#transliberationnow — Public Fediverse posts

Hey folks :TransHeart:

As you're almost-certainly already aware, access to GAHT is increasingly being restricted, being outright banned, or otherwise unavailableb to many trans+ people under 18 in many places across the world 😔

For example, the UK had already banned new prescriptions of GnRH agonists (a type of puberty blocker) for any trans+ person under 18, and is now genuinely considering banning all private GAHT prescriptions too 🤬

GAHT is literally lifesaving medication for many trans+ people :BlahajHuggingTransHeart:

Without it, many trans+ people under 18 will struggle even more with mental health, and many will not make it to adulthood 😭

If you are a trans+ person under 18, or are a supportive family member or friend of someone who is, please start to make contingency plans now for the worst-case scenarios 🥺

We highly recommend bookmarking the below website and making copies of all relevant info and links in case it gets taken down:

• HRT4All
  • Before the site will let you in, it'll ask you to answer a quiz, after which it'll create a cookie called "quiz_passed" with a value of "true".
  • The website seems to have intermittent issues with the quiz, so if you encounter any issues, delete all cookies for the website and reload.
  • If all else fails, you can use an extension called Cookiebro in Firefox or Edge to import a "quiz_passed" cookie from a JSON. (Contents for Firefox cookie; contents for Edge cookie.)

If you're 18+ or soon will be, please also do the same for these:

• The DIY HRT Directory 2.0
• HRT Café
• DIYHRT Market.
• r/TransDIY Wiki.

Please note that there is now at least one homebrewer who offers estradiol sprays.

We all need to prepare now, before it's too late 🥺😞

Enough lives have already been lost. We can't save everyone, but we need to try to save as many as we can ✊

Boosts very much appreciated :BoostsOKPrideSymbol:

Edit 2025-08-19:

• Added some info to help anyone struggling to log in to HRT4All.
• Added info on additional resources.

#trans #transgender #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #SupportTransKids #TransYouthAreLoved #FuckTransphobia #FuckBigotry #FuckTheUK #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #UnitedWeStandDividedWeFall #FirstTheyCame #GenderDysphoria #GenderIncongruence #GenderAffirmingCare #GAHT #HRT #TransGenocide #PSA #PleaseBoost #TransRights #TransRightsAreHumanRights

Hey folks

Needed to get this vent out of our system too, as it's been really bugging us lately.

Right now, the vast majority of the medical community, even those who consider themselves trans-supportive, are incredibly gatekeeping when it comes to giving trans youth any form of care, even puberty blockers like GnRH agonists.

In an ideal world, the following would happen:

• A trans kid says they're trans.
• If they've started or will soon start puberty, the trans kid goes to their GP or doctor with a parent or guardian.
  • If they can demonstrate Gillick competence, this can be without a parent or guardian.
• The GP or doctor offers the following options to the trans kid:
  • A puberty blocker (GnRH agonist or antagonist).
  • Monotherapy GAHT (i.e., maintaining a high enough estradiol or testosterone level to block gonadal hormone production).
  • A lower level of GAHT alongside a puberty blocker.

In the real-world, this sadly isn't the case. At the very best, trans kids:

• Won't be offered a puberty blocker unless they've at least reached stage 2 on the Tanner scale!
• Won't be offered HRT until 14 at the very, very earliest!

In practice, it's even worse than this in many places now. Even in many countries that consider themselves to be "progressive" on trans healthcare, trans youth will need to:

• Have been on a puberty blocker for 6-12 months before GAHT will be considered.
• Be at least 16 before GAHT will be offered.

In the worst places, there's no healthcare for trans youth whatsoever. In the UK, there's currently a permanent ban on new prescriptions of puberty blockers to any trans person under the age of 18. There are workarounds in place by private companies for this, but they're out of the price range for most people. Getting GAHT before the age of 18 will also require going private.

This forms the basis of the "wait and see" approach, which is conversion therapy by another name. Its nefarious aim is to reduce the number of people transitioning and to reduce the number of trans people overall, as many trans kids will not reach adulthood by being actively denied the right to transition medically.

The worst thing about this isn't the transphobia and transmisia from outside the trans community, but from within it :PleadingFace:

We've seen people agree with the age gatekeeping and the need for medical diagnoses of being trans (ICD-11 - gender incongruence of childhood or gender incongruence of adolescence or adulthood), as if they don't trust trans kids to know that they're trans.

If we're going to use that logic, then clearly no-one should be allowed to go through puberty until they're legally an adult, as clearly all kids can't be trusted, right? Oh, and we should distrust all kids about sexuality too and prevent relationships of any kind until they're 18, yes?

The false logic quickly falls apart there. It's not based on not trusting kids: it's based on not trusting trans kids. It's the same nonsense that leads people to assume that all kids are heterosexual by default ("heteronormativity") and to distrust that anyone under 18 could recognise this about themselves.

The only reason it took us so long to realise that we were trans and bi wasn't because we weren't both of these things all along, but due to external pressures (Section 28; transphobia and homophobia) that made us suppress and repress these feelings. If we had felt able to be ourselves, we'd have realised we weren't a boy in our early teens, and that we were bi not much later.

In the UK, estrogenic puberty typically starts anywhere from age 8 to 13 and androgenic puberty from 9 to 14. There's simply no reasonable argument for delaying puberty in trans kids until they're 16 or even older. The "appropriate" age to start GAHT is whenever they've met the minimum puberty start age (8 or 9), when their peers are starting, and when they feel ready to start.

So yeah, we fully support trans youth starting GAHT at 11-12 or possibly even earlier in some cases.

Puberty blockers are meant to be a short-term stop-gap only to delay puberty. Once puberty has started, they can be used alongside GAHT in order to provide an age-appropriate ramp up, but in most cases it would simply be safer and cheaper to go with GAHT monotherapy. With monotherapy, trans kids get the added emotional, physical, and psychological benefits that come with a slightly-higher sex hormone level. (Just think how shitty it feels to have a low estradiol or testosterone level.)

Anyways, that's enough venting for now. We'll probably come back to correct typos, make minor amendments, or add further thoughts later. Right now though, we need to head up to bed.

#trans #transgender #transition #PubertyBlockers #TransYouthAreLoved #TransKidsAreLoved #TransKidsDeserveBetter #TransYouthDeserveBetter #TransKidsDeserveToThrive #TransYouthDeserveToThrive #TransKidsDeserveToGrowUp #TransYouthDeserveToGrowUp #LGBTQ+ #LGBTQIA+ #queer #GAHT #HRT #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #InformedConsent #GillickCompetence

Hey folks

We all know how shite the Cass Review was/is, and how it's been universally discredited and rejected :PleadingFace:

Alas, NHS England has now set its gaze firmly on a review of adult trans+ healthcare services 😞

We would love to believe that this is being done in good faith, but NHS England has never been on the side of trans people.¹ As such, we believe that the best we can realistically hope for at this stage is damage limitation :FaceExhaling:

To this end, we wish to highlight that the page linked above links to an Adult Gender Services Review survey, which is open to:

• current, and recent, patients who have been seen at one, or more, of the [Gender Dysphoria Clinics] in the past five years
• family and friends of patients who have used services in the past five years
• current staff members, and those who have worked at one, or more, of the centres in the past five years

Even if it doesn't change a thing, we should make our voices heard loudly and defiantly ✊ :TransHeart: :NonBinaryHeart: :AgenderHeart: :BiGenderHeart: :GenderfluidHeart: :GenderqueerHeart: :DemiBoyHeart: :DemiGirlHeart:

So let's go all out and tell them what we actually want:

1. Depathologisation.
2. Desegregation.
3. Informed consent.

We don't want better gender clinics: we want them to be dismantled entirely, in favour of desegregated healthcare.

We don't want to be forced to get a formal medical diagnosis of being trans to access basic GAHT / HRT, to have the right to consent to gender-affirming surgeries, or to change our legal gender.

We want world leading gender-affirming healthcare, beyond the nonsense, unscientific biases that still exist even in WPATH SOC8.

They don't want to offer us this, and will do everything in their power to ignore us, but that doesn't mean that our voices shouldn't be heard.

Maybe trans liberation won't come today, but we need to fight for it at every stage :AnarchySymbol:

Boosts are very welcome and will be very much appreciated, by the by :BoostsOKPrideSymbol:

#trans #transgender #NonBinary #agender #bigender #DemiBoy #DemiGirl #genderfluid #genderqueer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #queer #TransLiberation #TransLiberationNow #TransRights #TransRightsAreHumanRights #NHS #CassReview #LevyReview #depathologisation #demedicalisation #desegregation #DesegregateTransHealthcare #InformedConsent #survey

¹ You can read all about the awful history of trans healthcare provided by NHS England in The Transgender Issue: An Argument For Justice by Shon Faye.

Hey folks 🩷

Just doing a quick update to let you all know that we're still here, and we're still recovering from (and coping with) depression, anxiety, neurodivergent burnout, and migraines.

It's not all sunshine and rainbows, but we're doing a little better and keeping ourselves occupied, whilst also allowing ourselves time to rest... though sometimes Hannah has to remind us to pause or stop when we get hyperfocussed 😅

On another note, we've got our 4th appointment with the NHS East of England Gender Service (EOEGS) tomorrow, which we're totally not entirely anxious about 😅🥺

This one is to get a 2nd surgical recommendation from another NHS medical "specialist". We need 2 before we can even join any surgical waiting list, and we already got the 1st from our 3rd appointment... back in March 2024.

