Integrated Health Care Prescribing Committee BLOCKS transgender Hormones

[Susan ✅]

In the US we can use LabCorp and self-pay if you really have to. In the UK you actually have several private blood testing options available that don't require NHS or GP involvement at all:

Randox Health – Charlotte already mentioned them upthread, and they have 40+ clinic locations across the UK and Ireland. No GP referral needed. They offer comprehensive panels that include oestradiol, testosterone, SHBG, prolactin, liver function, and FBC — basically everything Nottingham's letter specifies for monitoring. Charlotte's tip about the discount code is worth noting. Their home test kits start from around £21-69, while in-clinic health check packages start higher at £139+.

Medichecks – Another well-established option that offers both home finger-prick kits mailed to you and venous draw appointments at partner clinics nationwide. They have hormone panels covering the same biomarkers. The Gender Hormone Clinic specifically recommends their TRT Check Plus panel for trans patients. Important note: if you're on any gel-based hormones, they recommend venous draw over finger-prick to avoid contamination from residue on your hands.

Lola Health – A newer service that also offers home visits from a phlebotomist, which is convenient if clinic access is difficult.

For our London-based members, 56 Dean Street runs 56T, a dedicated trans and non-binary sexual health and wellbeing service every Wednesday (4:30-7pm, Level 2, appointment only) that includes hormone blood testing and injection services.

CliniQ at King's College Hospital runs a similar holistic service for trans and non-binary people every Tuesday (4:00-6:30pm, Caldecot Centre, by appointment). Both are primarily sexual health services but include hormone level monitoring as part of their care.

The results from any of these can be sent to your specialist — Nottingham's letter specifically says they'll interpret blood results forwarded to them and adjust the care plan accordingly.

None of this should be necessary. The fact that the NHS is blocking routine blood monitoring for established patients is genuinely dangerous, especially for people who are post-orchiectomy or oophorectomy, and have no endogenous hormone production.

At least these options exist as a stopgap while the bureaucratic battle plays out.

[Tills]

Thanks so much @Susan for your brilliant post. What a great resource this is.

It's so good to know that there are these options because for a while I felt abandoned. And if I feel that, how must so many others be faring under this cloud? This forum is a lifeline.

Which reminds me that a donation will be on its way. I have finally set up a new paypal account.

[Sarah B ✅]

Hi Tills

You said this:

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.

A thousand times this ^^^^^.

That paragraph alone clearly establishes medical dependency, foreseeable harm and liability.

Denying medically required treatment, regardless of background, does constitute gross negligence.  Once they are formally notified of harm risk, continued obstruction becomes indefensible.  At that point it is no longer "policy", it is failure of duty of care.

Legal pressure is unfortunately the only mechanism that reliably breaks these gate keeping practices.  If more people document harm and pursue action individually, it creates a pattern they cannot ignore.

I am genuinely surprised there is a so-called "gender care plan" involved at all.  This is basic endocrine replacement following orchidectomy.  That should sit squarely with your GP and standard NHS prescribing responsibilities.

Stay firm.  You are entirely justified.  Also, make sure everything stays in writing.

Ask each body for written justification of any refusal, including the clinical basis, the named decision maker and the policy being relied upon.  Request copies of all correspondence between the ICB, prescribing committee and surgery.

That paper trail matters if escalation becomes necessary.

This also applies to the "American system".  In other words;  "you must have standing".

Best Wishes Always
Sarah B
Global Moderator
@Tills

[Stottie Girl]

In the US we can use LabCorp and self-pay if you really have to. In the UK you actually have several private blood testing options available that don't require NHS or GP involvement at all:

Randox Health – Charlotte already mentioned them upthread, and they have 40+ clinic locations across the UK and Ireland. No GP referral needed. They offer comprehensive panels that include oestradiol, testosterone, SHBG, prolactin, liver function, and FBC — basically everything Nottingham's letter specifies for monitoring. Charlotte's tip about the discount code is worth noting. Their home test kits start from around £21-69, while in-clinic health check packages start higher at £139+.

