Gender identity guidance (Guidelines)



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

This is interim guidance while awaiting the national Trans Healthcare protocol to be published later this year.


The 2012 National Gender Reassignment Protocol (GRP) is currently being updated. See NHS Gender Identity 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 waiting list information. 


Patient is assessed at the Gender Identity Clinic.

  1. Gender Identity Clinic makes onward referral for psychological assessment.
  2. 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 (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 through Clinical Dialogue as this is how we like to receive any queries. If appropriate, these patients can be referred to the Gender Identity Clinic as per standard process. 

Timings for blood tests are also detailed in the Endocrine and Fertility Preservation Guidance.  

Editorial Information

Last reviewed: 27/04/2023

Next review date: 28/02/2025

Author(s): Sexual Health Department .

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr F Gibson, Lead Clinician, Gender Service.

Document Id: TAM564

Related resources

Further information for Health Care Professionals


Patient information