Toolkit
Navigating trans+ healthcare pathways in England
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Getting a bridging prescription from your GP
This toolkit offers helpful information and resources on adult (18+) trans+ care pathways in England, reviewed by Russell-Cooke LLP.
It is intended for general information only and should not be relied upon as legal or medical advice.
Content last reviewed: 20 October 2025
What is a bridging prescription?
A bridging prescription is something your GP can issue a trans+ person to help you access gender-affirming care while you wait for specialist care, such as via a Gender Dysphoria Clinic (GDC) or a specialist private provider.
Some key points:
- Bridging prescriptions are intended to ‘bridge the gap’ as a harm reduction measure while you are waiting for specialist treatment.
- To request a bridging prescription, you must have already asked for a referral to a GDC. See the Trans Actual list of Gender Dysphoria Clinics (GDCs), waiting times, and referral criteria.
- Prescribing GPs take individual ethical, clinical and legal responsibility for their actions.
- You can expect GPs to keep accurate records of their reasoning and decisions.
- While awaiting specialist assessment, GPs should attend to your general mental and physical health needs in the same way as they would for their other patient.
- GPs are not obliged to prescribe bridging prescriptions.
The GMC advises in their ethical hub (which does not replace the formal guidance) that GPs should only consider a bridging prescription for an individual patient when they meet all the following criteria:
- The patient is already self-prescribing or seems highly likely to self-prescribe from an unregulated source (over the internet or otherwise on the black market);
- The bridging prescription is intended to mitigate the risk of self-harm or suicide; and
- The doctor has sought the advice of an experienced gender specialist and prescribes the lowest acceptable dose in the circumstances.
The NHS Constitution says patients have a legal right to start specialist treatment within 18 weeks. The NHS has a responsibility to ‘offer a range of suitable alternative providers’ if it cannot meet this standard.
No GDC currently meets this standard; waiting times are measured in years, not weeks, and often exceed five years for a first appointment. There are reports of waiting times being in excess of several decades in some cases.
If the delay for specialist assessment is excessive, GPs have an important role as their patients’ advocates in making representations to the commissioning organisation to help ensure timely provision. You can ask your GP to do this on your behalf.
While patients cannot demand treatment, when a recognised treatment exists for a recognised medical need (e.g., masculinising or feminising hormone treatment) and the patient understands the risks, benefits, and side effects, their preferences should be a key factor when a medical professional is deciding their care and what is in their best interest.
The process
The key first step is to organise an appointment with your GP to discuss your request for a bridging prescription.
You can ask for a longer slot and organise a friend to come along to take notes.
Before your appointment
- Make sure you are aware of the relevant criteria (see above).
- You will need a baseline blood test before a bridging prescription can be issued. Consider whether you will ask your GP for this or if you have already had one recently that you can refer to during your consultation.
- Consider what length of prescription you are seeking and why.
When clinical responsibility for prescribing is transferred to general practice, NHS England’s policy states that it is important that the GP or other primary care prescriber is confident to prescribe the necessary medicines.
Of course, this comes down in part to their proactiveness in maintaining up-to-date knowledge through training, but you can also help by having helpful and relevant paperwork readily available. Preparation is key.
Assisting your GP by doing your research
Your GP may not be fully informed about:
- The bridging prescription process
- Medication options
- Guidance that relevant bodies have issued
Consider how to communicate what you want and why, within the context of the criteria the GP will be working with (above).
Once you have considered what you would like, think about how you want to discuss this with your GP and what information you can provide.
Tips
- Download and print guidance, resources, and information about all of the above (links to guidance are below) or have this ready on your phone, to show your GP
- Have the statements by the GMC about prescribing ready to show your GP
- If you can, consider getting a report from a qualified specialist therapist setting out the likely impact of the wait for treatment on your mental health
Information and documents to share with your GP
- Information about the specialist advice available to your GP
- Information to back up your prescribing request
- Either the results of a recent baseline blood test, or request one
- If you want to, write a letter requesting a prescription with the detailed information (template below)
- Proof of transition, such as a deed poll, is optional, though there is no threshold to ‘proving’ you are trans+ – stating you are should be sufficient.
