Making a referral

NHS Arden and GEM manage all referrals to NHS Children and Young People’s (CYP) Gender Services on behalf of NHS England and the CYP Gender Service Providers.

Information on how and who can make a referral is below, along with a guide for using the portal. However, if you have a query that you have not been able to find an answer in the information provided then please contact us using the email address at the bottom of the page.

As of 1 December 2024, the commissioned CYP Gender Service providers are:

North-West: Alder Hey Children’s NHS Foundation Trust; and Manchester University NHS Foundation Trust

South-West: University Hospitals Bristol and Weston NHS Foundation Trust

London: Great Ormond Street Hospital for Children NHS Foundation Trust; and Guy’s and St Thomas’ NHS Foundation Trust; and South London and Maudsley NHS Foundation Trust

Who can make a referral?

Referrals for patients from England

Referrals can only be made by NHS CYP mental health or NHS paediatric services for children and young people under the age of 18.

GPs looking to refer a patient will need to refer to one of the above services, dependent on which services are most appropriate for the patient’s needs. Referrals cannot not be accepted from any other source including primary care.

Guidance for secondary care services has been published here.

Referrals for patients from Wales

Referrals of children and young people in Wales will only be accepted if made by Child and Adolescent Mental Health Teams with prior approval from NHS Wales Joint Commissioning Committee.

Who can be referred?

Referrals to the NHS CYP Gender Service can be made for a child or young person who is registered with a GP in England or Wales, and who is showing symptoms of gender incongruence or dysphoria, up to the age of 18.

If a young person who is 17 years and 9 months will not be seen by their 18th birthday, they will be removed from the waiting list due to “ageing out” and advised to seek advice from their GP on the appropriateness of a referral to an Adult Gender Service. Should the GP make a referral to the adult Gender Service, then the original referral date to the children and young people’s service is honoured by the Adult Gender Service.

Therefore, as a practical measure, referrals are discouraged for individuals who are within 3 months of their 18th birthday, and a referral made to an adult Gender Service when they are 18.

Advice for referrers

Guidance for referrers has been published by NHS England.

Please carefully consider the appropriateness of a referral using the guidance before making a referral. Not everyone who identifies with a gender other than their natal sex, or whose gender expression is different from what others might expect of them, will need to be seen by the NHS CYP Gender Service. Please refer to the guidance available in the link above if you are unsure.

The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist. (Cass Review, April 2024)

Referring professionals must discuss the referral with the family / carer of the child / young person to provide detailed referral information and gain their consent.

Clinical responsibility remains with the referrer and the local professional network until the patient is seen by the NHS CYP Gender Service.

Advice on completing the forms

The electronic referral form is available via the portal below. Referrals via email can no longer be accepted for English referrals but they can be accepted if the referrer is in Wales.

The referral form requests both the information required for the NRSS to manage the waiting list, and the information required by the CYP Gender Services. The form asks for details about different aspects of the child or young person’s life -referrers should provide as much information as possible in the relevant sections.

To help us deal efficiently and effectively with referrals, the following referrals will not be accepted:

• Referrals not using the electronic referral form via the portal (except for Wales).
• Referrals from any source other than NHS paediatric services or NHS mental health services for children and young people.

It is important that all methods of contact are provided for the parent/carer patient and for the patient if they are 16 and over. Please advise the patient and their parent/carer that any changes in contact information, legal name, address, or GP Practice should be notified to us by them whilst they are waiting to be seen. This can be done online by the patient or parent at Change Your Contact Details, or via email to agem.cyp-gnrss@nhs.net to ensure that we can contact the patient without delay.

Referral portal and guide

Please read the electronical referral form guide before using the system.

Referral Form Guide (PDF, opens in a new tab)

It is necessary to complete all the requested information to start the process and receive a link to complete the form. The referrer’s email address and a work or personal mobile number are required to enable multifactual authentication. The mobile number shared for authentication can be updated to a landline number if required after the authentication process.

• The individual/referrers email address to receive the link to fill out the form.
• The individual/referrers mobile telephone number
• Patient’s NHS Number
• Patient’s First Name
• Patient Surname
• Patient’s DOB

This will enable the portal to check the referrer’s email address to confirm that it is an NHS digital email address.

