Integrated Health Care Prescribing Committee BLOCKS transgender Hormones

[Tills]

Good morning all from the UK where, for the first time in 12 years under the NHS, I am left without hormone therapy.

How so?

My Transgender Health Centre (formerly Gender Identity Clinic) in Nottingham wrote to my GP Surgery 10 days ago requesting that they increase my dose from Evorel 75 to Evorel 100 because my levels were a little low after switching from gels to patches.

I then hit a roadblock.

Surrey NHS now have in place a deliberate roadblock on all Transgender treatments, meaning that Transgender Clinics and GP Surgeries are, literally, not allowed to prescibe hormone therapy to patients without their Committee's prior approval via an individualised 'care plan'. Any attempt to prescribe hits their drug formulary traffic light system of 'amber'. So there's no prescribing until the petty little bureaucrats intervene. The process for obtaining this appears to be lengthy and will further damage the physical, hormonal, emotional, and mental wellbeing of transgender patients.

They have also blocked all blood tests for me until such time as a 'Care' Plan is agreed by them, the committee.

This has Health Secretary Wes Streeting's oily hands all over it.

I almost feel like emigrating right now.

[Tills]

So I've written to them a fairly stinging letter:


17 February 2026
To: Dr [Redacted] GP Transgender Healthcare
BMedSci, BMBS, DRCOG, MRCGP, DFFP and Clinical Team
Nottingham Centre for Transgender Health
12 Broad Street
Nottingham NG1 3AL
 
Ref: [Redacted]
NHS Number: [Redacted]

URGENT!
 
Dear Dr [Redacted],
 
Thank you for your excellent letter of 09 February 2026 which clearly set out my updated care plan from you, the NHS experts, in the field of transgender care.
 
Regrettably however, Surrey Heartlands are blocking my care. They have refused to permit my GP to issue the prescription because they, a committee, have enacted a new policy of refusing transgender care unless there is an Agreed Care Plan in place between yourselves and them. As I understand it, you just need to re-tune your letter to include that phrase. Which is kind of ironic because anything less caring or careful than the Surrey bureaucrats you could scarcely conceive. It all smacks of gatekeepery, bullying, and transphobia: traits entirely in keeping with Wes Streeting and Labour, for whom I mistakenly voted.
 
There's nothing amusing about this, however. Following my bilateral orchidectomy in 2016 I have no naturally occurring hormones and am about to run out. Less resourceful transgender patients than myself would be left flailing without provision. And our demographic are often already highly vulnerable patients. Perhaps that is, after all, part of Surrey Heartland's plan: their Final Solution to finish us off so that we don't have to besmirch their leafy lands. Surrey Heartlands Integrated "Care" System Area Prescribing Committee truly are complete clowns.
 
Please could you re-write your letter with an 'Agreed Care Plan' request stuffed into it to tick their small-minded bureaucratic boxes?
 
With warmest best wishes,
 

[Tills]

Grrrrrrrrrrrrrrrrrrrr

[Tills]

I'm intending to go and live in Scotland and just hope it's better up there. The NHS there is run entirely separately from NHS England and Wales. I won't repeat here so as not to cross-post. See here: https://www.susans.org/index.php/topic,250751.new.html#quickreply_anchor

[Paulie]

I'm so sorry disruptions in you healthcare, I hope it gets resolved quickly.  It's such a horrid turn of events. 

Please keep us updated. 

Prayers
Paulie.

[Lori Dee ✅]

I have recently encountered similar gatekeeping from the VA.

My approach is slightly different. According to my medical records, I transitioned in 2022. Since the VA policy no longer supports Gener Affirming Care, I have insisted that I am not seeking that.

I am only seeking to maintain my hormone therapy, which is to replace the hormones that are not being produced by my ovaries (because they have never existed). By framing it in that light, it is not GAC, which they don't do, and is inline with standard medical protocol for women my age.

If you continue getting roadblocked, try changing your approach to fit a "non-transgender" medical criterion and see if that helps.

[Tills]

Well my GP has driven through the amber traffic light. She told me she was going to try to do this as she didn't agree with their policy. I hope the cops don't catch her.

