All the Scottish gender specialists currently follow the internationally accepted Standards of Care established by the Harry Benjamin International Gender Dysphoria Association (HBIGDA) which is now known as the World Professional Association for Transgender Health (WPATH). The Standards of Care are updated and revised as new scientific information becomes available. The latest version of the Standards of Care is Version 7 which was published in September 2011.
The NHS Scotland Gender Reassignment Protocol is based upon the latest version of the WPATH Standards of Care. The purpose of the Protocol is to reduce the postcode lottery of access to NHS funding for gender reassignment services such as assessment, hair removal, counselling, speech therapy, hormones and surgery. It affirms that:
- people can self-refer to NHS Gender Identity Clinics (GICs) in Scotland.
- that psychotherapy/counselling, support and information should be made available to people seeking gender reassignment and their families where needed.
- that two gender specialist assessments and 12-months experience living in accordance with desired gender role are needed for referral for NHS funded genital surgeries and that arrangements for delivering agreed procedures are under review with the objective of ensuring that an effective, equitable and sustainable service is implemented.
- only one gender specialist assessment is needed for referral for hair removal, speech therapy, hormone treatment and FtM chest reconstruction surgery and that these can take place in an individualised patient-centred order either prior to starting the 12-month experience or concurrently to the 12-month experience.
- that, in addition to access to genital surgeries, access to hair removal is regarded as essential to provide for trans women and access to FtM chest reconstruction is regarded as essential to provide for trans men.
- that surgeries which are not exclusive to gender reassignment, such as breast augmentation and facial surgeries, continue to need to be accessed via the Adult Exceptional Aesthetic Referral Protocol but there will be a more transparent and equitable panel process for making funding decisions in such cases.
- that young people aged 16 are entitled to be assessed and treated in the same manner as adults in terms of access to hormones and surgeries.
- that children and young people under age 16 are entitled to child and adolescent specialist assessment and treatment as per the relevant section of the WPATH Standards of Care. NOTE: at the time the protocol was created the staffing of a specialist Under 16s service at the Sandyford GIC in Glasgow was uncertain but it now looks likely that there will be a sustainable Under 16s service provided at the Sandyford GIC in Glasgow and this part of the protocol will soon be updated.