Many local NHS bodies have prescribing guidelines on the pharmacological treatment of gender dysphoria, with several based on information published by the GIC at the Tavistock & Portman.^{7,8,9,10,11,12}

Its GIC website provides a range of information, including shared-care prescribing guidance for treating gender dysphoria in transitioning people, and leaflets about ongoing and post-discharge hormone management. It also has patient booklets on hormones setting out what to expect from treatment, the benefits and risks, and expected monitoring requirements.¹²

Other guidelines include Good practice guidelines for the assessment and treatment of adults with gender dysphoria, published in 2013 by the Royal College of Psychiatrists. The US-based Endocrine Society, supported by the European Society of Endocrinology among others, updated its clinical guidelines on the endocrine treatment of gender dysphoric/gender incongruent persons in 2017.^13,14

Most of the drugs initiated by specialist clinics are prescribed off-label, placing additional expectations on clinicians when discussing gender confirmation treatment options. Sustanon (testosterone injection) is an exception as it is licensed for use as “supportive therapy for female-to-male transsexuals” in addition to use in testosterone-replacement therapy for male hypogonadism.^15,16

Sex hormones, gonadotrophin analogues (GnRH analogues) and sometimes antiandrogens are the core prescribed drugs. Some hormones will be used long-term; others may be used short-term or until surgery (if undertaken), or to an age where other physiological changes would occur.