Technically we should have had that all sorted back during our 2nd appointment in August 2023, when they agreed that we did indeed meet the diagnostic criteria for gender incongruence (ICD-11, HA60), but NHS gender identity clinics (GICs) are a crumbling anachronism, designed intentionally to make the process drawn-out, difficult, and full of gatekeeping 😔

Of course, they couldn't just accept the gender incongruence diagnosis we got privately in July 2021... from someone literally recognised by the UK government as a gender specialist for the purposes of applying for a gender recognition certificate, and who still works for the NHS 😑😮‍💨🤦‍♀️

Plus the EOEGS then took nearly 6 months to send the final report and letter to my NHS GP before booking this 4th appointment and getting started on other requests.

On top of that, they made several factual errors in the report too 🤦‍♀️ We sent it back to them and our GP, with highlighted corrections. Our GP was most grateful for this, as it highlighted that the responsibility of Individual Funding Requests (IFRs) lies with the gender clinic, not the patient's GP.

So, yeah. We're a bit anxious right now 😅😖

#EOEGS #EastOfEnglandGenderService #NHS #NHSEngland #TransHealthcare #trans #transgender #UK #queer #LGBTQIA+ #DesegregateTransHealthcare #TransRightsAreHumanRights #TransLiberationNow #MentalHealth #depression #anxiety #neurodivergent #NeurodivergentBurnout

Hey folks :TransHeart: :NonBinaryHeart:

You may receive an SMS text from +44 7860 039092 or similar. It will read along the lines of:

From: Tavistock GIC

Hello, you are on the waiting list waiting to be seen at the GIC you were referred between 20## - 20##. We understand during this wait some patients will no longer wish or need to be seen.

Please respond to our question via our secure portal within the next 14 days. https://drdoctor.thirdparty.nhs.uk/???????????????

Thank you.

We've seen screenshots of people of people referred 2019-2020 and 2020-2021. This was the Reddit post that made us aware of this. A friend of ours, referred in 2019-2020, received and responded last week.

It very much looks like the NHS powers that be have contracted a third party to reach out to patients on this GIC's waiting list, in the hopes that many won't respond in time for any number of reasons. They're trying to artificially reduce their huge waiting list via nefarious means, rather than tackling the systemic issues.

If you have been referred to this GIC and haven't yet received an SMS text, or you have changed your mobile phone number or any other details, you can attempt to log in to the main login portal without the unique code.

Please note that you may not be able to log in to their portal without this third party having been sent your details. We'd highly recommend that if you've not yet received an SMS text and were referred between 2019 and 2021 that you urgently message both your NHS GP surgery and the GIC via email ([email protected]) or phone number.

Please spread this far and wide. People need to know about this, so they don't lose their place in the queue and have to be referred again 🥺

Lives could literally depend on this 😞

#trans #transgender #NHS #NHSEngland #TransRightsAreHumanRights #TransHealthcare #TransLivesMatter #healthcare #LGBTQ+ #LGBTQIA+ #queer #TransLiberation #TransLiberationNow #TransPeopleAreLoved

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

Hey folks :FediverseSymbol:

What with our AuDHD burnout, real-life stuff, and other recent fedi dramas, we had had neither the time nor spoons to give you all an update.

To bring you all up-to-date, this has been our experience with the NHS:

• Late May 2021 - referred to the London GIC (aka Tavistock).
• Asked to be put on TransPlus pilot scheme waiting list, in case we became eligible.
• January 2022 - discovered the East of England Gender Service (EOEGS) pilot scheme and was transferred.
• November 2022 - 1st appointment with EOEGS. No care or support offered.
• Early in 2023, TransPlus rang to offer us an appointment 🤦‍♀️ We were not allowed to accept or transfer to them, because of NHS rules 😞
• August 2023 - 2nd appointment with EOEGS. Gender incongruence diagnosis agreed, but was told we'd need a further appointment to discuss HRT and other requests.
• March 2024 - finally got all requests in (HRT, surgerical, voice training, hair removal etc.)

Now, you think it wouldn't take long to send a letter from the EOEGS to my GP, right? Right? 😅😞

That 3rd appointment was on 12th March 2024. The letter wasn't printed untiil 28th August 2024: almost 6 months later 😑

On the plus side, my GP has now been sent this, can process it, and can start officially giving us prescriptions for meds... as soon as we sign a stupid declaration to receive meds that "are not licenced for the treatment of Gender Incongruence" 🤦‍♀️

They've also put down the wrong date on which we had our 1st appointment on the letter, so gonna need to update all parties of that. How do we know?

1. We store all such things in our calendar and have kept all the emails.
2. The date they've quoted is around the time we'd had a life-saving surgery.

On a good note though, approval was granted also immediately for limited hair removal and we can continue to use our existing electrologist 🥰 It's the only part of the process that has been quick and easy 😅😑

It's a bit of a postcode lottery with the NHS, but the details we got said they'd fund 8 hours of laser OR 16 hours of electrolysis OR some combination of those.

We replied quickly to ask for 16 hours of electrolysis with our existing electrologist.

And yes: it will all be on our face and neck. Totally no other areas whatsoever, as the NHS doesn't cover that (with the exception of hair removal down below for any surgeries).

And it will totally take all 16 hours to finally finish off my face and neck.

Anyway, just thought you might like to know that it's only taken me about 1,188 days to get to this point (at the time of writing this post).

That's about 39 months: roughly 3 years 3 months.

And this is considered very quick by NHS standards (at least NHS England) 🙄

We still need a further review before we can even join the vaginoplasty waiting list (for Tina Rashid), let alone to get to the consultation stage :FaceExhaling:

And we're presently still waiting on the EOEGS to accept the ruling from the official NHS Individual Funding Request (IFR) team that it is the responsibility of the gender clinic (whilst under their care) to fill these out for any requested surgeries not offered as standard by the NHS.

e.g.,

• Bilateral orchidectomy (sometimes called a bofaectomy)
• Facial Feminisation Surgery (FFS)
• Voice Feminisation Surgery (VFS) (types include glottoplasty, cricothyroid approximation, laser assisted voice adjustment)

They originally were trying to argue that our GP would need to do it, so we went above them to check, and then sent the EOEGS the email chain.

These IFRs will need to be submitted to the IFR team at our local Integrated Care Board (ICB) for review. The local ICB will almost certainly refuse them all, so that they don't set any precedent and then have to pay for other gender-affirming care recommended by international experts. Nonetheless, at least we'll know we've exhausted all avenues before likely turning to crowdfunding or other means.

We might add to and/or edit this later, but we'll stop there for now and add some hashtags.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

 
(Please note that we've¹ defaulted to the British English spellings of oestrogen and oestradiol instead of estrogen and estradiol, as this issue affects those in the UK. In general, we use and prefer the versions without the leading, silent O.

Also, GnRH means gonadotropin-releasing hormone. You'll see us writing it a lot followed by "analogue", "agonist" or "antagonist". Those are all types of "puberty blockers".

Lastly, GAHT means gender-affirming hormone therapy. We prefer using this to HRT -- hormone replacement therapy -- which is a broader term.)
 

Original puberty blockers ban

Back on 2024-05-31, we wrote a post in response to the transphobic emergency restrictions for new prescriptions of puberty blockers to trans youth by the then health minister.

Our original post explaining that in more detail can be found here, but we have now unpinned it and replaced it with this post to ensure everyone has the most up-to-date info.
 

New government hopes dashed

It was hoped that the new government would not extend the ban, but as soon as they announced Wes "Weasel" Streeting (a highly vocal transphobe and self-loathing gay man) as the new Health Secretary, he pretty much immediately announced his intention to extend the temporary ban, with an aim to making it permanent.

Per this post by TransActual, it's not like Weasel and his advisors weren't made aware of all the negative impacts an extension would have, as "he was told about it when meeting with the representatives of LGBTQ+ organisations".

Even more darkly-farcical is that the justification Weasel used for continuing the targeted medical discrimination against trans youth is that it's being done "to avoid serious danger to health", which is not only contrary to the information provided by those LGBTQ+ organisations, but completely contrary to:

• increasing international condemnation of the Cass Review, which was the primary justification for the order;
• all valid scientific studies over decades, which were excluded by the Cass Review because they weren't "double blinded controlled studies" (which is medically unethical);
• even the frickin' BMA criticising and planning to review the Cass Review.

It's not that Weasel doesn't understand this: it's that he either doesn't care or actively wants to hurt trans youth by making it as difficult as possible for them to medically transition :PleadingFace: 😞
 

The temporary ban extension explained

The news page on on the government is coldly entitled Puberty blockers temporary ban extended, as if it's no big deal. It links to the original ban and to the new-and-worsened "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024" that's replacing it.

This order extends the duration of the original ban until 2024-11-26, but also increases its scope. The original order did not apply to Northern Ireland and allowed EU professionals to prescribe. This small loophole gave a glimmer of hope for supportive parents of trans youth, who could essentially:

• Get a prescription via a private online gender service from an EU medical professional.
• Travel to Northern Ireland to pick up the prescription.
• Travel back home to use it to support their trans kid.

The government clearly discovered this, as the new order has 2 very clear statements on the news page:

It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.

The government has also extended the order to cover Northern Ireland, following agreement from the Northern Ireland Executive, to come into effect from 27 August 2024.
 

Temporary ban extension number 2 😞

On 6th November 2024, a 2nd extension to the temporary ban was created, which will come into force on 27th November 2024 and last until the end of 31st December 2024.

