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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
Blood tests are necessary at various points in your transition journey. They are typically taken when starting, when care is being taken over, if you have a dose change and of course, if any problems arise. It provides a baseline health check for trans-related healthcare and for healthcare more broadly.
You may have opted for care with a private healthcare provider to help you access hormone therapy while you wait for specialist care at a Gender Dysphoria Clinic (GDC) in the UK, or instead of waiting for this care through the NHS. You may be self-medicating due to the expense of seeking private care and the lengthy NHS waiting lists.
You can find a list of GDC services, wait times, and referral criteria from Trans Actual here.
The NHS Constitution says patients have a legal right to start specialist treatment within 18 weeks. But no UK GDC 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 exceeding several decades in some cases.
The NHS has a responsibility to ‘offer a range of suitable alternative providers’ if it cannot meet this standard. The GMC’s updated guidelines on decision-making and consent emphasise that patients have the right to be involved in decisions about their care and to receive support to make informed choices:
“All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.”
While patients cannot demand any treatment, when a recognised treatment exists for a recognised medical need (e.g. through a private provider) and the patient understands the risks, benefits, and side effects, their preferences should be a key factor in deciding their care.
Some GPs may refuse to provide support for private treatment, such as blood tests. They are entitled to do so, but you are entitled to understand the reasons and seek advice as to whether such reasons are reasonable.
You may need to make the case for support for any aspect of private treatment. This could include requests for blood tests for monitoring purposes, to cover your GDC waiting period, until the GDC can take over.
A key first step to consider is whether your GP is likely to be open to supporting you by providing monitoring through blood tests, and how to discuss this with them.
Your GP may not know anything about:
You should prepare in advance of seeing your GP and be ready with answers, including what you want them to support you with and why this is important to you.
Consider how you would like to discuss this with your GP and what information you can provide to ensure they feel comfortable providing this support for you.
Information and documents to share with your GP:
These resources explain the prescribing guidelines for GDCs.
Take a look at the ones below to ensure that what you have been prescribed or are seeking from your private provider falls within these guidelines. If so, explain this to your GP, as it may strengthen your case for requesting blood tests to monitor your treatment and ensure safety, as recommended by your GP.
Here are some things to consider when planning your appointment:
At the appointment, you will need to:
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.
They may argue that they are not allowed to support you with access to private treatment. However, GPs have a responsibility to keep their knowledge up to date, including when it comes to trans healthcare. They might argue that these medications are off-licence, so they cannot support your use of them through a private provider. Again, this is incorrect. Medicines are prescribed off-licence thousands of times every day across the UK.
Remind yourself that:
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.
Even with your best efforts, your GP may refuse this kind of support.
This 2018 survey by Trans Health reports on the transphobia within primary care and the detrimental impact on patients’ lives caused by the current GDC services.
Some GPs say they don’t know enough to support their trans+ patients confidently, even though the GMC has stated that gender healthcare is not a highly specialised treatment. Ultimately, it is up to your GP’s professional discretion whether they will provide you with blood test support.
If your GP refuses to support you in this way, here are a few steps you can take.
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.
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.
Specialist input often carries significant weight and can override a GP’s hesitation, with copies of any correspondence you may have.
You could ask that your GP liaise directly with the specialist to consider the appropriate approach.
Things to know:
For help and support in making a complaint, you can contact the Patients Association Helpline, which covers all of health and social care.
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.
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.
These sample letter templates have been reviewed by solicitors at Russell-Cooke LLP prior to publication. Notes on using these templates:
Subject: Request for blood test monitoring
(Your Name)
(Your Address)
(City, Postal Code)
(Your Phone Number)
(Your Email)
(Date)
(GP’s Name)
(Practice Name)
(Practice Address)
(City, Postal Code)
Dear Dr (GP’s Surname),
Request for blood test monitoring: Gender-affirming hormone therapy
My NHS Number: [NHS Number]
I am currently receiving gender-affirming hormone replacement therapy (HRT). I am writing to request regular blood test monitoring whilst I await care via a Gender Dysphoria Clinic (GDC).
I understand that blood tests are important to ensure my health and safety while undergoing this treatment.
Current treatment details: [set out details of your HRT]
Monitoring requirements: Based on clinical guidelines for gender-affirming HRT, I understand that the following blood tests are typically recommended:
For all patients:
Additional tests as clinically indicated:
Monitoring schedule: I understand that monitoring frequency typically involves:
[Adjust based on your prescribing clinician’s recommendations]
I would be grateful if you could arrange these blood tests and continue to monitor them as part of my ongoing care.
I am happy to discuss this further at an appointment if needed or if you require any additional information from my prescribing clinician.
My prescribing clinician can be contacted at: [Contact details if applicable]
[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 your support with my healthcare needs. I look forward to hearing from you soon.
