Gender identity guidance


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  • All NHS Highland
  • Primary and Secondary Care
  • Adults and Paediatrics

This is interim guidance while awaiting the national Gender Recognition Protocol to be published later this year.


The 2012 National Gender Reassignment Protocol (GRP) (see resources) is currently being updated. See NHS Gender Idendity services: strategic action framework 2022-2024 for more information (see resources). 
When this protocol is published further guidance for NHS Highland will be given.

Referral process

The Gender Identity Clinic (within Highland Sexual Health) sees any adult patients with gender incongruence.

  • Patients 17 and over: refer via SCI Gateway to the Gender Identity Clinic.
  • Patients under 17: refer via SCI Gateway to the Gender Identity Clinic.
    The Gender Identity Clinic are unable to see patients under 18. However, it will manage the onward referral to the Young Persons Service at the Sandyford clinic and provide the patient with useful '16 and under' patient waiting list information. 


  1. Patient is assessed at the Gender Identity Clinic, including a psychological assessment.
  2. Gender Identity Clinic performs blood tests, initiates any necessary treatment(s) and makes onward referral(s), as appropriate. 
  3. Gender Identity Clinic liaises with primary care for ongoing management of the patient. 

For further information on the provision of feminising and masculinising gender affirming hormone treatment for transgender, non binary and gender diverse (TGD) people see: Endocrine and fertility preservation guidance (National Gender Identity Clinical Network for Scotland) (see resources). 

This may be useful for those situations where primary care prescribers are asked to continue the management of patients who have sought treatment in the private sector. The decision whether to continue management of these patients is the responsibility of the prescribing clinician but further advice can be sought from the Gender Identity Clinic, eg Clinical Dialogue. If appropriate, these patients can be referred to the Gender Identity Clinic as per standard process. 

Related resources

Patient information 

Last reviewed: 27 April 2023

Next review: 29 February 2024

Author(s): Highland Sexual Health

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer Name(s): Fiona Gibson, Lead Clinician, Gender Service

Document Id: TAM564