Fortunately, it was only a time extension: not an expansion of the meds being blocked.

Indefinite ban

We bleeping hate this country. On 11th December 2024, an indefinite ban was imposed by the scumbags in power, under the false guise of safety. This will come into force from 1st January 2025 :FaceExhaling:

And now for the good news 🥰

GnRH antagonists

Weasel isn't as smart as he thinks he is. Under Article 2, they've continued to define GnRH analogues as:

a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin

It's been this way since the original temporary ban was introduced by the previous government and nobody has updated the wording.

Whilst technically calling them analogues isn't incorrect, all of the medications listed above are actually more-specifically GnRH agonists.

Just like the original order, they've ignored GnRH antagonists, as these don't tend to be typically prescribed for trans+ GAHT, despite being just as safe and effective, with the same low-risk profile.

GnRH agonists and antagonists are both types of GnRH analogues. It's just that, for some reason, the agonists tend to be prescribed rather than the antagonists.

The wiki page on GnRH antagonists even specifically states in the Other uses section:

GnRH antagonists could be used as puberty blockers in transgender youth and to suppress sex hormone levels in transgender adolescents and adults, but have not been studied in this context.

We've checked through the list of GnRH antagonists listed on NICE ("National Institute for Health and Care Excellence") as being able to be prescribed, and the following ones could be legally prescribed by any willing UK medical professional without infringing on the order:

• Cetrorelix (Wiki) (NICE) (EMC)
• Degarelix (Wiki) (NICE) (EMC)
• Ganirelix (Wiki) (NICE) (EMC)
• Relugolix (Wiki) (NICE) (No EMC page, but NICE has some details here)

The drugs would be being used off-label, but so are all the existing meds for trans people anyway! There are no officially-licensed medications for trans people in the UK. It's all outside of their prescription guidelines.

We actually had to sign 2 consent forms to request feminising GAHT (aka feminising hormone therapy), 1 of which genuinely reads:

I confirm I understand feminising hormones are not licenced for the treatment of Gender lncongruence; however, I am happy to receive this treatment.

That's not an outdated form either. It's what we had to return to the East of England Gender Service (EOEGS) in May 2024.

Elagolix appears to be starting to be used at 150 mg daily or 200 mg twice daily, but does not appear to be approved for use by NICE.
 

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens (steroidal and non-steroidal)

For those who want to block testosterone, the other options are broadly steroidal anti-androgens or non-steroidal anti-androgens. They're typically grouped together under anti-androgens.

Of these, the prescribable options are:

• spironolactone (NICE)
• cyproterone acetate (NICE)
• bicalutamide (NICE)

Why no mention of 5-alpha-reductase inhibitors like finasteride or dutasteride? Because all they do is reduce the conversion of testosterone into dihydrotestosterone (DHT). They're technically considered anti-androgens, but both have some pretty common side effects, haven't been shown to be effective for trans healthcare, and interact badly with micronised progesterone.

Spironolactone

Spironolactone has tonnes of common, negative side effects and is a weak anti-androgen at best. The fact that it's still even prescribed to trans people to block testosterone is probably solely because it's cheap. Even its Wiki page states:

Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.

Cyproterone acetate

Cyproterone acetate, even at low daily doses (6.25-12.5 mg), isn't particular great either. It's a progestin (a synthetic progestogen), has a fair number of common side effects, and can cause liver issues. It can even cause depression and negatively impact breast development if taken from the start of feminising GAHT.

The only safe progestogen for feminising GAHT is bioidentical micronised progesterone, and only after at least 6 months and having reached stage 3 on the Tanner Scale. It's best to avoid progestins at all costs, due to their inherent risks.

Bicalutamide

Now we come to the oft-overlooked and demonised bicalutamide, even though one of its key uses, as listed on its wiki page, is:

as a puberty blocker and component of feminizing hormone therapy for transgender girls and women

Bicalutamide is a first-generation non-steroidal anti-androgen and works in a different way to other anti-androgens. It actually increases testosterone production slightly, but then converts the excess into oestradiol (E2) and blocks androgen receptors. It's kind of an invisible blocker, as any blood tests will show a higher testosterone level, but androgenic effects will stop, due to the blocked receptors.

Its common side-effects are actually positive effects for many seeking feminisation (e.g., breast growth; decreased libido; reduced body hair growth) alongside blocking androgen receptors. This is, however, worth taking into consideration for someone who may want to block androgenic effects, but not particularly feminise, as this would not be best for them.

Bicalutamide does have a common chance of raising liver enzymes, so it's absolutely vital to monitor closely and get regular liver function blood tests.

Why vital? Because seeing elevated liver enzymes is an indicator of liver cells breaking down at an unusual rate, which can be an early warning sign of liver toxicity (toxic hepatitis). Further tests can then be run to confirm.

The liver is very capable organ in terms of recovery and regeneration, so stopping bicalutamide early if further tests are positive for liver toxicity will stop further damage and increase the likelihood of the liver repairing any slight damage caused.

And now we come to the reason why it's not more-commonly used: there have been 10 published case reports of liver toxicity reported to the FDA Adverse Event Reporting System (FAERS) in the USA, from which there were 2 deaths. As far as we can tell from reading the links into this, none of these were trans people (of any age) taking a low daily dose of 25-50 mg.

In other words, the fear of bicalutamide is disproportionate to the actual real-world risk, especially for trans patients taking low doses.

This is what the bicalutamide comparison section has to say:

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison....Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.... In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.

Bicalutamide is the best alternative for most, but not all, trans youths wishing to block testosterone and achieve some bonus feminisation before being prescribed oestradiol. It has a lower risk profile overall than cyproterone acetate, but due to extremely rare risks of liver toxicity and lung diseases, many medical practitioners won't prescribe it 😞

Second generation non-steroidal anti-androgens

There are some promising second generation non-steroidal anti-androgens which may both be more effective and have an even lower risk profile than bicalutamide. These are:

• Apalutamide
• Darolutamide
• Enzalutamide

Of these, enzalutamide appears to be beginning to be used as part of feminising GAHT, at a dose of 160 mg daily, and the drug is approved by NICE at this dose.

Apalutamide has been approved by NICE at a dose of 240 mg daily.

Darolutamide, the newest of the meds, has been approved at a higher dose of 600 mg twice daily.

Each of these has its own risks and side effects that should be reviewed and taken into account. Enzalutamide purportedly "shows no risk of elevated liver enzymes or hepatotoxicity", but both it and apalutamide list a low possible risk of seizures.

Anti-oestrogens

There are anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

We wish we could be more positive about them here, but we wouldn't recommend any of them for anyone wishing to block oestrogen production or an oestrogenic puberty.

Look to the GnRH antagonists that aren't blocked (like relugolix), or consider the option below.

Monotherapy

It's very notable that the extended ban still does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is still nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormones.

This is due to the HPG axis, which works by negative feedback.

For people with testes taking feminising GAHT, sufficient estradiol indirectly puts testes into sleep mode.

For people with ovaries taking masculinising GAHT (aka masculinising hormone therapy), sufficient testosterone likewise puts ovaries into sleep mode.

For those taking testosterone, please do be careful not go above recommend peaks, as otherwise testosterone aromatisation will kick in and convert the excess into estradiol.

Aromatase is localized in the endoplasmic reticulum where it is regulated by tissue-specific promoters that are in turn controlled by hormones, cytokines, and other factors. It catalyzes the last steps of estrogen biosynthesis from androgens (specifically, it transforms androstenedione to estrone and testosterone to estradiol).

Please note that DHT (dihydrotestosterone) (aka androstanolone) -- a powerful androgen synthesised irreversibly from testosterone -- is not aromatised into any forms of oestrogen. Whilst not widely available, it can be used as an alternative to testosterone for masculinising GAHT.

Level ranges for monotherapy

Please note that the figures quoted below are the typical figures for trans adults. Even WPATH SOC8 seems to have no defined ranges for trans youth, just same vague dosage suggestions adapted from the Endocrine Society Guidelines under "Appendix C GENDER-AFFIRMING HORMONAL TREATMENTS" within "Table 3".

Feminising GAHT

For feminising GAHT in adults, monotherapy typically requires maintaining an oestradiol trough of ~734 pmol/L (200 pg/mL). It varies from person to person, so some folks might need as little as ~367 pmol/L (100 pg/mL) or as high as ~918 pmol/L (250 pg/mL).

You'll know if their oestradiol trough is sufficient if their testosterone level is <=2.4 nmol/L, though <=3 nmol/L is often still considered to be within the high-end of normal range. Please note that the target range varies wildly, with ranges such as 30-100 ng/dL (~1.04 to ~3.47 nmol/L) and <50 ng/dL (~1.73 nmol/L).

(On a sports tangent, the flawed Court of Arbitration for Sports (CAS) arbitrarily assigned a maximum testosterone level of 2 nmol/L in 2019 in relation to Caster Semenya. Please note that Semenya took CAS to the ECtHR over their regulations and won in July 2025.)

Please note that there's a lot of scaremongering over oestradiol level. The NHS typically demands you be within 400 to 600 pmol/L... despite the fact that the NHS considers normal, safe ranges during menstruation to be:

• Mid-luteal: 180 to 1068 pmol/L
• Peri-ovulatory: 349 to 1590 pmol/L

Broadly-speaking, an oestradiol range that is considered safe in the long-term for monotherapy is 200 to 400 pg/mL (~734 to ~1469 pmol/L). If you wish to be more cautious, then you could aim for 200 to 300 pg/mL (~734 to ~1101 pmol/L).

