Bridging Hormones

Karis Medical Centre Policy on the Prescription of “Bridging Hormones” Whilst Awaiting Specialist Review in a Gender Identity Clinic

We have had an increasing number of enquiries from patients about the prescribing and monitoring of hormone therapy whilst awaiting specialist assessment, in particular “bridging hormones”. We recognise that there is currently inadequate provision for patients with waiting times in excess of 24 months for initial NHS appointments. However, it is our practice policy that confirmation of diagnosis and commencement of initial hormonal treatment for gender incongruence should be made by a specialist gender identity service in all cases.

Please note that from 1st December 2024 we are no longer able to enter into new shared care agreements with private specialists. This means that we will no longer be able to prescribe or monitor treatments initiated by a private specialists. Please see the shared care agreement section of our website for more detail.

We recognise there is guidance from the Royal College of Psychiatrists and other organisations that GPs may prescribe ‘bridging’ endocrine treatments as part of a holding and harm reduction strategy while the patient awaits specialised endocrinology or other gender identity treatment” particularly if patients are already taking hormones from illicit sources. However, we are not experienced in initiating hormonal treatments for gender dysphoria and do not feel able to provide “bridging hormones” safely in any circumstance, including undertaking the monitoring of these hormones.

Unfortunately, the appropriate support is just not currently available for us to do this. It should be recognised that all the NHS gender identity clinics only initiate hormonal treatment after a number of investigations and input from a specialist team of psychiatrists, endocrinologists, and psychologists. This includes counselling on the side effects and potential long term risks of hormonal treatment. It is not realistic that the same level of support could safely be provided within our practice.