The only trouble is that she could only issue 4 weeks, and it had to be for the old dose of Evorel 75 instead of the new request from Nottingham Transgender Clinic for 3 months of Evorel 100. So slightly pointless but at least she tried.

What a state of affairs. Big Brother. And an ignorant Big Brother at that.

xx

[Tills]

I am only seeking to maintain my hormone therapy, which is to replace the hormones that are not being produced by my ovaries (because they have never existed). By framing it in that light, it is not GAC, which they don't do, and is inline with standard medical protocol for women my age.

If you continue getting roadblocked, try changing your approach to fit a "non-transgender" medical criterion and see if that helps.

Yes indeed. Good points. That's exactly how I got my private prescription which arrived on Monday after I ordered it Friday: 3 months of Evorel 100 for £34 including postage and packing. I can live with that. I went down the cis female route on a 'needs must' basis and it all worked fine.

But the refusal to conduct blood testing would be a serious issue and there would be many others in our community who are at a less relatively stable point in their transitioning.

It's awful. Absolutely awful.

xx

[Charlotte Kitty ✅]

So sorry to hear this. I really hope you get something sorted soon as it's completely wrong. It doesn't surprise me though as the NHS seemingly leaves people suffering for ridiculous reasons and amounts of time.

Charlotte x

[Courtney G]

I'm sorry. I'm sorry so many people here in America voted for hate and intolerance and that so many still support it. It paved the way for the cruelest element of humanity to emerge elsewhere and begin to do its evil work.

[Charlotte Kitty ✅]

Yes indeed. Good points. That's exactly how I got my private prescription which arrived on Monday after I ordered it Friday: 3 months of Evorel 100 for £34 including postage and packing. I can live with that. I went down the cis female route on a 'needs must' basis and it all worked fine.

But the refusal to conduct blood testing would be a serious issue and there would be many others in our community who are at a less relatively stable point in their transitioning.

It's awful. Absolutely awful.

xx

You shouldn't need to do this but if you need private blood testing it's about £40 through Randox. Cheapest i could find. I use them as I'm diy. Just an option if you're totally stuck. If you want a discount use support10 as the code!!

[Tills]

You shouldn't need to do this but if you need private blood testing it's about £40 through Randox. Cheapest i could find. I use them as I'm diy. Just an option if you're totally stuck. If you want a discount use support10 as the code!!

That's really helpful Charlotte.Thank you so much.

xx

[Tills]

Hi gals and others,

An UPDATE.

Here is the letter from NHS Nottingham Centre for Transgender Care:

date:  24/2/2026
Date printed: 
 
Private & Confidential
GP/Clinician
Sunny Meed Surgery, Sunny Meed Surgery
15/17 Heathside Road
Woking
GU22 7EY

Dear GP/Clinician

Re:    [Redacted]
Address: [Redacted]


Thank you for your letter dated 18.2.26. In it you request a shared care agreement prior to commencing treatment. As we are a national Centre we are not able to provide specific shared care agreements for each APC region. However, I hope the following is helpful and acceptable to you so we can work together to provide ongoing transgender healthcare for your patient. At the time of writing we are unable to prescribe for patients and cannot administer medication as we are a national centre. These services are currently not commissioned by NHS England.

The expectations from primary care would be:

•   The prescribing of advised hormone therapy under clear direction from the Specialist (which includes the dosage, a change to dosage, dosage frequency and any change to dosage frequency).

•   The undertaking of blood monitoring with advice from the Nottingham Centre for Transgender Health. This will normally include: FBC, LFTs, prolactin, oestradiol, testosterone and SHBG. The conditions under which the bloods should be taken, as well as the timings, will also be indicated. If the blood results are forwarded to us, we will interpret these and advise primary care on any alteration to the treatment regime as required.

•   When the hormone regime is stable and discharge is appropriate we will send out very clear guidance for ongoing treatment after discharge. You will then be responsible for ongoing care. You can re-refer if you have concerns.

•   If you become concerned and make contact with our service, we will advise accordingly.


The expectations from the Nottingham Centre for Transgender Health would be:

•   We will review your patient on a regular basis while they are in the treatment programme at our Centre. We will send documentation from these reviews to you. This will include a review of hormone therapy as well as general wellbeing. It will also include a clear care plan regarding their hormone therapy and any onward steps.