Masculinising GAHT

For masculinising GAHT in adults, the targets vary and keep changing.

On the previous 2024 version of Tavistock and Portman guidance ("Treatment of Gender Dysphoria in Trans masculine People v12.4.1"), the levels were listed as follows when using the prescription testosterone medication Sustanon 250 mg/mL every 2-4 weeks:

• a rather-low testosterone trough of ~10-12 nmol/L "on the day of the injection just before it is administered";
• a peak of ~25-30 nmol/L "one week after the injection".

The latest version of guidance we've found is Treatment of Gender Incongruence in Transgender men, Transmasculine and Non-
binary People (Assigned Female at Birth) v13.1 from April 2025. If anything, it's even shittier now, aiming for a trough range of 8-12 nmol/L!!!

The aim of therapy is to achieve trough testosterone levels at the bottom
of the normal male range (8-12 nmol/l) on the day of the injection, just
before it is administered, and to achieve peak testosterone levels in the
high normal male range but less than 30 nmol/l one week after the
injection.

For context, international guidance is 300 to 1,000 ng/dL (~10.4 nmol/L to ~34.7 nmol/L).

The NHS trough aim allows for a narrow testosterone range that is right at the very low end of tolerability and actually goes below it. Please note that low testosterone levels are associated with low mood and low energy.

In relation to arbitrarily taking a blood test 1 week after administration, please note that Sustanon 250 tends to peak within a few days, then steadily falls. (Put something like "sustanon 250 level curve" into your preferred search engine and look for image graphs: you'll soon see what we mean.) It's just nonsense endocrinology!

For Nebido 1000 mg (4 mL), the testosterone trough range is 10 to 15 nmol/L, which is low, but not as ridiculously bad as the guidance for Sustanon 250.

With testosterone gel (testogel), the guidance is very odd. They aim for a target range of 15 to 20 nmol/L, which is fairly decent... but they want this to be tested 4 to 6 hours after application, rather than at trough... which kind of makes their guidance dumb AF.

To give you a real-world comparison, our testosterone level before starting feminising GAHT was ~18.6 nmol/L in our late 30s. Given that our voice had broken at age 10 and fully dropped by age 11, we are fairly sure our testosterone level was much higher than 18.6 nmol/L back then!

You'll typically know if your kid's testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Benefits of monotherapy

Monotherapy completely avoids the need for any kind of puberty blocker, anti-androgen, or anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

With feminising GAHT, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) typically applied to the thighs or abdomen, but could in theory be achieved by sufficient patches applied twice weekly. Transdermal methods can benefit from being applied on the upper buttocks, but this will not be convenient or comfortable for everyone. Injections are sadly not available on prescription, and implants will be very, very expensive and only privately prescribed.

For masculinising GAHT, monotherapy can be easily achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon). However, the injection recommendations are all for adults, so these may be harder to adjust.

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://web.archive.org/web/20250416012633/https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/ 

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

We've already written up a shorter post with links to other resources here.

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help from the community :TransHeart:​ :HeartHands:

Here is a non-exhaustive list of organisations who may be able to offer you some immediate support:

• Mermaids
• Gendered Intelligence
• Switchboard National LGBTQIA+ Support Line

You can find more info resources and support on this Gender Construction Kit page.

And here are some other websites / people you may want to look up:

• Trans Kids Deserve Better
• Trans Kids Deserve To Grow Up
• Dee Whitnell (Founder of TransKidsDeservetoGrowUp)
• Queer AF
• Nancy Kelley (Executive Director of DIVA Magazine) and big supporter of trans youth
• Anne (aka Anne Health Limited), which has a helpline and offers trans+ gender-affirming healthcare 

Edits: Apologies for all the typos. We're trying to gradually get rid of them all 😅 Further apologies for the minor formatting edits as we notice issues.

Edits 2025-08-19:

• Added additional details for why we cyproterone acetate isn't recommended, including details from Wiki Trans (French resource).
• Added a link to a later post we've made to other resources.
• Updated some masculinising info based on most-recent NHS guidelines, mostly to show how dumb the guidance is.
• Fixed at least one dead link.
• Added in a note about switching terminology to GAHT.
• Added a note at the end about our plurality.

#TransKidsMatter #TransYouthAreLoved #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #TransKids #ProtectTransKids #trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransLiberationNow #TransRightsAreHumanRights #TransRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRHAgonists #GnRHAntagonists #GnRHAnalogues #AntiAndrogens #AntiEstrogens #AntiOestrogens #SERM #spironolactone #CyproteroneAcetate #bicalutamide

¹ We're plural (median, blurian)

 
(Please note that we've¹ defaulted to the British English spellings of oestrogen and oestradiol instead of estrogen and estradiol, as this issue affects those in the UK. In general, we use and prefer the versions without the leading, silent O.

Also, GnRH means gonadotropin-releasing hormone. You'll see us writing it a lot followed by "analogue", "agonist" or "antagonist". Those are all types of "puberty blockers".

Lastly, GAHT means gender-affirming hormone therapy. We prefer using this to HRT -- hormone replacement therapy -- which is a broader term.)
 

Original puberty blockers ban

Back on 2024-05-31, we wrote a post in response to the transphobic emergency restrictions for new prescriptions of puberty blockers to trans youth by the then health minister.

Our original post explaining that in more detail can be found here, but we have now unpinned it and replaced it with this post to ensure everyone has the most up-to-date info.
 

New government hopes dashed

It was hoped that the new government would not extend the ban, but as soon as they announced Wes "Weasel" Streeting (a highly vocal transphobe and self-loathing gay man) as the new Health Secretary, he pretty much immediately announced his intention to extend the temporary ban, with an aim to making it permanent.

Per this post by TransActual, it's not like Weasel and his advisors weren't made aware of all the negative impacts an extension would have, as "he was told about it when meeting with the representatives of LGBTQ+ organisations".

Even more darkly-farcical is that the justification Weasel used for continuing the targeted medical discrimination against trans youth is that it's being done "to avoid serious danger to health", which is not only contrary to the information provided by those LGBTQ+ organisations, but completely contrary to:

• increasing international condemnation of the Cass Review, which was the primary justification for the order;
• all valid scientific studies over decades, which were excluded by the Cass Review because they weren't "double blinded controlled studies" (which is medically unethical);
• even the frickin' BMA criticising and planning to review the Cass Review.

It's not that Weasel doesn't understand this: it's that he either doesn't care or actively wants to hurt trans youth by making it as difficult as possible for them to medically transition :PleadingFace: 😞
 

The temporary ban extension explained

The news page on on the government is coldly entitled Puberty blockers temporary ban extended, as if it's no big deal. It links to the original ban and to the new-and-worsened "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024" that's replacing it.

This order extends the duration of the original ban until 2024-11-26, but also increases its scope. The original order did not apply to Northern Ireland and allowed EU professionals to prescribe. This small loophole gave a glimmer of hope for supportive parents of trans youth, who could essentially:

• Get a prescription via a private online gender service from an EU medical professional.
• Travel to Northern Ireland to pick up the prescription.
• Travel back home to use it to support their trans kid.

The government clearly discovered this, as the new order has 2 very clear statements on the news page:

It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.

The government has also extended the order to cover Northern Ireland, following agreement from the Northern Ireland Executive, to come into effect from 27 August 2024.
 

Temporary ban extension number 2 😞

On 6th November 2024, a 2nd extension to the temporary ban was created, which will come into force on 27th November 2024 and last until the end of 31st December 2024.

Fortunately, it was only a time extension: not an expansion of the meds being blocked.

Indefinite ban

We bleeping hate this country. On 11th December 2024, an indefinite ban was imposed by the scumbags in power, under the false guise of safety. This will come into force from 1st January 2025 :FaceExhaling:

And now for the good news 🥰

GnRH antagonists

Weasel isn't as smart as he thinks he is. Under Article 2, they've continued to define GnRH analogues as:

a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin

It's been this way since the original temporary ban was introduced by the previous government and nobody has updated the wording.

Whilst technically calling them analogues isn't incorrect, all of the medications listed above are actually more-specifically GnRH agonists.

Just like the original order, they've ignored GnRH antagonists, as these don't tend to be typically prescribed for trans+ GAHT, despite being just as safe and effective, with the same low-risk profile.

GnRH agonists and antagonists are both types of GnRH analogues. It's just that, for some reason, the agonists tend to be prescribed rather than the antagonists.

The wiki page on GnRH antagonists even specifically states in the Other uses section:

GnRH antagonists could be used as puberty blockers in transgender youth and to suppress sex hormone levels in transgender adolescents and adults, but have not been studied in this context.

We've checked through the list of GnRH antagonists listed on NICE ("National Institute for Health and Care Excellence") as being able to be prescribed, and the following ones could be legally prescribed by any willing UK medical professional without infringing on the order:

• Cetrorelix (Wiki) (NICE) (EMC)
• Degarelix (Wiki) (NICE) (EMC)
• Ganirelix (Wiki) (NICE) (EMC)
• Relugolix (Wiki) (NICE) (No EMC page, but NICE has some details here)

The drugs would be being used off-label, but so are all the existing meds for trans people anyway! There are no officially-licensed medications for trans people in the UK. It's all outside of their prescription guidelines.

We actually had to sign 2 consent forms to request feminising GAHT (aka feminising hormone therapy), 1 of which genuinely reads:

I confirm I understand feminising hormones are not licenced for the treatment of Gender lncongruence; however, I am happy to receive this treatment.

