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. 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 or telephone number 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 paediatric services or NHS mental health services for children and young people.

Referrals will 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.

Young people removed from the waiting list due to “ageing out” are advised to seek advice from their GP on the appropriateness of a referral to an adult Gender Dysphoria Clinic (GDC). Should the GP make a referral to the adult GDC, then the original referral date to the children and young people’s service is honoured by the GDC.

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 GDC.

Advice for referrers

Guidance for referrers has been published by NHS England (click here).

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.

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 in WORD format and email are no longer accepted.

The referral form requests the information required to maintain 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. And referrers should provide as much information as possible at the earliest opportunity.

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

• Referrals made without use of the electronic referral form
• Referrals from any source other than NHS paediatric services or NHS mental health services for children and young people.

It is important that all forms of contact details requested for the patient, if 16 and over or the parent/carer are provided. 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 via email to agem.cyp-gnrss@nhs.net and will ensure that we can contact the patient without delay.

Referral portal and guide

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

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 mobile number are required to enable multifactual authentication and all details provided will automatically be included in the referral form.

• 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.

A referrer 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.

If there are any issues with using the portal or the referral form, please agem.cyp-gnrss@nhs.net. If you can screenshot any messages to include in the email and advise what is the issue, we would be grateful.

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 plans are drawn up 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.

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 such cases, 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 puberty suppressing hormones made indefinite

As an outcome of Government legislation, the sale and supply of puberty suppressing hormones (puberty blockers) 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.

Government restrictions on use of puberty suppressing hormones - information for primary care - December 2024

Ban on puberty blockers to be made indefinite on experts’ advice

The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024 (legislation.gov.uk)

NHS England letter: Government restrictions on use of puberty suppressing hormones (puberty blockers): information for primary care

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 or call 0300 131 6775.

Service Specification and Secondary Care Guidance

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

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