Medichecks – Another well-established option that offers both home finger-prick kits mailed to you and venous draw appointments at partner clinics nationwide. They have hormone panels covering the same biomarkers. The Gender Hormone Clinic specifically recommends their TRT Check Plus panel for trans patients. Important note: if you're on any gel-based hormones, they recommend venous draw over finger-prick to avoid contamination from residue on your hands.

Lola Health – A newer service that also offers home visits from a phlebotomist, which is convenient if clinic access is difficult.

For our London-based members, 56 Dean Street runs 56T, a dedicated trans and non-binary sexual health and wellbeing service every Wednesday (4:30-7pm, Level 2, appointment only) that includes hormone blood testing and injection services.

CliniQ at King's College Hospital runs a similar holistic service for trans and non-binary people every Tuesday (4:00-6:30pm, Caldecot Centre, by appointment). Both are primarily sexual health services but include hormone level monitoring as part of their care.

The results from any of these can be sent to your specialist — Nottingham's letter specifically says they'll interpret blood results forwarded to them and adjust the care plan accordingly.

None of this should be necessary. The fact that the NHS is blocking routine blood monitoring for established patients is genuinely dangerous, especially for people who are post-orchiectomy or oophorectomy, and have no endogenous hormone production.

At least these options exist as a stopgap while the bureaucratic battle plays out.

Wow, Excellent information there Susan! Thank you!

[Tills]

Thanks again ladies for your further comments, superb insights, and helpful guidance. From which you'll also see @Sarah B that I am a lover of the Oxford comma so if quoting me directly, please leave my passion intact Seriously though, the replies to this thread have been so brilliant. I need this forum. Had you not been here, and had I not been in a better place, something like this event might have tipped me over the edge. I fear for vulnerable others.

Anyway, there has been an update. My surgery have now issued a Collaborative Care Protocol to sign. In fact, it has come from Nottingham. I'm sure that somewhere within the system there are those who have convinced themselves that all of this was necessary and protective, even though I have been on estrogen for 14 years, the last 12 of which have been within the NHS.

I'll post the link in case it works and it case it is of interest.

From the surgery:

Could you kindly read through and sign the form on the attached link

https://www.nottsapc.nhs.uk/media/qaafcl52/feminising-hormones-information-sheet.pdf?UNLID=8732158592026225162944 🔗

We have also sent a form to the clinic to sign to accept the terms of collaborative care protocol, as it is an Amber drug.

Once we have received yours and the clinic's signed form back, we can prescribe under shared care

Kind regards

On behalf of Sunny Meed Surgery

[Tills]

p.s Methinks the the word "care" trips too easily off their tongues ...

[Sarah B ✅]

Hi Tills

I must humbly apologise for the removal of your Oxford comma before the word "and" in your quote.  There is no way that I would ever intentionally alter someones post.  I faithfully copied the quote into my reply and as I check my reply I use a macro called "Clean_Up_Document" and as you can guess it removed all traces of a comma before the word "and".

I was not thinking of the implications when I ran the macro and the effect it would have on a quote.

As you can guess I do not like a comma before the word "and" and when cut and pasting into my documents from various sources, there is that ubiquitous comma before the word "and", hence my macro that removes them one and all.

Once again I must profusely apologise to you for my inherent behaviour.

Best Wishes Always
Sarah B
Global Moderator
PS Do not allow any administrative obstruction to compromise your health.  Your health matters.
@Tills

[Tills]

Hi Tills

I must humbly apologise for the removal of your Oxford comma before the word "and" in your quote.  There is no way that I would ever intentionally alter someones post.  I faithfully copied the quote into my reply and as I check my reply I use a macro called "Clean_Up_Document" and as you can guess it removed all traces of a comma before the word "and".

I was not thinking of the implications when I ran the macro and the effect it would have on a quote.

As you can guess I do not like a comma before the word "and" and when cut and pasting into my documents from various sources, there is that ubiquitous comma before the word "and", hence my macro that removes them one and all.

Once again I must profusely apologise to you for my inherent behaviour.