That's not an outdated form either. It's what we had to return to the East of England Gender Service (EOEGS) in May 2024.

Elagolix appears to be starting to be used at 150 mg daily or 200 mg twice daily, but does not appear to be approved for use by NICE.
 

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens (steroidal and non-steroidal)

For those who want to block testosterone, the other options are broadly steroidal anti-androgens or non-steroidal anti-androgens. They're typically grouped together under anti-androgens.

Of these, the prescribable options are:

• spironolactone (NICE)
• cyproterone acetate (NICE)
• bicalutamide (NICE)

Why no mention of 5-alpha-reductase inhibitors like finasteride or dutasteride? Because all they do is reduce the conversion of testosterone into dihydrotestosterone (DHT). They're technically considered anti-androgens, but both have some pretty common side effects, haven't been shown to be effective for trans healthcare, and interact badly with micronised progesterone.

Spironolactone

Spironolactone has tonnes of common, negative side effects and is a weak anti-androgen at best. The fact that it's still even prescribed to trans people to block testosterone is probably solely because it's cheap. Even its Wiki page states:

Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.

Cyproterone acetate

Cyproterone acetate, even at low daily doses (6.25-12.5 mg), isn't particular great either. It's a progestin (a synthetic progestogen), has a fair number of common side effects, and can cause liver issues. It can even cause depression and negatively impact breast development if taken from the start of feminising GAHT.

The only safe progestogen for feminising GAHT is bioidentical micronised progesterone, and only after at least 6 months and having reached stage 3 on the Tanner Scale. It's best to avoid progestins at all costs, due to their inherent risks.

Bicalutamide

Now we come to the oft-overlooked and demonised bicalutamide, even though one of its key uses, as listed on its wiki page, is:

as a puberty blocker and component of feminizing hormone therapy for transgender girls and women

Bicalutamide is a first-generation non-steroidal anti-androgen and works in a different way to other anti-androgens. It actually increases testosterone production slightly, but then converts the excess into oestradiol (E2) and blocks androgen receptors. It's kind of an invisible blocker, as any blood tests will show a higher testosterone level, but androgenic effects will stop, due to the blocked receptors.

Its common side-effects are actually positive effects for many seeking feminisation (e.g., breast growth; decreased libido; reduced body hair growth) alongside blocking androgen receptors. This is, however, worth taking into consideration for someone who may want to block androgenic effects, but not particularly feminise, as this would not be best for them.

Bicalutamide does have a common chance of raising liver enzymes, so it's absolutely vital to monitor closely and get regular liver function blood tests.

Why vital? Because seeing elevated liver enzymes is an indicator of liver cells breaking down at an unusual rate, which can be an early warning sign of liver toxicity (toxic hepatitis). Further tests can then be run to confirm.

The liver is very capable organ in terms of recovery and regeneration, so stopping bicalutamide early if further tests are positive for liver toxicity will stop further damage and increase the likelihood of the liver repairing any slight damage caused.

And now we come to the reason why it's not more-commonly used: there have been 10 published case reports of liver toxicity reported to the FDA Adverse Event Reporting System (FAERS) in the USA, from which there were 2 deaths. As far as we can tell from reading the links into this, none of these were trans people (of any age) taking a low daily dose of 25-50 mg.

In other words, the fear of bicalutamide is disproportionate to the actual real-world risk, especially for trans patients taking low doses.

This is what the bicalutamide comparison section has to say:

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison....Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.... In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.

Bicalutamide is the best alternative for most, but not all, trans youths wishing to block testosterone and achieve some bonus feminisation before being prescribed oestradiol. It has a lower risk profile overall than cyproterone acetate, but due to extremely rare risks of liver toxicity and lung diseases, many medical practitioners won't prescribe it 😞

Second generation non-steroidal anti-androgens

There are some promising second generation non-steroidal anti-androgens which may both be more effective and have an even lower risk profile than bicalutamide. These are:

• Apalutamide
• Darolutamide
• Enzalutamide

Of these, enzalutamide appears to be beginning to be used as part of feminising GAHT, at a dose of 160 mg daily, and the drug is approved by NICE at this dose.

Apalutamide has been approved by NICE at a dose of 240 mg daily.

Darolutamide, the newest of the meds, has been approved at a higher dose of 600 mg twice daily.

Each of these has its own risks and side effects that should be reviewed and taken into account. Enzalutamide purportedly "shows no risk of elevated liver enzymes or hepatotoxicity", but both it and apalutamide list a low possible risk of seizures.

Anti-oestrogens

There are anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

We wish we could be more positive about them here, but we wouldn't recommend any of them for anyone wishing to block oestrogen production or an oestrogenic puberty.

Look to the GnRH antagonists that aren't blocked (like relugolix), or consider the option below.

Monotherapy

It's very notable that the extended ban still does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is still nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormones.

This is due to the HPG axis, which works by negative feedback.

For people with testes taking feminising GAHT, sufficient estradiol indirectly puts testes into sleep mode.

For people with ovaries taking masculinising GAHT (aka masculinising hormone therapy), sufficient testosterone likewise puts ovaries into sleep mode.

For those taking testosterone, please do be careful not go above recommend peaks, as otherwise testosterone aromatisation will kick in and convert the excess into estradiol.

Aromatase is localized in the endoplasmic reticulum where it is regulated by tissue-specific promoters that are in turn controlled by hormones, cytokines, and other factors. It catalyzes the last steps of estrogen biosynthesis from androgens (specifically, it transforms androstenedione to estrone and testosterone to estradiol).

Please note that DHT (dihydrotestosterone) (aka androstanolone) -- a powerful androgen synthesised irreversibly from testosterone -- is not aromatised into any forms of oestrogen. Whilst not widely available, it can be used as an alternative to testosterone for masculinising GAHT.

Level ranges for monotherapy

Please note that the figures quoted below are the typical figures for trans adults. Even WPATH SOC8 seems to have no defined ranges for trans youth, just same vague dosage suggestions adapted from the Endocrine Society Guidelines under "Appendix C GENDER-AFFIRMING HORMONAL TREATMENTS" within "Table 3".

Feminising GAHT

For feminising GAHT in adults, monotherapy typically requires maintaining an oestradiol trough of ~734 pmol/L (200 pg/mL). It varies from person to person, so some folks might need as little as ~367 pmol/L (100 pg/mL) or as high as ~918 pmol/L (250 pg/mL).

You'll know if their oestradiol trough is sufficient if their testosterone level is <=2.4 nmol/L, though <=3 nmol/L is often still considered to be within the high-end of normal range. Please note that the target range varies wildly, with ranges such as 30-100 ng/dL (~1.04 to ~3.47 nmol/L) and <50 ng/dL (~1.73 nmol/L).

(On a sports tangent, the flawed Court of Arbitration for Sports (CAS) arbitrarily assigned a maximum testosterone level of 2 nmol/L in 2019 in relation to Caster Semenya. Please note that Semenya took CAS to the ECtHR over their regulations and won in July 2025.)

Please note that there's a lot of scaremongering over oestradiol level. The NHS typically demands you be within 400 to 600 pmol/L... despite the fact that the NHS considers normal, safe ranges during menstruation to be:

• Mid-luteal: 180 to 1068 pmol/L
• Peri-ovulatory: 349 to 1590 pmol/L

Broadly-speaking, an oestradiol range that is considered safe in the long-term for monotherapy is 200 to 400 pg/mL (~734 to ~1469 pmol/L). If you wish to be more cautious, then you could aim for 200 to 300 pg/mL (~734 to ~1101 pmol/L).

Masculinising GAHT

For masculinising GAHT in adults, the targets vary and keep changing.

On the previous 2024 version of Tavistock and Portman guidance ("Treatment of Gender Dysphoria in Trans masculine People v12.4.1"), the levels were listed as follows when using the prescription testosterone medication Sustanon 250 mg/mL every 2-4 weeks:

• a rather-low testosterone trough of ~10-12 nmol/L "on the day of the injection just before it is administered";
• a peak of ~25-30 nmol/L "one week after the injection".

The latest version of guidance we've found is Treatment of Gender Incongruence in Transgender men, Transmasculine and Non-
binary People (Assigned Female at Birth) v13.1 from April 2025. If anything, it's even shittier now, aiming for a trough range of 8-12 nmol/L!!!

The aim of therapy is to achieve trough testosterone levels at the bottom
of the normal male range (8-12 nmol/l) on the day of the injection, just
before it is administered, and to achieve peak testosterone levels in the
high normal male range but less than 30 nmol/l one week after the
injection.

For context, international guidance is 300 to 1,000 ng/dL (~10.4 nmol/L to ~34.7 nmol/L).

The NHS trough aim allows for a narrow testosterone range that is right at the very low end of tolerability and actually goes below it. Please note that low testosterone levels are associated with low mood and low energy.

In relation to arbitrarily taking a blood test 1 week after administration, please note that Sustanon 250 tends to peak within a few days, then steadily falls. (Put something like "sustanon 250 level curve" into your preferred search engine and look for image graphs: you'll soon see what we mean.) It's just nonsense endocrinology!

For Nebido 1000 mg (4 mL), the testosterone trough range is 10 to 15 nmol/L, which is low, but not as ridiculously bad as the guidance for Sustanon 250.

With testosterone gel (testogel), the guidance is very odd. They aim for a target range of 15 to 20 nmol/L, which is fairly decent... but they want this to be tested 4 to 6 hours after application, rather than at trough... which kind of makes their guidance dumb AF.