(If a GP asks you questions that make you uncomfortable, you have a right not to answer them. You should take a note of what they have asked/requested, leave the room and seek an alternative GP or go to a new GP practice.)
Official guidance and resources to show your GP
These resources explain the prescribing guidelines for Gender Dysphoria Clinics; take a look at the ones below to inform yourself of what care you want to request.
- Tavistock and Portman GDC Information Page includes multiple helpful resources, including downloads on hormone treatments
- Leeds and York GDC Bridging Prescriptions Information
- GMC Trans Healthcare Ethical Hub
- BMA Role of GPs in managing adult patients with gender incongruence
During your appointment
At the appointment, you can expect to:
- Share your experience of being a trans+ or gender diverse adult, and whether you have already been referred to a GDC. If you haven’t, you can ask your GP to arrange a referral, explaining where you wish to be referred and the process involved.
- Explain how being trans+ affects your life and, importantly, why a bridging prescription is necessary to your wellbeing.
- Explain what a bridging prescription is, if necessary.
- Explain why you personally need a bridging prescription. For example, you might quote the waiting times in excess of 5 years, how that wait will affect you, and how hormones will improve your quality of life.
- Show the GP the resources you have for them (as discussed above)
- Ask for baseline blood tests if you have not already had them
You can expect your GP to then ask you questions; however, you do not have to answer if they make you uncomfortable or cause distress. Everything you say to your GP is confidential.
There is no need for your GP to examine you physically or refer you to mental health services unless you have asked for help with your mental health. Gender dysphoria is not a mental health condition, and suggesting that it is can be harmful and discriminatory.
If they say no
Your GP may decide not to prescribe a bridging prescription for you.
Remind yourself that:
- Prescribing a bridging prescription does not place the GP at risk
- GPs are allowed to prescribe bridging prescriptions in line with relevant criteria
Keeping records of your consultations with your GP
If you speak to the GP on the phone or in person, consider recording the conversation, as there will be a lot to remember. You may also have a friend accompany you to take notes.
You can inform your GP that you will be recording the call/visit if you want, for your records. They cannot use this as a justification to stop the call/visit or discharge you from their service.
You do not, however, need their permission to record. As noted by the Medical Defence Union, it’s your personal information, so GDPR doesn’t apply. Recordings (even if made secretly) can generally be used as evidence when dealing with these kinds of issues, either to show wrongdoing or to support your case.
What you can do if your GP refuses a bridging prescription
Even with your best efforts, your GP may refuse to prescribe a bridging prescription. If you are refused, you can consider these options:
1. Understand why the GP refused
Sometimes it’s due to clinical judgement, safety concerns, interactions, or monitoring requirements.
At other times, it’s about practice policy; certain medications are only prescribed under a specialist’s care, or the practice may have a global refusal to support trans healthcare.
Ask the GP to explain their reasons clearly, in writing, with reference to any policy, guidance, rule or standard they seek to rely on.
You can also request a copy of your medical record, which should detail the GP’s reasoning.
2. Request a second opinion
You are entitled to request a second opinion from another GP within the practice.
Some surgeries allow you to book directly with a different GP if you’re unhappy with the first decision.
You should be clear why you disagree with the first decision. Remember, the second GP will be able to access your medical history and records.
3. Involve a specialist
If a GDC clinician initially recommended the medication, refer to this, along with copies of any correspondence you may have. You can ask your GP to liaise directly with the clinician to discuss your case.
Specialist input often carries significant weight and may override a GP’s hesitation.
Any further decision made should be documented in writing, and you can request a copy.
4. Follow the NHS complaints process
Things to know:
- Everyone who provides an NHS service in England must have their own complaints procedure in place.
- You can informally raise a concern with the GP practice manager first; they may be able to resolve the issue quickly.
- If unresolved, you can make a formal complaint to the GP surgery under the NHS complaints procedure. All healthcare providers have a complaint policy in place. You should request a copy and specific details on how to file a complaint, with confirmation of the timescales they will work to.