Best Wishes Always
Sarah B
Global Moderator
PS Do not allow any administrative obstruction to compromise your health.  Your health matters.
@Tills

That's so sweet Sarah, very kind, and truly not something we should be fussing over. I was being a little playful. It's a running joke in my family as both my daughter and I like the Oxford comma. Our Alma mater has left its stamp. The whole 'Eats, Shoots & Leaves' thing amuses me, grammar fascists less so. When a previous Secretary of State for Health dictated that Oxford commas must be removed from all NHS documents, I ensured I inserted them everywhere All of this is reminding me of Jonathan Swift's description of arguments about which end to crack open an egg. Thank you though.

On much more serious and important matters, I feel like a breakthrough occurred. But I still feel as if I've been treated like a naughty schoolgirl. I am sure somewhere they must feel that they have been protective but isn't that a most loaded word?

xx

[Lori Dee ✅]

I support the Oxford Comma, and Grammarly agrees with me!
Long live the Oxford Comma.

[Sarah B ✅]

Hi Tills

Thank you for your response to the comma "issue".  I genuinely did notice the glint of playfulness in your earlier comment.  The egg analogy sealed it.  No feathers ruffled here.

My apology was really about clarity for everyone reading.  I wanted it unmistakably clear that I do not alter members' words in quotes unless moderation genuinely requires it.  A macro on autopilot is one thing.  Quietly editing someone's prose is quite another.

As to the brave interloper and supporter of the "Oxford comma" invoking Grammarly as a higher authority, I feel duty bound to escalate matters.  The comma before the word "and" should not be shown the door.  It should be ceremoniously launched into orbit without a space suit.  Grammarly does not speak English or even for me.  It speaks American, which is a bold re-imagining of the English language carried out with great enthusiasm, minimal supervision, no spelling sense and certainly no grammar sense in the world.

So rather than "Long live the Oxford comma", I respectfully submit:  May the Oxford comma be catapulted into the Pacific Ocean where it can contemplate its choices.

All said with a gleeful smile.

Best Wishes Always
Sarah B
Global Moderator
@Tills @Lori Dee

[Tills]

Hi Tills

Thank you for your response to the comma "issue".  I genuinely did notice the glint of playfulness in your earlier comment.  The egg analogy sealed it.  No feathers ruffled here.

[...]
All said with a gleeful smile.

Best Wishes Always
Sarah B
Global Moderator
@Tills @Lori Dee

🤣 Nice one

I really dislike the ambiguities generated by the absent comma.

However, although I don't 'own' this thread maybe we can leave it there respectfully to agree to disagree with one another on commas and return on topic.

Still no resolution from my GP surgery. Their pharmacist is waiting for the signed form from Nottingham before he/she will permit the prescription to be released.

It all feels incredibly gatekeepery and a hell of a palaver. If they put everyone of our community through this it's going to cause such damage, as well as add layers of bureaucracy.

xx

[Tills]

Well Surrey Heartlands have written to let me know that they still have not received the signed protocol from Nottingham Centre for Transgender Health. I don't know why, but I suspect Notts are double checking that they want to get dragged into this potentially litigious bureaucratic quagmire.

It's completely absurd.

I am losing my rag with Surrey over this. I've written to Notts with a copy to the Surrey top brass and my surgery.

xx

[Tills]

Dear Notts Centre for Transgender Care,

I have heard today from Surrey Heartlands that neither they nor my surgery at Sunny Meed Woking have yet received your signed protocol.

Without this they are continuing to refuse my treatment. They are doing this under the spurious pretext of my safety: which is of course nonsense but they are an intransigent block. Putting patients Last would be the most appropriate description for Surrey Heartless and my surgery.

Can you please let these bureaucrats know that either a) you are signing the agreement or b) you will agree to adhere to your own Terms within the document (even more absurd, I am sure you will agree!).

Just for your information, I began your advised dose of Evorel 100 2 x per week on January 30th as I am certainly not taking any notice of Surrey's transphobic gatekeeping. But I would prefer to come back under the NHS please, as the blood testing and monitoring is important and I don't see why I should have to pay privately when I've been under your sensible and safe auspices for 12 years. Your knowledge in these matters is of course a thousand times more extensive than all the medics in Surrey combined ... but there's seemingly no telling them.

yours, Tilly

[Tills]

A senior Doctor at Nottingham Centre for Transgender Health phoned me this afternoon.