To give you a real-world comparison, our testosterone level before starting feminising GAHT was ~18.6 nmol/L in our late 30s. Given that our voice had broken at age 10 and fully dropped by age 11, we are fairly sure our testosterone level was much higher than 18.6 nmol/L back then!

You'll typically know if your kid's testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Benefits of monotherapy

Monotherapy completely avoids the need for any kind of puberty blocker, anti-androgen, or anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

With feminising GAHT, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) typically applied to the thighs or abdomen, but could in theory be achieved by sufficient patches applied twice weekly. Transdermal methods can benefit from being applied on the upper buttocks, but this will not be convenient or comfortable for everyone. Injections are sadly not available on prescription, and implants will be very, very expensive and only privately prescribed.

For masculinising GAHT, monotherapy can be easily achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon). However, the injection recommendations are all for adults, so these may be harder to adjust.

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://web.archive.org/web/20250416012633/https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/ 

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

We've already written up a shorter post with links to other resources here.

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help from the community :TransHeart:​ :HeartHands:

Here is a non-exhaustive list of organisations who may be able to offer you some immediate support:

• Mermaids
• Gendered Intelligence
• Switchboard National LGBTQIA+ Support Line

You can find more info resources and support on this Gender Construction Kit page.

And here are some other websites / people you may want to look up:

• Trans Kids Deserve Better
• Trans Kids Deserve To Grow Up
• Dee Whitnell (Founder of TransKidsDeservetoGrowUp)
• Queer AF
• Nancy Kelley (Executive Director of DIVA Magazine) and big supporter of trans youth
• Anne (aka Anne Health Limited), which has a helpline and offers trans+ gender-affirming healthcare 

Edits: Apologies for all the typos. We're trying to gradually get rid of them all 😅 Further apologies for the minor formatting edits as we notice issues.

Edits 2025-08-19:

• Added additional details for why we cyproterone acetate isn't recommended, including details from Wiki Trans (French resource).
• Added a link to a later post we've made to other resources.
• Updated some masculinising info based on most-recent NHS guidelines, mostly to show how dumb the guidance is.
• Fixed at least one dead link.
• Added in a note about switching terminology to GAHT.
• Added a note at the end about our plurality.

#TransKidsMatter #TransYouthAreLoved #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #TransKids #ProtectTransKids #trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransLiberationNow #TransRightsAreHumanRights #TransRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRHAgonists #GnRHAntagonists #GnRHAnalogues #AntiAndrogens #AntiEstrogens #AntiOestrogens #SERM #spironolactone #CyproteroneAcetate #bicalutamide

¹ We're plural (median, blurian)

 
(Please note that we've¹ defaulted to the British English spellings of oestrogen and oestradiol instead of estrogen and estradiol, as this issue affects those in the UK. In general, we use and prefer the versions without the leading, silent O.

Also, GnRH means gonadotropin-releasing hormone. You'll see us writing it a lot followed by "analogue", "agonist" or "antagonist". Those are all types of "puberty blockers".

Lastly, GAHT means gender-affirming hormone therapy. We prefer using this to HRT -- hormone replacement therapy -- which is a broader term.)
 

Original puberty blockers ban

Back on 2024-05-31, we wrote a post in response to the transphobic emergency restrictions for new prescriptions of puberty blockers to trans youth by the then health minister.

Our original post explaining that in more detail can be found here, but we have now unpinned it and replaced it with this post to ensure everyone has the most up-to-date info.
 

New government hopes dashed

It was hoped that the new government would not extend the ban, but as soon as they announced Wes "Weasel" Streeting (a highly vocal transphobe and self-loathing gay man) as the new Health Secretary, he pretty much immediately announced his intention to extend the temporary ban, with an aim to making it permanent.

Per this post by TransActual, it's not like Weasel and his advisors weren't made aware of all the negative impacts an extension would have, as "he was told about it when meeting with the representatives of LGBTQ+ organisations".

Even more darkly-farcical is that the justification Weasel used for continuing the targeted medical discrimination against trans youth is that it's being done "to avoid serious danger to health", which is not only contrary to the information provided by those LGBTQ+ organisations, but completely contrary to:

• increasing international condemnation of the Cass Review, which was the primary justification for the order;
• all valid scientific studies over decades, which were excluded by the Cass Review because they weren't "double blinded controlled studies" (which is medically unethical);
• even the frickin' BMA criticising and planning to review the Cass Review.

It's not that Weasel doesn't understand this: it's that he either doesn't care or actively wants to hurt trans youth by making it as difficult as possible for them to medically transition :PleadingFace: 😞
 

The temporary ban extension explained

The news page on on the government is coldly entitled Puberty blockers temporary ban extended, as if it's no big deal. It links to the original ban and to the new-and-worsened "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024" that's replacing it.

This order extends the duration of the original ban until 2024-11-26, but also increases its scope. The original order did not apply to Northern Ireland and allowed EU professionals to prescribe. This small loophole gave a glimmer of hope for supportive parents of trans youth, who could essentially:

• Get a prescription via a private online gender service from an EU medical professional.
• Travel to Northern Ireland to pick up the prescription.
• Travel back home to use it to support their trans kid.

The government clearly discovered this, as the new order has 2 very clear statements on the news page:

It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.

The government has also extended the order to cover Northern Ireland, following agreement from the Northern Ireland Executive, to come into effect from 27 August 2024.
 

Temporary ban extension number 2 😞

On 6th November 2024, a 2nd extension to the temporary ban was created, which will come into force on 27th November 2024 and last until the end of 31st December 2024.

Fortunately, it was only a time extension: not an expansion of the meds being blocked.

Indefinite ban

We bleeping hate this country. On 11th December 2024, an indefinite ban was imposed by the scumbags in power, under the false guise of safety. This will come into force from 1st January 2025 :FaceExhaling:

And now for the good news 🥰

GnRH antagonists

Weasel isn't as smart as he thinks he is. Under Article 2, they've continued to define GnRH analogues as:

a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin

It's been this way since the original temporary ban was introduced by the previous government and nobody has updated the wording.

Whilst technically calling them analogues isn't incorrect, all of the medications listed above are actually more-specifically GnRH agonists.

Just like the original order, they've ignored GnRH antagonists, as these don't tend to be typically prescribed for trans+ GAHT, despite being just as safe and effective, with the same low-risk profile.

GnRH agonists and antagonists are both types of GnRH analogues. It's just that, for some reason, the agonists tend to be prescribed rather than the antagonists.

The wiki page on GnRH antagonists even specifically states in the Other uses section:

GnRH antagonists could be used as puberty blockers in transgender youth and to suppress sex hormone levels in transgender adolescents and adults, but have not been studied in this context.

We've checked through the list of GnRH antagonists listed on NICE ("National Institute for Health and Care Excellence") as being able to be prescribed, and the following ones could be legally prescribed by any willing UK medical professional without infringing on the order:

• Cetrorelix (Wiki) (NICE) (EMC)
• Degarelix (Wiki) (NICE) (EMC)
• Ganirelix (Wiki) (NICE) (EMC)
• Relugolix (Wiki) (NICE) (No EMC page, but NICE has some details here)

The drugs would be being used off-label, but so are all the existing meds for trans people anyway! There are no officially-licensed medications for trans people in the UK. It's all outside of their prescription guidelines.

We actually had to sign 2 consent forms to request feminising GAHT (aka feminising hormone therapy), 1 of which genuinely reads:

I confirm I understand feminising hormones are not licenced for the treatment of Gender lncongruence; however, I am happy to receive this treatment.

That's not an outdated form either. It's what we had to return to the East of England Gender Service (EOEGS) in May 2024.

Elagolix appears to be starting to be used at 150 mg daily or 200 mg twice daily, but does not appear to be approved for use by NICE.
 

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens (steroidal and non-steroidal)

For those who want to block testosterone, the other options are broadly steroidal anti-androgens or non-steroidal anti-androgens. They're typically grouped together under anti-androgens.

Of these, the prescribable options are:

• spironolactone (NICE)
• cyproterone acetate (NICE)
• bicalutamide (NICE)

Why no mention of 5-alpha-reductase inhibitors like finasteride or dutasteride? Because all they do is reduce the conversion of testosterone into dihydrotestosterone (DHT). They're technically considered anti-androgens, but both have some pretty common side effects, haven't been shown to be effective for trans healthcare, and interact badly with micronised progesterone.

Spironolactone

Spironolactone has tonnes of common, negative side effects and is a weak anti-androgen at best. The fact that it's still even prescribed to trans people to block testosterone is probably solely because it's cheap. Even its Wiki page states:

Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.

Cyproterone acetate

Cyproterone acetate, even at low daily doses (6.25-12.5 mg), isn't particular great either. It's a progestin (a synthetic progestogen), has a fair number of common side effects, and can cause liver issues. It can even cause depression and negatively impact breast development if taken from the start of feminising GAHT.

The only safe progestogen for feminising GAHT is bioidentical micronised progesterone, and only after at least 6 months and having reached stage 3 on the Tanner Scale. It's best to avoid progestins at all costs, due to their inherent risks.

Bicalutamide

Now we come to the oft-overlooked and demonised bicalutamide, even though one of its key uses, as listed on its wiki page, is:

as a puberty blocker and component of feminizing hormone therapy for transgender girls and women

Bicalutamide is a first-generation non-steroidal anti-androgen and works in a different way to other anti-androgens. It actually increases testosterone production slightly, but then converts the excess into oestradiol (E2) and blocks androgen receptors. It's kind of an invisible blocker, as any blood tests will show a higher testosterone level, but androgenic effects will stop, due to the blocked receptors.