- If still unsatisfied, you are entitled to escalate matters to your local Integrated Care Board (ICB) (England). Find your local Integrated Care Board (ICB) using the NHS directory.
- If you are unsatisfied with the response to your formal complaint, you can contact the Parliamentary and Health Service Ombudsman (PHSO). The PHSO is an independent complaint-handling service for complaints that the NHS has not resolved in England. Note: the PHSO does not deal with complaints involving the private sector.
For help and support in making a complaint, you can contact the Patients Association Helpline, which covers all of health and social care.
5. Seek legal advice
Many law firms have regulatory, equality law, and medical experts who can consider your set of facts and determine whether you could successfully challenge the decision.
Remember that there are deadlines you must meet if you wish to challenge a decision via a formal, legal route. You should therefore not delay seeking an initial steer on whether there is merit in pursuing a legal challenge promptly to protect yourself on a ‘limitation’ front.
6. Look for another GP
Some GPs are more knowledgeable and supportive of trans healthcare. This resource from Trans Healthcare Intelligence lists trans-friendly GPs based on real patient experiences.
If you’re in a rural area with fewer local options, consider an LGBTQ-inclusive online UK GMC-registered GP service.
If you’ve completed all these steps without success, please get in touch with us at community@anne.health.
Using our sample letter templates
These sample letter templates have been reviewed by solicitors at Russell-Cooke LLP prior to publication. Notes on using these templates:
- Always keep a copy of all messages for your records.
- Make sure that you read and review the template and make amendments to the template to reflect your personal circumstances, where indicated
- Check that all changes have been made, all addresses and names are included, and that no brackets remain before sending the template.
- Ensure that all relevant supporting documents are included before sending.
Letter templates
-
Subject: Request for bridging prescription
(Your Name)
(Your Address)
(Your Phone Number)
(Your Email)
(Date)
(GP’s Name)
(Practice Name)
(Practice Address)Dear Dr. [GP’s Name],
I am writing to request your consideration for a bridging prescription for gender affirming hormone treatment while I await specialist care through the NHS Gender Dysphoria Clinic (GDC).
My NHS number is (NHS number) and my date of birth is (DOB
Background
I am a transgender [woman/man/person] who has been experiencing gender dysphoria for [time period]. I have been referred to [GDC name]. [My referral was accepted on [date], with an expected waiting time of approximately [X years/months].
Current Situation
The extended waiting times for specialist gender services are causing me significant distress and negatively impacting my mental health and quality of life. I believe that starting hormone therapy would provide substantial relief from my gender dysphoria and improve my overall well-being during this waiting period.
Request
I am requesting a bridging prescription for:
- [Name of prescription – e.g., estradiol and anti-androgen, or testosterone]
- Regularly monitor blood tests as clinically appropriate
I understand that bridging prescriptions are recognised by the GMC, BMA, and Royal College of GPs as appropriate care for transgender patients facing long waits for specialist treatment. I am committed to:
- Following all medical advice and prescribed dosages
- Attending regular monitoring appointments
- Transferring care to the specialist service when my appointment becomes available
- Informing you of any concerns or side effects
Supporting information
[(Include any relevant details such as:
- Previous private consultations or assessments
- Mental health support you’re receiving
- Any letters from counsellors or therapists
- Evidence of social transition steps you’ve taken]
I would be very grateful for the opportunity to discuss this request with you in person. I understand you may wish to consult with colleagues or the local CCG for guidance, and I am happy to provide any additional information that would be helpful.
[Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]
Thank you for considering my request. I look forward to hearing from you.
Yours sincerely,
(Your Signature)
(Your Printed Name) -
Subject: Request for reconsideration of bridging prescription refusal
(Your Name)
(Your Address)
(Your Phone Number)
(Your Email)
(Date)
(GP’s Name)
(Practice Name)
(Practice Address)Dear Dr. [GP’s Name],
I am writing to request a reconsideration of your decision not to provide a bridging prescription for my gender-affirming hormone therapy.