Referrers from the CYP mental health or Paediatric teams will need to have an nhs.net or nhs.uk email address to be able to submit the information. A mobile number is also required for the authentication process to receive a numeric code. The mobile number can be changed on the form before it is submitted if a personal mobile is used.

Portal – please click the following link CYP Gender Service Referral Form Platform (opens in a new tab) or

If there are any issues with using the portal or the referral form, please email agem.cyp-gnrss@nhs.net. To help us understand what issue you are experiencing, please can you send a screenshot of the error message and detail the problem in the email.

Risk and safety

Children and young people experiencing gender incongruence or gender dysphoria can be particularly vulnerable and may experience a higher incidence of co-occurring mental health issues or adverse childhood experiences. At present there are long waiting times for the NHS Children and Young People’s Gender Services, and children, young people and their families may require support while they wait. It is strongly recommended that holistic and patient centred treatment plans are co-developed by the referrer and local professional network to ensure the needs of the young person are being met in the interim and that this is clearly communicated on the referral form.

An immediate pause on children or young person aged 16 -17 being initiated onto masculinising or feminising hormones by the specialist Children and Young People’s Gender Service was announced on Monday 9th March 2026.

This decision has been taken in response to the completion of extensive independent evidence reviews in relation to safety, risks, benefits and outcomes of this treatment.

More information on the evidence reviews can be found here https://www.england.nhs.uk/publication/consultation-feminising-and-masculinising-medicines-in-the-management-of-gender-incongruence-in-children-and-young-people-evidence-reviews/

The NHS had already placed restrictions on the prescribing of these medications, following the recommendations of the final Cass Report in 2024. Individuals would only be considered for these medications in cases where 'extreme caution' had been applied to clinical decision making, and where a national MDT had endorsed the recommendation for referral to an endocrinology team.

A 90-day consultation on a new draft policy has also been launched on Monday 9th March. More information on the consultation can be found here https://www.engage.england.nhs.uk/consultation/prescribing-masculinising-and-feminising-hormones/

We understand the uncertainty and anxiety that this action may cause if it was your expectation that you (or your child) would be referred to an endocrinology team for consideration of masculinising or feminising hormones.

The pause on the initiation of new prescriptions does not affect individuals who are already receiving NHS prescriptions for these medications. In these cases, prescribing may continue under the clinical supervision of an NHS-commissioned gender service.

All information regarding the latest advice from NHS England regarding hormones and the ban on puberty suppressing hormones can be found in the FAQ section of the website.

Children, young people, and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies.

In cases where CYP are accessing unregulated medicines, GPs and local health professionals are advised to consider what safeguarding protocols may be appropriate for the individual child or young person’s wider circumstances including the extent to which the parents / carers are able to protect or safeguard the child or young person. Safeguarding procedures may be necessary regardless of the endeavours and best intentions of the parents / carers in reducing risk of harm. Safeguarding protocols should be initiated immediately where the child or young person is at risk of immediate, serious harm. It would also be important for the GP or local health professional to explore what regulatory bodies may need to be informed if healthcare professionals registered with a UK professional body are prescribing medication contrary to NHS protocols.

Government ban on gonadotrophin-releasing hormone (GnRH) analogues (puberty suppressing hormones) made indefinite

As an outcome of Government legislation, the sale and supply of GnRH analogues to young people under 18 as a treatment option for gender incongruence, including through private prescription, is banned. Possession in breach of the ban is a criminal offence.

Information can be found at the bottom of the FAQ page Frequently Asked Questions

Contact us

If you have a query regarding referring a child/young person that still hasn’t been answered in the information above, please contact us by email at agem.cyp-gnrss@nhs.net.

Service Specification and Secondary Care Guidance

Helpful information is included below with guidance to CYPMH and Paediatric services regarding the support required for children and young people and gender.