Yours sincerely,
(Your signature)
(Your printed name)
NHS Number: (Your NHS number)
Date of Birth: (Your DOB)
Subject: Letter to GP requesting reconsideration of refusal to provide blood test monitoring
(Your Name)
(Your Address)
(City, Postal Code)
(Your Phone Number)
(Your Email)
(Date)
Dr (GP’s Name)
(Practice Name)
(Practice Address)
(City, Postal Code)
Dear Dr (GP’s Name),
Re: Request for reconsideration of refusal of blood test monitoring
My NHS Number: [NHS Number]
I am writing to formally request that you reconsider the recent decision made by [NAME] on [DATE] to refuse blood test monitoring whilst I am receiving gender affirming hormone replacement therapy (HR). [Attach a copy of the decision letter, if available].
My request was reasonable. This monitoring is medically necessary and falls within the standard of care for patients receiving HR.
Clinical rationale for monitoring
Regular blood test monitoring during HR is recommended by established clinical guidelines, including:
The monitoring typically includes assessment of:
My current situation
[Include relevant details about your treatment, such as:]
Request for shared care
I understand that [a specialist service can initiate HR/ I am self-medicating], but ongoing monitoring can appropriately be provided in primary care as (part of a shared care arrangement OR harm reduction (if self-medicating)).
This approach has the following benefits:
Patient safety considerations
Without appropriate monitoring, there are potential risks, including undetected adverse effects on liver function, cardiovascular health, or hormone imbalances. Regular blood tests represent a standard safety measure that helps ensure the therapy remains both safe and effective.
I would be grateful if you could reconsider your decision and arrange the necessary blood tests. I am happy to discuss the monitoring schedule and specific tests required, and can provide additional clinical information from my prescribing clinician if needed.
[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 look forward to your response and to continuing to work together to ensure my healthcare needs are met appropriately.
Thank you for your time and consideration.
Yours sincerely,
(Your Signature)
(Your Printed Name)
(Your Date of Birth)
(Your NHS Number)
Subject: Complaint letter to GP practice regarding refusal to provide blood test monitoring for gender-affirming hormone therapy
(Your Name)
(Your Address)
(City, Postcode)
(Your Phone Number)
(Your Email Address)
(Date)
(Practice Manager’s Name)
(GP Practice Name)
(Practice Address)
(City, Postcode)
Re: Formal complaint: refusal to provide essential blood test monitoring
Patient details:
Nature of complaint
I am writing to formally complain about the refusal by [GP’s Name/Practice] following the unreasonable refusal to provide essential blood test monitoring while I am receiving gender affirming hormone replacement therapy (HRT). This refusal compromises my safety and contradicts established medical guidelines.
Background
Specific issues
I believe the decision to refuse blood test monitoring is unreasonable for the following reasons:
Medical safety concerns: Without regular monitoring, I am at risk of serious complications, including (mention specific risks relevant to your treatment, such as):
Professional guidelines: The refusal contradicts professional guidance, including:
Duty of care: As my registered GP, the practice has a duty of care to provide essential monitoring for any medication I am taking, regardless of the prescribing source.
Impact
This refusal has caused me: [include details, for example:]
Resolution sought
I request: [Choose all those that apply to you, plus add anything you consider necessary]
Immediate provision of the required blood test monitoring
Next steps
I expect a full written response within [10 working days]. If this matter is not resolved satisfactorily, I will escalate my complaint to:
[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 trust this matter will be resolved promptly to ensure my ongoing safety and appropriate medical care.
Yours sincerely,
(Your signature)
(Your printed name)
Supporting documents to include: List any supporting evidence you want to attach to support your letter.
Subject: Escalation of formal complaint to ICB/PALS following GP refusal to provide gender-affirming hormone therapy monitoring
To: (PALS/ICB Name)
Date: (Date)
Your Name: (Your Full Name)
Your Address: (Your Address)
Your Contact Details: (Phone/Email)
NHS Number: (Your NHS Number)
GP Practice: (Practice Name and Address)
Subject: Formal complaint regarding refusal to provide essential blood test monitoring for Gender-affirming hormone therapy
Background
I am writing to make a formal complaint about my GP practice’s refusal on [DATE] to agree to providing me with essential blood test monitoring while I am receiving gender-affirming hormone replacement therapy (HRT).
I do not think the reasons given to explain the refusal are adequate. This refusal is impacting my health and safety, and I believe it constitutes inadequate care.
Details of the issue
Treatment background:
Monitoring requirements: According to established clinical guidelines, including those from the General Medical Council, NHS England, and relevant endocrine societies, patients on hormone therapy require regular monitoring through blood tests to check:
GP practice response: On [date], I requested the necessary blood tests for monitoring my HRT. Though the test requested is a fairly standard request used by many who are undergoing HRT for non-trans related purposes, the practice refused, stating: [quote their reason if given, or state “no clear reason was provided”].
Impact on my health and wellbeing
This refusal has resulted in: [explain the impact of the decision, include for example:]
Relevant guidelines and standards
The refusal to provide this monitoring appears to contravene:
What I am seeking
As a next step, can I request from you:
I request:
Supporting information
To assist, I provide: [include all those that are relevant to you]
Next steps
This matter can be resolved promptly to ensure my continued safe treatment. However, I reserve the right to escalate this complaint further if necessary.
[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 your attention to this serious matter.
Yours sincerely,
(Your Signature)
(Your Printed Name)
(Date)
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