Its common side-effects are actually positive effects for many seeking feminisation (e.g., breast growth; decreased libido; reduced body hair growth) alongside blocking androgen receptors. This is, however, worth taking into consideration for someone who may want to block androgenic effects, but not particularly feminise, as this would not be best for them.

Bicalutamide does have a common chance of raising liver enzymes, so it's absolutely vital to monitor closely and get regular liver function blood tests.

Why vital? Because seeing elevated liver enzymes is an indicator of liver cells breaking down at an unusual rate, which can be an early warning sign of liver toxicity (toxic hepatitis). Further tests can then be run to confirm.

The liver is very capable organ in terms of recovery and regeneration, so stopping bicalutamide early if further tests are positive for liver toxicity will stop further damage and increase the likelihood of the liver repairing any slight damage caused.

And now we come to the reason why it's not more-commonly used: there have been 10 published case reports of liver toxicity reported to the FDA Adverse Event Reporting System (FAERS) in the USA, from which there were 2 deaths. As far as we can tell from reading the links into this, none of these were trans people (of any age) taking a low daily dose of 25-50 mg.

In other words, the fear of bicalutamide is disproportionate to the actual real-world risk, especially for trans patients taking low doses.

This is what the bicalutamide comparison section has to say:

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison....Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.... In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.

Bicalutamide is the best alternative for most, but not all, trans youths wishing to block testosterone and achieve some bonus feminisation before being prescribed oestradiol. It has a lower risk profile overall than cyproterone acetate, but due to extremely rare risks of liver toxicity and lung diseases, many medical practitioners won't prescribe it 😞

Second generation non-steroidal anti-androgens

There are some promising second generation non-steroidal anti-androgens which may both be more effective and have an even lower risk profile than bicalutamide. These are:

• Apalutamide
• Darolutamide
• Enzalutamide

Of these, enzalutamide appears to be beginning to be used as part of feminising GAHT, at a dose of 160 mg daily, and the drug is approved by NICE at this dose.

Apalutamide has been approved by NICE at a dose of 240 mg daily.

Darolutamide, the newest of the meds, has been approved at a higher dose of 600 mg twice daily.

Each of these has its own risks and side effects that should be reviewed and taken into account. Enzalutamide purportedly "shows no risk of elevated liver enzymes or hepatotoxicity", but both it and apalutamide list a low possible risk of seizures.

Anti-oestrogens

There are anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

We wish we could be more positive about them here, but we wouldn't recommend any of them for anyone wishing to block oestrogen production or an oestrogenic puberty.

Look to the GnRH antagonists that aren't blocked (like relugolix), or consider the option below.

Monotherapy

It's very notable that the extended ban still does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is still nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormones.

This is due to the HPG axis, which works by negative feedback.

For people with testes taking feminising GAHT, sufficient estradiol indirectly puts testes into sleep mode.

For people with ovaries taking masculinising GAHT (aka masculinising hormone therapy), sufficient testosterone likewise puts ovaries into sleep mode.

For those taking testosterone, please do be careful not go above recommend peaks, as otherwise testosterone aromatisation will kick in and convert the excess into estradiol.

Aromatase is localized in the endoplasmic reticulum where it is regulated by tissue-specific promoters that are in turn controlled by hormones, cytokines, and other factors. It catalyzes the last steps of estrogen biosynthesis from androgens (specifically, it transforms androstenedione to estrone and testosterone to estradiol).

Please note that DHT (dihydrotestosterone) (aka androstanolone) -- a powerful androgen synthesised irreversibly from testosterone -- is not aromatised into any forms of oestrogen. Whilst not widely available, it can be used as an alternative to testosterone for masculinising GAHT.

Level ranges for monotherapy

Please note that the figures quoted below are the typical figures for trans adults. Even WPATH SOC8 seems to have no defined ranges for trans youth, just same vague dosage suggestions adapted from the Endocrine Society Guidelines under "Appendix C GENDER-AFFIRMING HORMONAL TREATMENTS" within "Table 3".

Feminising GAHT

For feminising GAHT in adults, monotherapy typically requires maintaining an oestradiol trough of ~734 pmol/L (200 pg/mL). It varies from person to person, so some folks might need as little as ~367 pmol/L (100 pg/mL) or as high as ~918 pmol/L (250 pg/mL).

You'll know if their oestradiol trough is sufficient if their testosterone level is <=2.4 nmol/L, though <=3 nmol/L is often still considered to be within the high-end of normal range. Please note that the target range varies wildly, with ranges such as 30-100 ng/dL (~1.04 to ~3.47 nmol/L) and <50 ng/dL (~1.73 nmol/L).

(On a sports tangent, the flawed Court of Arbitration for Sports (CAS) arbitrarily assigned a maximum testosterone level of 2 nmol/L in 2019 in relation to Caster Semenya. Please note that Semenya took CAS to the ECtHR over their regulations and won in July 2025.)

Please note that there's a lot of scaremongering over oestradiol level. The NHS typically demands you be within 400 to 600 pmol/L... despite the fact that the NHS considers normal, safe ranges during menstruation to be:

• Mid-luteal: 180 to 1068 pmol/L
• Peri-ovulatory: 349 to 1590 pmol/L

Broadly-speaking, an oestradiol range that is considered safe in the long-term for monotherapy is 200 to 400 pg/mL (~734 to ~1469 pmol/L). If you wish to be more cautious, then you could aim for 200 to 300 pg/mL (~734 to ~1101 pmol/L).

Masculinising GAHT

For masculinising GAHT in adults, the targets vary and keep changing.

On the previous 2024 version of Tavistock and Portman guidance ("Treatment of Gender Dysphoria in Trans masculine People v12.4.1"), the levels were listed as follows when using the prescription testosterone medication Sustanon 250 mg/mL every 2-4 weeks:

• a rather-low testosterone trough of ~10-12 nmol/L "on the day of the injection just before it is administered";
• a peak of ~25-30 nmol/L "one week after the injection".

The latest version of guidance we've found is Treatment of Gender Incongruence in Transgender men, Transmasculine and Non-
binary People (Assigned Female at Birth) v13.1 from April 2025. If anything, it's even shittier now, aiming for a trough range of 8-12 nmol/L!!!

The aim of therapy is to achieve trough testosterone levels at the bottom
of the normal male range (8-12 nmol/l) on the day of the injection, just
before it is administered, and to achieve peak testosterone levels in the
high normal male range but less than 30 nmol/l one week after the
injection.

For context, international guidance is 300 to 1,000 ng/dL (~10.4 nmol/L to ~34.7 nmol/L).

The NHS trough aim allows for a narrow testosterone range that is right at the very low end of tolerability and actually goes below it. Please note that low testosterone levels are associated with low mood and low energy.

In relation to arbitrarily taking a blood test 1 week after administration, please note that Sustanon 250 tends to peak within a few days, then steadily falls. (Put something like "sustanon 250 level curve" into your preferred search engine and look for image graphs: you'll soon see what we mean.) It's just nonsense endocrinology!

For Nebido 1000 mg (4 mL), the testosterone trough range is 10 to 15 nmol/L, which is low, but not as ridiculously bad as the guidance for Sustanon 250.

With testosterone gel (testogel), the guidance is very odd. They aim for a target range of 15 to 20 nmol/L, which is fairly decent... but they want this to be tested 4 to 6 hours after application, rather than at trough... which kind of makes their guidance dumb AF.

To give you a real-world comparison, our testosterone level before starting feminising GAHT was ~18.6 nmol/L in our late 30s. Given that our voice had broken at age 10 and fully dropped by age 11, we are fairly sure our testosterone level was much higher than 18.6 nmol/L back then!

You'll typically know if your kid's testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Benefits of monotherapy

Monotherapy completely avoids the need for any kind of puberty blocker, anti-androgen, or anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

With feminising GAHT, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) typically applied to the thighs or abdomen, but could in theory be achieved by sufficient patches applied twice weekly. Transdermal methods can benefit from being applied on the upper buttocks, but this will not be convenient or comfortable for everyone. Injections are sadly not available on prescription, and implants will be very, very expensive and only privately prescribed.

For masculinising GAHT, monotherapy can be easily achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon). However, the injection recommendations are all for adults, so these may be harder to adjust.

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://web.archive.org/web/20250416012633/https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/ 

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

We've already written up a shorter post with links to other resources here.

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help from the community :TransHeart:​ :HeartHands:

Here is a non-exhaustive list of organisations who may be able to offer you some immediate support:

• Mermaids
• Gendered Intelligence
• Switchboard National LGBTQIA+ Support Line

You can find more info resources and support on this Gender Construction Kit page.

And here are some other websites / people you may want to look up:

• Trans Kids Deserve Better
• Trans Kids Deserve To Grow Up
• Dee Whitnell (Founder of TransKidsDeservetoGrowUp)
• Queer AF
• Nancy Kelley (Executive Director of DIVA Magazine) and big supporter of trans youth
• Anne (aka Anne Health Limited), which has a helpline and offers trans+ gender-affirming healthcare 

Edits: Apologies for all the typos. We're trying to gradually get rid of them all 😅 Further apologies for the minor formatting edits as we notice issues.