I fully appreciate the challenges and responsibilities that come with prescribing. However, I would like to highlight relevant clinical and professional guidance which supports the provision of bridging prescriptions in certain circumstances:
- General Medical Council (GMC) guidance: Good practice in prescribing and managing medicines and devices (2021) and the GMC’s advice on Trans healthcare confirm that GPs should collaborate with gender identity clinics, and may issue prescriptions (including as bridging care) where this is in the patient’s best interests and safeguards are in place.
- NHS England’s Interim Gender Dysphoria Service Specification (June 2023) recognises the role of primary care in prescribing and monitoring, including in situations where patients are already self-medicating or where a delay in treatment could cause harm.
My request is based on the following considerations [complete with relevant information about the possible impact on you] e.g:
- I am at risk of (worsening gender dysphoria / mental health difficulties / self-medication) due to the long waiting times for specialist appointments.
- A bridging prescription would mitigate these risks and enable safe, monitored care under your supervision, including regular blood tests and health checks.
- Prescribing in this context would be a harm-reduction measure, consistent with GMC and NHS guidance.
I am not asking you to take on the role of a specialist, but rather to provide interim, evidence-based care until a specialist GDC sees me.
I would therefore be grateful if you could reconsider your decision. If you remain unable to prescribe, I kindly ask for:
- A clear written explanation of the reasons for refusal, referencing the relevant clinical or legal basis; and
- A copy of the practice’s policy on bridging prescriptions.
[Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]
I hope to work together to ensure my care is safe, lawful, and consistent with current guidance.
Yours sincerely,
(Your Name) -
Subject: Complaint to GP/practice manager regarding refusal to provide bridging prescription for gender-affirming hormone therapy
(Your Name)
(Your Address)
(Your Phone Number)
(Your Email)
(Date)
(GP’s Name)
(Practice Name)
(Practice Address)Dear Dr. [GP’s Name],
I am writing to formally complain about the refusal to provide me with a bridging prescription for gender affirming hormone therapy during my appointment on [date of appointment] with [NAME OF DOCTOR].
Background
I am a patient registered at your practice [Patient ID: [your patient number]. I have been [briefly describe your situation – e.g., “waiting for specialist gender identity services for X months/years/previously receiving treatment that has been interrupted – PROVIDE DETAILS]. ).
The issue
During my consultation on [date], I made a reasonable request for a bridging prescription for [specific medication, e.g., testosterone/estradiol] to continue/commence my gender affirming hormone replacement therapy.
On [DATE] this request was refused because [state the reason given by the GP, e.g., “lack of expertise,” “practice policy,” “awaiting specialist input”, OR for reasons that have not been explained to me].
Why this refusal is problematic:
- Clinical guidelines: The NHS England Service Specification for Gender Identity Services, along with guidance from professional bodies such as the General Medical Council, British Medical Association, and Royal College of General Practitioners, supports GPs in providing bridging prescriptions where appropriate.
- Duty of care: Under your duty of care, patients should not be left without necessary medical treatment due to lengthy waiting times for specialist services.
- Equality Act 2010: Refusing treatment based on my being transgender may constitute discrimination under the Equality Act 2010.
- Patient safety: [Include if applicable – e.g., “Discontinuing hormone therapy poses risks to my mental and physical health” or “Delays in starting treatment are causing significant psychological distress”]
My request
I am requesting that you [choose all that apply, or add any further requests you may have]:
- Reconsider your decision and provide the bridging prescription as requested
- Seek advice from specialist services or colleagues, as necessary and confirm in writing what has been sought if this is done
- Refer me to another GP within the practice who may be willing to prescribe
- Provide a written explanation of your refusal if you maintain this position
Evidence of my situation
[Include any relevant documentation you can reference, such as:]
- Referral confirmation to gender identity services dated [date]
- Previous prescription history
- Supporting letter from counsellor/therapist
- Evidence of self-medication risks, if applicable
Desired outcome
I would like this matter resolved promptly by providing the requested bridging prescription. I am happy to work with you to ensure safe monitoring and appropriate care.