Referral guidance for mental health and paediatric services (published alongside the CYP Gender referral pathway specification)

CYPMH guidance documents

Paediatrics guidance documents

Further guidance for healthcare professionals

RCGP: Transgender Care

RCPsych: Supporting transgender and gender-diverse people

BPS: Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity

NSPCC: Gender identity; Advice to help you understand what gender identity is and how to support a child

MindEd: Catalogue of resources

Primary Care Guidance; Referring and Prescribing for Children and Young People’s Gender Care

A Patient Safety Investigation (PSI) was launched following concerns about inappropriate prescribing of hormone medicines to children and young people under 18 for gender incongruence. The investigation identified the need to strengthen compliance with the nationally commissioned specialist gender service pathway and to clarify expectations for prescribing practice.

This guidance explains the current arrangements for gender care for children and young people and clarifies the role of Primary Care within the specialist pathway. The PSI also highlighted areas of more general good medical practice; we are taking the opportunity to share these with you by way of a reminder.

Primary Care Prescribing Guidance for Gender Care in Children and Young People (under 18 yrs)

Key prescribing message

• Medical intervention is not the standard approach in the NHS for children and young people under 18 with gender incongruence.
• Primary Care clinicians should not initiate prescribing for gender incongruence in children and young people under 18 unless this is explicitly requested within an NHS pathway and supported by appropriate specialist governance. Such requests are likely to be rare.
• NHS England’s Children and Young People’s Gender Service provides specialist assessment and care through a multidisciplinary model, with psychosocial and psychological support as the core intervention.
• Puberty-suppressing hormones (GnRH analogues) are subject to national restrictions and are not routinely available through the NHS outside of a clinical trial. Primary Care clinicians should not support new private prescribing or shared care requests from unregulated providers for these medicines.
• The NHS has paused initiating new prescriptions for masculinising and feminising hormones to children and young people under 18 years while it concludes a process of consultation on proposals to prevent their routine use in the future.
• Primary Care clinicians should also refuse requests from unregulated providers to prescribe alternative puberty-suppressing medicines or masculinising and feminising hormones for under-18s.
• Where there is safety concerns about medicines obtained from unregulated sources, safeguarding and appropriate clinical review should be considered.

The referral process for the Children and Young People’s Gender Service is outlined in the National Referral Support Service for CYP with Gender Incongruence. The pathway is set out below, step by step.

Children & Young People Gender Service (under 18 years of age) – Referral Pathway (Simplified Steps)

1. First contact (usually Primary Care)
   • Child/young person typically presents via GP/primary care – can be any age
   • Primary care:
     • Identifies possible gender incongruence and any co-existing needs
     • Discusses concerns with child and parent/carer
     • The initial face to face consultation should make an initial assessment including record of any relevant PMH, comorbidities and assessment of family context.

     Discussions with a child or young person and their parent/carer should support informed, shared decision making, using a variety of resources and different communication methods appropriate to the child’s developmental age and neurodiversity.

   • Possible outcomes at this stage:
     • No referral (monitor/support in primary care)
     • GP refers either to:
       • CYP Mental Health Services (CYPMHS) if there are existing concerns about the child’s mental health.
       • Paediatric services for young people who meet access criteria for paediatrics including relating to neurodevelopmental/autism needs.
2. Assessment in Secondary Care

   Referral progresses into secondary services (not directly to the specialist service).

   A. CYP Mental Health Services (CYPMHS)

   • Assess:
     • Mental health needs
     • Wider/holistic needs
     • Degree of gender-related distress
   • Consider neurodevelopmental referral where appropriate
   • Complete referral form to specialist gender service
   
   

   B. Paediatric Services (if no significant mental health need)

   • Assess gender-related distress (not diagnosing)
   • Complete referral form to specialist gender service
   
   

   Key decision:

