Welcome to the home of information about gender services in Wales.
This website has been created to bring you as much information as possible from different places, all under one roof.
The website is provided by XIST, the Gender Information and Support Team from Umbrella Cymru to EMPOWER, INFORM and SUPPORT you through your transition and access to services.
Whether you’re looking for information about health services in Wales, or looking for support with family and social elements of transition, we hope to provide something you’ll find useful.
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What happens at an appointment?
The Welsh Gender Service was first announced by the Health Minister, Vaughan Gething AM in 2017. We are a multidisciplinary administrative and clinical team, and we currently accept referrals for anyone aged 17.5 years or older registered with a GP in Wales.
The Welsh Gender Team (WGT) is based at St David’s in Cardiff with Local Gender Teams (LGT) based in each health board. Your Local Gender Team will be closer to home and is made up of a doctor who prescribes hormone therapies, and a speech and language therapist.
We all work together in order to provide holistic patient-centred care focussing on hormonal, psychological, and social aspects of transition.
When you get referred to the Welsh Gender Service, you'll receive confirmation of your referral date and three forms:
- How we manage your information - Consent Form
- Current Personal Information Form (optional)
- Umbrella Cymru Support Consent Form (optional)
You will need to complete the 'how we manage your information - consent form' and return it to the Cardiff Clinic.
The other two forms are optional. You don't have to complete these if your details haven't changed and you don't want support.
If you do want to provide updated or additional contact details, or wish to access support, you can either complete these and return them with the consent form, or click HERE to update details and request support online.
NOTE: If you complete the online form, you do not need to return the optional paper forms.
Which forms do you need?
If you prefer to fill out the paper forms, rather than the online form above, please complete the following:
If your details have changed, or you would like to provide additional contact information, please complete the 'Current Personal Information Form'.
If you would like Umbrella Cymru to contact you to discuss the support provided by XIST, please complete the 'Umbrella Cymru Support Consent Form'
We will publish the 'current referral month' information on the website, so please keep checking.
This will show the month / year referrals were received for the people currently being offered appointments. This will give you an indication of how far through the waiting list we are.
We endeavour to book appointments 4-6 weeks’ in advance of your appointment date. We will send you a letter (or a text if you have agreed to receive texts) to let you know the date and time of your appointment. If you can’t attend the appointment you need to let us know straight away so that we have time to rearrange it for you and offer this slot to someone else.
Yes. Umbrella Cymru provide support to anyone on the waiting list who wishes to access it. If you have not already been contacted by Umbrella Cymru and would like the team to call you to discuss support options, please complete the request form HERE.
Umbrella Cymru can provide a range of support such as information about the pathway, useful information and links to groups, help with name changes, building confidence and so much more. The team will contact you to discuss what you think would help you now and in the future, and will develop a plan with you to achieve your goals and get the best outcome.
Your appointment invitation will give you all the information you need about what to do before the appointment. This will usually include getting blood tests. We cannot take blood samples at The Cardiff Clinic, so these will need to be taken by your GP. We use the blood test results as a general health check and to establish a baseline for your hormone levels.
Please also have the following items ready for your first appointment:
- A detailed list of any medications that you are taking including those purchased over the counter or through the internet.
- A note of any details that you may need to update eg: GP address, name and telephone number, your address, etc.
- Any official change of name documents, if you have them.
- A note of the clinic telephone number just in case you have any problems on the day and need to get in touch.
Appointments take place during the mornings and afternoons. Clinic appointments are generally booked up in advance and while we do our best to accommodate latecomers, it might not always be possible for us to see you on that day. Do get in touch if you are running late or unable to gain access to the video consultation session so that we can do our best to help you.
We see a variety of people at the clinic with different needs and goals in terms of gender. In order to get to know you better, we ask a number of questions about your background, current circumstances and future plans. The purpose of these questions is to help us gain a clear idea of how we can help you.
Taking initial steps towards changing how you express your identity, sometimes called ‘coming out’ or ‘transition’ can be challenging. This may be due to social stigma, transphobia, fears of rejection or discrimination by family, friends, or cultural and faith groups.
