This Section is designed for healthcare professionals and GP Practice staff.

For public information, please visit the Brighton and Hove CCG public home page.

Available Treatments - Adults

Guide To Supporting Patients Accessing Specialist Gender Identity Services

Section 4.4

In addition to mental health support, electrolysis and speech and language therapy, the bio-medical treatments available can be divided into two categories: administration of cross-sex hormones and surgical procedures. Detailed guidance on the hormonal treatment regime is available in Appendices 2 and 3 of the Royal College of Psychiatrists (RCP) Good Practice Guidelines.

Please see the table below for the surgical procedures available via the NHS in England. Not all patients will undergo all procedures and will be referred in accordance with their treatment plan. However, according to the NHS England guidance (p.19), all patients with a uterus receiving long-term testosterone therapy will be offered hysterectomy and bilateral salpingo-oophorectomy, and are strongly recommended to undergo this after receiving continuous testosterone therapy after 2-5 years due to increased risk of endometrial hyperplasia and malignancy.

In addition to the ‘core’ surgical procedures available, the following can be sought through special application to the patient’s Clinical Commissioning Group (CCG).

  • Breast augmentation (augmentation mammoplasty)
  • Facial Feminisation Surgery (FFS) Treatments including: Thyroid chondroplasty/Tracheal shave (reducing size of larynx), Rhinoplasty, Facial bone reduction, Blepharoplasty/Facelift
  • Lipoplasty: Contouring liposuction and/or body sculpture
  • Gamete storage using similar protocols as with those receiving radiotherapy and other gamete damaging procedures.


Introduction Guide Home Page
Section 1.0 About This Guide
Section 1.1 Why This Guide Is Needed
Section 1.2 Current Context
Section 2.0 Developing Understanding About Trans People
Section 2.1 New Thinking About Gender
Section 2.2 About Trans Identities
Section 2.3 About Gender Pronouns
Section 3.0 High Quality Services for Trans People
Section 3.1 Getting It Right
Section 3.2 A Special Note on Children and Young People
Section 3.3 A Special Note on Screening: Screen for the Organs Present
Section 4.0 Understanding the Patient Groups
Section 4.1 Understanding Specialist Gender Identity Services
Section 4.2 The Approach to Treatment
Section 4.3 Treatment Protocols
Section 4.4 Available Treatments - Adults
Section 4.5 Available Treatments - Children and Young People
Section 4.6 The Role of the GP
Section 5.0 Changing NHS Records
Section 5.1 Information Sharing - The Gender Recognition Act 2004
Section 5.2 Medical Reports
Section 6.0 Supporting Patients
Section 6.1 Sources of Information and Support
Section 7.0 Glossary

Surgical Treatments Available: Male to Female (MtF)

  • ​Penectomy (removal of the penis)
  • Bilateral orchidectomy (removal of the testes)
  • Vaginoplasty (creation of the vagina)
  • Clitoroplasty & Labiaplasty (creation of clitoris and labia).

Source: Interim NHS England Gender Dysphoria Protocol and Guideline 2013/14

Surgical Treatments Available: Female to Male (FtM)


  • Bi-lateral mastectomy (removal of breasts) and chest reconstruction 
  • Hysterectomy (removal of uterus) 
  • Vaginectomy (removal of vagina) 
  • Salpingo-oophorectomy (removal of ovaries and Fallopian tubes) 
  • Metoidoplasty (creation of micropenis) 
  • Phalloplasty (creation of a penis from using skin and muscle tissue from another site, e.g. abdomen, forearm or thigh) 
  • Urethoplasty (creation/join-up of urethra)
  • Scrotoplasty (creation of scrotum) 
  • Placement of an appropriate penile prosthesis (inflatable or malleable) 
  • Placement of testicular prostheses 
  • Subsequent specialist surgery to restore urinary or sexual function, if clinically indicated.

Source: Interim NHS England Gender Dysphoria Protocol and Guideline 2013/14