Notts are tearing their hair out about this. They have several hundred different patients and this is happening with 3 or 4 different Health Authorities, of whom Surrey are one. It's basically a deliberate Anti-Trans block on hormone treatment. Up until now, GP surgeries accepted the lead advisory from the Transgender centres and prescribed relevant medications and conducted blood tests, feeding back the info to the centres.

When I said to him, 'What do I do?' his response was, 'Move to Brighton.'

The good part is that I was able to tell him that I am now obtaining my meds privately and was able to confirm to him that I'm on Evorel 100 as they advised. I'm a fairly robust person at the moment and won't be pushed around by bureaucrats. But many of our community are vulnerable people and it's deeply unsettling.

The situation is an absolute shambles and absolutely disgraceful. It clearly traces back to that odious anti-Trans wretch Wes Streeting. This Labour Government are failing all vulnerable groups. We are being turned into pariahs.

[Charlotte Kitty ✅]

I'm seriously worried about the rate at which trans people are being attacked both in the UK and USA. At this rate there will be nothing left in a few years. But how do we fight this? As minorities and no one else really caring? Call me pessimistic but I don't see anything getting better in this world ever now. I honestly think humanity is on its way out. It starts with the minorities first until its each for their own.

Charlotte 😻

[Stottie Girl]

I'm seriously worried about the rate at which trans people are being attacked both in the UK and USA. At this rate there will be nothing left in a few years. But how do we fight this? As minorities and no one else really caring? Call me pessimistic but I don't see anything getting better in this world ever now. I honestly think humanity is on its way out. It starts with the minorities first until its each for their own.

Charlotte 😻

Going to courts is how we fight back I think Charlotte, it's becoming a violation of human rights now. Unfortunately, not many trans people have funds spare to fight the government or NHS trusts in court due to all the other expenses.

Tills - it is clear by now that there is nothing labour about this and previous labour governments. They don't care about minorities, they are bringing in policies that infringe on human rights, they can't even define what a working man is let alone represent them! They need to be ousted but who is available to fill the void? Farage looks to be next in line which is frankly terrifying. I honestly think only the greens in England have socialist leaning policies now. The SNP in Scotland too of course but I can't vote for them due to geography.

I said I wasn't going to post on political matters anymore but this takes the biscuit😡😡

To quote private Fraser "We're all doomed"!

[Tills]

Thanks so much ladies ^^^ and I totally agree.

The doctor this afternoon used the word 'negligent' for Surrey Area Health Authority's new transgender policy. Medical professionals don't use that word lightly.

[Tills]

There's someone on the support admin staff at my GP surgery with whom I interact by email. I've always stayed polite with her because she's caught in the crossfire and I can tell that she doesn't agree with the Surrey Health Authority's anti-trans block.

Last evening she sent me a lovely message:

'Although we have not met face to face, my interactions with you have always been so pleasant. I want to help you as much as I can, and help I will.

Have a good evening and I will be in contact tomorrow.

Kindest regards'

I'm posting this because although things may seem bleak there are always good people around. There's light in the midst of darkness.

xx

[ChrissyRyan]

Yes there are good people around.

We must not hate people, we must love people.

How does one treat people you love?  With much kindness and consideration.


Chrissy

[Stottie Girl]

When it sounds like it is so widespread I'm surprised the media haven't picked up on it. Surely people can blow the whistle annonymously these days. Maybe they have and the media doesn't care.

It does make for depressing reading but as you say there are good people caught up in this. I doubt it is the medical professionals denying care as the medical evidence of gender disphoria and maintaing correct hormone balance for health is concrete. It has to be the management class at it again looking to save cash or finding a convenient way to get us off their books. It is these people, along with politicians, who are the real cause for the failings of the NHS. I think there should be a root and branch clearout and reduction in number of these people.

Probably won't happen but I can dream.