If you would like to, but have not yet made a social gender transition, you might wish to talk through any barriers you’re experiencing and to consider ways to address these. You might wish to discuss the possibility of a referral to our therapeutic services, and other forms of support that you might find helpful.
After each appointment we will write a letter to your GP. If appropriate, and with your consent, we may also send a copy to your Local Gender Team or other key people directly involved in your care. The letter will summarise the content of the appointment and make recommendations for treatment and/or support. You will also receive a printed copy in the post, unless you indicate to us that you would prefer to receive it via email instead. If, having received your letter, you wish to let us know about any inaccuracies, do get in touch so that we can put things right.
In Wales, gamete (sperm/eggs) storage is free in the NHS.
As hormone treatment will potentially reduce fertility, it is better to undertake this before hormones are started. It is important that you carefully consider whether you wish to use this option, and you will be given the opportunity to discuss this with the gender specialist team at your appointment. In the meantime, you can access an informative leaflet HERE.
If you smoke you will be advised to stop altogether, at least three months prior to starting hormones. This is because smoking adds to the risk of blood clot formation associated with oestrogen and to the risk of overproduction of red blood cells that is associated with testosterone.
People who smoke are more likely to experience complications when they have surgery, including poor healing, scarring and tissue loss. Any licensed pharmacological aid to stop smoking is considered safe with hormone therapy, eg: nicotine replacement therapy and Varenicline/Champix.
Advice and support around stopping smoking can be accessed through Help Me Quit 0800 0852219, your GP, and NHS smoking cessation services. More information can be found HERE
The number of appointments depends on a number of factors. Sometimes it might take one appointment, and sometimes it might take more. If you need a follow up appointment, this will be discussed at your initial appointment so you understand why and when this might take pace.
We try where possible to focus the timing and type of follow up appointment around your needs. You might see a different clinician for your follow up appointment. They will review the report of the first clinician and ask for an update of any progress you might have made or any difficulties you might have experienced since your last appointment. The second clinician might not cover exactly the same ground as the first but might instead focus more specifically on issues particular to you and your individual circumstances at that time.
If gender-affirming hormone therapy is one of your transition goals, and after agreement has been reached between you and your gender specialist, a recommendation is usually made to the Local Gender Team (LGT) or to your GP.
The WGS sees patients from all over Wales, so it is not possible for us to prescribe and monitor hormones directly. We depend on your LGT and GP services to do this with our guidance.
If gender-affirming surgery is one of your transition goals, speak with your gender specialist about this. They can refer you to the appropriate surgical team when you fulfil eligibility criteria and are ready to proceed from a health and psychosocial perspective. The criteria we use are NHS-wide and are based upon authoritative clinical guidelines developed with input from people with lived experience.
The WGS can provide first recommendation for surgery at the initial (or follow up) appointment if you meet you the criteria. The clinician can refer you for a second opinion (previously a referral would have been made to London, but this is no longer required in most cases). The clinician you meet with will discuss this at the initial appointment when determining the outcomes you would like to achieve.
Chest reconstruction surgery for trans men and AFAB non-binary people is funded as part of the NHS package of care. Breast augmentation/implantation surgery for trans women and transfeminine people is not available on the NHS, but some people elect to self-fund this procedure. Those who take oestrogen are recommended to wait at least 12 months from first prescription to allow for breast development.
Genital reconstruction surgery is funded as part of the NHS package of care. Being significantly overweight increases your risk of complications during and after surgery, and it may also result in a poor outcome. Many surgeons recommend that people with a BMI of 30 or more should lose weight before having genital surgery. If you are overweight, we can still refer you to a surgeon, so that an individualised discussion of risk and likely outcome can be included in the pre-operative counselling and consent process.
Should you need to get in touch, contact the team by telephone on 029 2183 6612, by email at firstname.lastname@example.org or by post to the address at the bottom of the website.
We appreciate that the transition process can be anxiety provoking and stressful at times, and that waiting times can be frustrating. We do ask that you treat our administrative staff with care and respect. The WGS is a busy NHS service and our team are working to the best of their ability to help you.
If you are unhappy with your care, please contact a member of the Concerns Department on 029 2074 4095 or 029 2074 3301. They will be happy to discuss your concerns with you and pass them on to the relevant department. You can also email their team at email@example.com or download and complete a form HERE