication as required.
Can individuals use the hormone clinic as a standalone service or do they also need to use Gender Plus’ psychological services?
We are a fully integrated multi-disciplinary service that brings with it the benefit of a comprehensive assessment with links to our hormone clinics at any given time. This relationship continues throughout a patient’s medical transition with the team being able to offer psychosocial support as needed.
If a patient comes to you with a diagnosis of gender incongruence/ dysphoria which they have obtained elsewhere, can they access hormones via the Gender Plus Hormone clinic?
All patients wishing to refer to the Gender Plus Hormone Clinic will first need to attend a gender assessment meeting with the Gender Plus psychosocial team. Any previous gender assessment reports can then be reviewed and the clinician who can then decide whether to refer to the Gender Plus Hormone Clinic. We follow robust referral procedures into the hormone clinic via a MDT meeting. It may be possible for patients with a previous assessment, having attended at least one assessment appointment with Gender Plus, to follow this referral process into the hormone clinic.
How much does it cost to use the service and what is included?
The cost for the assessment process is £275/ €320 per session and we recommend six sessions over a period of six months for those under 18 years of age, and usually 2-3 appointments for those aged 18 years plus - this can be slightly more or slightly less depending on the individual. If the decision at the end of that assessment period is to refer into the Gender Plus Hormone Clinic your clinician would take that referral to a Multidisciplinary Team (MDT) meeting for review. Following the MDT’s agreement, patients receive a letter inviting them to book an initial appointment. This will include details of what will be required in terms of blood tests and medical history. Once that information has been gathered by the patient they will be able to book an initial consultation with the hormone clinic, at a cost of £275/ €320. That meeting will be with the consultant and with input from our psychosocial team, bearing in mind the holistic needs of the individual. The patient’s endocrine needs will be considered at that stage alongside their psychological and social needs. Once the decision is made to issue the first prescription, the individual begins a journey of up to two-years building up to a fully established, individualised hormone treatment plan. This would include six monthly reviews over that two year period with endocrine and psychological review included. At the end of the 24 month period the individual will be fully established on a hormone treatment plan at which point they will be discharged back to their GP. The gender affirming hormone pathway costs £80/ €95 per month. If your GP is unwilling to provide shared care, the cost of medication and blood tests are charged on top of this subscription amount by those relevant agencies.
To get in touch with a member of the team email: admin@genderplus.com