Next steps
I would appreciate a written response [within 10 working days]. If this matter cannot be resolved at practice level, I am prepared to escalate this complaint to:
- Your Clinical Commissioning Group/Integrated Care Board
- The Parliamentary and Health Service Ombudsman
- The General Medical Council
I hope we can resolve this matter cooperatively and maintain our patient-doctor relationship while ensuring I receive appropriate medical care.
Thank you for your time and consideration.
Yours sincerely,
(Your Signature)
(Your Printed Name)
Attachments (if applicable):
- Copy of referral confirmation
- Relevant medical records
- Supporting documentation
-
Subject: Formal complaint: refusal to prescribe bridging hormone therapy
Personal details
- Name: (Your full name)
- Date of Birth: (DD/MM/YYYY)
- NHS Number: (Your NHS number)
- Address: (Your full address)
- Contact number: (Your phone number)
- Email: (Your email address)
GP practice details
- Practice Name: (GP practice name)
- GP Name: (Name of GP who refused)
- Practice Address: (Practice address)
- Date of Refusal: (Date of appointment/refusal)
Nature of complaint
I am writing to make a formal complaint regarding my above GP’s refusal to prescribe bridging hormone therapy for gender dysphoria treatment.
Previous action taken
- (If applicable: “I raised this initially with the practice manager on (date) but received no satisfactory response”)
- (Any other steps taken)
Background
- I experience gender dysphoria and require hormone replacement therapy as part of my gender transition.
- I am on the waiting list for [Name of GDC] with an estimated wait time of [X years/months]
- My current waiting list position is [if known] with a referral date of [date]
- The extended waiting times are causing significant distress and negatively impacting my mental health, and I require a bridging prescription to ensure my wellbeing in the meantime
The incident
On [date], I attended an appointment with Dr [Name] at [Practice Name, as set out above]. At this appointment, I made a reasonable request for bridging hormone therapy.
During this appointment:
[Describe what happened – e.g., “Dr X refused to prescribe bridging hormones”]
On [DATE], I was informed of the decision not to prescribe me a bridging prescription for the following reasons [and I attach the decision letter, for your information]:
[Include any reasons given – e.g., “They stated they were not comfortable prescribing”]
[Note any dismissive language or lack of consideration of your distress]
[(Mention if they failed to discuss alternatives or refer appropriately]
Impact on my health and wellbeing
The refusal to provide a bridging prescription has resulted in [add details, for example, it may include:]
- Continued and worsening gender dysphoria
- Specific mental health impacts – anxiety, depression, etc.
- Impact on daily life, work, and relationships
- Feeling unsupported by my healthcare provider
Relevant guidelines and standards
I believe this refusal contravenes several professional guidelines:
- GMC Good Medical Practice (2024): Doctors must provide care based on clinical need and best evidence
- NHS England Service Specification for Gender Identity Services: Recognises the role of bridging prescriptions during long waiting times
- WPATH Standards of Care (Version 8): Supports bridging therapy to prevent psychological distress
- GMC Trans Healthcare Guidance: Emphasises the importance of supporting trans patients during waiting periods
Please review the facts of my case and contact the GP surgery to investigate the recent decision they have made in relation to my bridging prescription request.
I request that you:
- Investigate this complaint thoroughly
- Respond within the statutory timeframe
- Provide a detailed explanation of your findings
- Outline what steps will be taken to prevent similar incidents
Supporting evidence
I am prepared to provide: [include those that apply to you, as well as anything further you consider may be helpful]
- Medical records documenting my gender dysphoria diagnosis
- Evidence of my GDC referral and waiting list position
- Documentation of the impact on my mental health
- Relevant clinical guidelines supporting bridging therapy
I look forward to your prompt response and resolution of this matter.
Yours faithfully,
(Your signature)
(Your printed name)
(Date)Attachments
Copy of NHS number/ID
(Any relevant medical documentation)
(Correspondence with GP practice)
(Evidence of GIC referral if available)
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