•   We will advise on any monitoring that needs to be undertaken including the specific bloods as well as the time frame.

•   When monitoring bloods results are forwarded to us, we will interpret these and incorporate these into our care plan.

•   We will advise on all aspects of your patient's hormone therapy which will include the specific form, dosage and frequency/dosage interval. We will advise on any changes to this.

•   When your patient has come to the end of her treatment process at the Centre, I will advise on what is required in the future hormone therapy, the monitoring of as well as suggestions to commonly occurring situations.

•   If you have concerns after discharge we will accept a re-referral and/or give advice on what would be necessary as appropriate.

We hope this is acceptable to you and believe that this is very much in keeping with NHS England's guidance as well as the GMC's ethical/good practice in transgender health care.

If you still feel unable to support the care of transgender patients please contact your local ICB to help resolve the issue and ensure care is offered to these NHS patients.

I did try to ring the surgery to discuss this issue with you but was unable to reach reception at a busy time for your team.

Yours sincerely

Dr PA Nathan Bmed.sci.,BM.BS.,DCH.,FRCGP.,MSc
GP transgender health care

[Tills]

And here's my missile to Surrey ICB and APC:

24 February 2026
To: Surrey ICB and Area Prescribing Committee
Surrey Heartlands
&
Dr Mehdi
Sunny Meed Surgery Woking

Ref: [Redacted]
URGENT!

Dear Surrey ICB and Sunny Meed Surgery,

Further to letters of 17th February 2026 copied to yourselves please see the attached letter from NHS Nottingham Centre for Transgender Care, under whose auspices I have been for the past 14 years. During all those years no-one has ever blocked my treatment and refused their guidance.

In the light of their letter setting out their position with regards to my treatment kindly unblock my medication with immediate effect. Specifically this is:

Evorel 100 2x per week. An initial 3-month prescription
Testogel 16.2mg 88 gram 0.2 ml microdose p.d.

Blood tests also need to be within my care plan as per NHS Nottingham's letter

Your attention is drawn to the fact that following a bilateral orchidectomy in 2016 I have no naturally occurring hormones. Failure to unblock my prescription for Evorel 100 would constitute an act of gross negligence resulting in physical, hormonal, and mental ill-health. Should you persist in blocking treatment the matter will be taken further to include legal proceedings against Surrey Heartlands ICB, the Area Prescribing Committee, and Sunny Meed Surgery.

It is to be hoped that you will find a way to discover sense.

Yours sincerely,


[Redacted]

c.c. Dr Mehdi Sunny Meed Surgery

[Tills]

I think we're in a serious situation here. I've been told this policy is being rolled out throughout NHS England.

xx

[Stottie Girl]

That's a good letter you wrote Tills. If you're right about this being rolled out everywhere then there will likely be legal cases coming in to the various trusts in their droves.

I can't quite believe the change in our country over the last year. I thought we were a caring society and were better than this.

Is there any scope to purchase the medication privately then seek redress? Completely dropping to no hormones could be dangerous and definitely bad for your health.

[Charlotte Kitty ✅]

Honestly this doesn't surprise me. I think in reality anything other than physical, immediately life threatening conditions are being completely ignored by the NHS. As a professional employee I know I would have far superior care under a private system. Instead stuck under a system that's breaking down further year after year.

I hope you can sort something...seems like you are well prepared to take them on even though you shouldn't have to!

Charlotte 😻

[Dances With Trees]

It is to be hoped that you will find a way to discover sense.

The epistolary you shared is straight out of Kafka, Orwell, and Heller and would almost be amusing if so much was not at stake. I sincerely hope you get things sorted out to your benefit soon, Tills. And if by some miracle they find a way to discover sense, please share the path with US politicians.

[Tills]

Thanks so much ladies ^^^^ for your excellent posts.

I have a private prescription at the moment but this is a point of principle and I don't really want to operate outside the NHS

xx

[Lori Dee ✅]

this is a point of principle and I don't really want to operate outside the NHS

If no one complains, nothing will change. They will assume that what they are doing is acceptable to everyone. I hope it resolves in your favor, without the legal hassle.