   • Shared decision (clinician + child + family) on referral to specialist service
3. Referral to National Referral Support Service (NRSS)
   • If appropriate, secondary care makes referral to NRSS (not directly to specialist service)
   • Referral must come from a registered clinician within:
     • CYPMHS, or
     • Paediatric services
     • Submitted via digital national referral form
4. NRSS Review and Waiting List Management
   • NRSS is a non-clinical service that holds and manages referrals
     • Optional but recommended:
       • Completion of a Gender Experience Summary (GES) by the young person / family
   • NRSS actions:
     • Stores referral and GES information
     • Reviews referral for completeness
     • Updates demographic information
     • Communicates receipt of referral with family and referrer
   • Possible outcomes:
     • Added to specialist service waiting list (using date of referral by GP to secondary care)
     • Added, but more information requested
     • Not added (insufficient information or referral made to incorrect service) – referrer informed
5. Waiting List Phase
   • CYP remains on national waiting list held by NRSS
   • Ongoing monitoring remains the responsibility of the GP until they are accepted by the specialist service. Individual care plans may be in place as appropriate through paediatric or CYPMH services.
   • NRSS:
     • Maintains contact and information – patients contact NRSS via email, website updated regularly for patients. Key information would be sent out to whole waiting list by their preferred contact route.
     • Monitors data and waiting times
   • Young people who are approaching their 18th birthday will be removed from the national waiting list, and advised to consult with their GP regarding a referral to an NHS Adult Gender Service. If such a referral is made, the adult service will honour the referral date to the CYP waiting list.
6. Transfer to Specialist Service
   • When a patient approaches the top of the waiting list:
     • NRSS:
       • Makes contact with the young person or parent/carer to confirm if they still require/want care
       • Updates any other information (e.g. GES)
     • Young person allocated:
       • Based on chronological order on waiting list
       • Allocated to nearest regional service (currently operational: North-West (Warrington); East England (Cambridge); South-West (Bristol); and London.
     • Provider receives patient related information in advance (approx. 3 months) of first appointment.
7. Specialist Service Assessment
   • Clinical service takes over responsibility
   • First assessment carried out
   • Patient is then closed on NRSS system once seen

Safe prescribing and shared care for children and young people under the care of the specialist gender service

• A request by a specialised NHS CYP Gender Service for a prescribing arrangement is likely to be rare outside of a clinical trial.
• Any prescribing arrangement should follow national principles for safe prescribing and shared care.
• The prescriber must confirm that a child/young person has voluntarily agreed to consent to treatment having considered capacity to consent.
• Shared care is not mandatory and should only be entered into where responsibilities are explicit, communication is timely, and the clinician is satisfied that the arrangement is clinically appropriate and safe.
• The role and scope of non-medical prescribers in Primary care must be clear, regularly reviewed, and limited to their competence, with specialist advice or referrals sought when necessary.

Records, coding and roles and responsibilities

• Practices should maintain clear, accurate and contemporaneous records of all discussions, prescribing decisions, specialist advice received, consent discussions, safeguarding considerations, and follow-up actions.
• Records should include the rationale for any decision not to prescribe, particularly where requests come from private or unregulated providers.
• Coding should be accurate and consistent with local and national standards.
• Practices should ensure that correspondence from specialist services is filed promptly and in a way that it can be acted upon appropriately.
• Recording keeping must be in line with professional guidance. Risk assessments should be securely saved into patient records.
• All GP practices must ensure that the role and remit of non professionally regulated staff is clear and monitored.

References

1. NHS England. Service specification: NHS Children and Young People’s Gender Service. Published 1 April 2026.
2. NHS England Clinical Policy for Puberty Suppressing Hormones, March 2024
3. NHS England Clinical Policy: Prescribing of masculinising and feminising hormones for children and adolescents who have gender incongruence or dysphoria – public consultation guide, March 2026
4. NHS England. Updated guidance to primary care about unregulated providers who supply hormone medications to children and young people for gender incongruence. March 2026.
5. The Royal College of General Practitioners. Position Statement: The role of GPs in transgender care. March 2025
6. NICE. Shared decision making (NG197). 2021.
7. General Medical Council. Good practice in proposing, prescribing, providing and managing medicines and devices. 2021 (updated 2024).
8. NHS England. Shared Care Protocols and Responsibility for prescribing between primary and secondary/tertiary care.
9. Royal Pharmaceutical Society's "A Competency Framework for all Prescribers" (updated 2021).
10. Royal College of Paediatrics and Child Health. Guidance for clinicians working with gender diverse children and young people. Published 2025.

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