Edits 2025-08-19:

• Added additional details for why we cyproterone acetate isn't recommended, including details from Wiki Trans (French resource).
• Added a link to a later post we've made to other resources.
• Updated some masculinising info based on most-recent NHS guidelines, mostly to show how dumb the guidance is.
• Fixed at least one dead link.
• Added in a note about switching terminology to GAHT.
• Added a note at the end about our plurality.

#TransKidsMatter #TransYouthAreLoved #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #TransKids #ProtectTransKids #trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransLiberationNow #TransRightsAreHumanRights #TransRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRHAgonists #GnRHAntagonists #GnRHAnalogues #AntiAndrogens #AntiEstrogens #AntiOestrogens #SERM #spironolactone #CyproteroneAcetate #bicalutamide

¹ We're plural (median, blurian)

 
(Please note that we've¹ defaulted to the British English spellings of oestrogen and oestradiol instead of estrogen and estradiol, as this issue affects those in the UK. In general, we use and prefer the versions without the leading, silent O.

Also, GnRH means gonadotropin-releasing hormone. You'll see us writing it a lot followed by "analogue", "agonist" or "antagonist". Those are all types of "puberty blockers".

Lastly, GAHT means gender-affirming hormone therapy. We prefer using this to HRT -- hormone replacement therapy -- which is a broader term.)
 

Original puberty blockers ban

Back on 2024-05-31, we wrote a post in response to the transphobic emergency restrictions for new prescriptions of puberty blockers to trans youth by the then health minister.

Our original post explaining that in more detail can be found here, but we have now unpinned it and replaced it with this post to ensure everyone has the most up-to-date info.
 

New government hopes dashed

It was hoped that the new government would not extend the ban, but as soon as they announced Wes "Weasel" Streeting (a highly vocal transphobe and self-loathing gay man) as the new Health Secretary, he pretty much immediately announced his intention to extend the temporary ban, with an aim to making it permanent.

Per this post by TransActual, it's not like Weasel and his advisors weren't made aware of all the negative impacts an extension would have, as "he was told about it when meeting with the representatives of LGBTQ+ organisations".

Even more darkly-farcical is that the justification Weasel used for continuing the targeted medical discrimination against trans youth is that it's being done "to avoid serious danger to health", which is not only contrary to the information provided by those LGBTQ+ organisations, but completely contrary to:

• increasing international condemnation of the Cass Review, which was the primary justification for the order;
• all valid scientific studies over decades, which were excluded by the Cass Review because they weren't "double blinded controlled studies" (which is medically unethical);
• even the frickin' BMA criticising and planning to review the Cass Review.

It's not that Weasel doesn't understand this: it's that he either doesn't care or actively wants to hurt trans youth by making it as difficult as possible for them to medically transition :PleadingFace: 😞
 

The temporary ban extension explained

The news page on on the government is coldly entitled Puberty blockers temporary ban extended, as if it's no big deal. It links to the original ban and to the new-and-worsened "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024" that's replacing it.

This order extends the duration of the original ban until 2024-11-26, but also increases its scope. The original order did not apply to Northern Ireland and allowed EU professionals to prescribe. This small loophole gave a glimmer of hope for supportive parents of trans youth, who could essentially:

• Get a prescription via a private online gender service from an EU medical professional.
• Travel to Northern Ireland to pick up the prescription.
• Travel back home to use it to support their trans kid.

The government clearly discovered this, as the new order has 2 very clear statements on the news page:

It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.

The government has also extended the order to cover Northern Ireland, following agreement from the Northern Ireland Executive, to come into effect from 27 August 2024.
 

Temporary ban extension number 2 😞

On 6th November 2024, a 2nd extension to the temporary ban was created, which will come into force on 27th November 2024 and last until the end of 31st December 2024.

Fortunately, it was only a time extension: not an expansion of the meds being blocked.

Indefinite ban

We bleeping hate this country. On 11th December 2024, an indefinite ban was imposed by the scumbags in power, under the false guise of safety. This will come into force from 1st January 2025 :FaceExhaling:

And now for the good news 🥰

GnRH antagonists

Weasel isn't as smart as he thinks he is. Under Article 2, they've continued to define GnRH analogues as:

a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin

It's been this way since the original temporary ban was introduced by the previous government and nobody has updated the wording.

Whilst technically calling them analogues isn't incorrect, all of the medications listed above are actually more-specifically GnRH agonists.

Just like the original order, they've ignored GnRH antagonists, as these don't tend to be typically prescribed for trans+ GAHT, despite being just as safe and effective, with the same low-risk profile.

GnRH agonists and antagonists are both types of GnRH analogues. It's just that, for some reason, the agonists tend to be prescribed rather than the antagonists.

The wiki page on GnRH antagonists even specifically states in the Other uses section:

GnRH antagonists could be used as puberty blockers in transgender youth and to suppress sex hormone levels in transgender adolescents and adults, but have not been studied in this context.

We've checked through the list of GnRH antagonists listed on NICE ("National Institute for Health and Care Excellence") as being able to be prescribed, and the following ones could be legally prescribed by any willing UK medical professional without infringing on the order:

• Cetrorelix (Wiki) (NICE) (EMC)
• Degarelix (Wiki) (NICE) (EMC)
• Ganirelix (Wiki) (NICE) (EMC)
• Relugolix (Wiki) (NICE) (No EMC page, but NICE has some details here)

The drugs would be being used off-label, but so are all the existing meds for trans people anyway! There are no officially-licensed medications for trans people in the UK. It's all outside of their prescription guidelines.

We actually had to sign 2 consent forms to request feminising GAHT (aka feminising hormone therapy), 1 of which genuinely reads:

I confirm I understand feminising hormones are not licenced for the treatment of Gender lncongruence; however, I am happy to receive this treatment.

That's not an outdated form either. It's what we had to return to the East of England Gender Service (EOEGS) in May 2024.

Elagolix appears to be starting to be used at 150 mg daily or 200 mg twice daily, but does not appear to be approved for use by NICE.
 

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens (steroidal and non-steroidal)

For those who want to block testosterone, the other options are broadly steroidal anti-androgens or non-steroidal anti-androgens. They're typically grouped together under anti-androgens.

Of these, the prescribable options are:

• spironolactone (NICE)
• cyproterone acetate (NICE)
• bicalutamide (NICE)

Why no mention of 5-alpha-reductase inhibitors like finasteride or dutasteride? Because all they do is reduce the conversion of testosterone into dihydrotestosterone (DHT). They're technically considered anti-androgens, but both have some pretty common side effects, haven't been shown to be effective for trans healthcare, and interact badly with micronised progesterone.

Spironolactone

Spironolactone has tonnes of common, negative side effects and is a weak anti-androgen at best. The fact that it's still even prescribed to trans people to block testosterone is probably solely because it's cheap. Even its Wiki page states:

Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.

Cyproterone acetate

Cyproterone acetate, even at low daily doses (6.25-12.5 mg), isn't particular great either. It's a progestin (a synthetic progestogen), has a fair number of common side effects, and can cause liver issues. It can even cause depression and negatively impact breast development if taken from the start of feminising GAHT.

The only safe progestogen for feminising GAHT is bioidentical micronised progesterone, and only after at least 6 months and having reached stage 3 on the Tanner Scale. It's best to avoid progestins at all costs, due to their inherent risks.

Bicalutamide

Now we come to the oft-overlooked and demonised bicalutamide, even though one of its key uses, as listed on its wiki page, is:

as a puberty blocker and component of feminizing hormone therapy for transgender girls and women

Bicalutamide is a first-generation non-steroidal anti-androgen and works in a different way to other anti-androgens. It actually increases testosterone production slightly, but then converts the excess into oestradiol (E2) and blocks androgen receptors. It's kind of an invisible blocker, as any blood tests will show a higher testosterone level, but androgenic effects will stop, due to the blocked receptors.

Its common side-effects are actually positive effects for many seeking feminisation (e.g., breast growth; decreased libido; reduced body hair growth) alongside blocking androgen receptors. This is, however, worth taking into consideration for someone who may want to block androgenic effects, but not particularly feminise, as this would not be best for them.

Bicalutamide does have a common chance of raising liver enzymes, so it's absolutely vital to monitor closely and get regular liver function blood tests.

Why vital? Because seeing elevated liver enzymes is an indicator of liver cells breaking down at an unusual rate, which can be an early warning sign of liver toxicity (toxic hepatitis). Further tests can then be run to confirm.

The liver is very capable organ in terms of recovery and regeneration, so stopping bicalutamide early if further tests are positive for liver toxicity will stop further damage and increase the likelihood of the liver repairing any slight damage caused.

And now we come to the reason why it's not more-commonly used: there have been 10 published case reports of liver toxicity reported to the FDA Adverse Event Reporting System (FAERS) in the USA, from which there were 2 deaths. As far as we can tell from reading the links into this, none of these were trans people (of any age) taking a low daily dose of 25-50 mg.

In other words, the fear of bicalutamide is disproportionate to the actual real-world risk, especially for trans patients taking low doses.

This is what the bicalutamide comparison section has to say:

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison....Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.... In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.

Bicalutamide is the best alternative for most, but not all, trans youths wishing to block testosterone and achieve some bonus feminisation before being prescribed oestradiol. It has a lower risk profile overall than cyproterone acetate, but due to extremely rare risks of liver toxicity and lung diseases, many medical practitioners won't prescribe it 😞

Second generation non-steroidal anti-androgens

There are some promising second generation non-steroidal anti-androgens which may both be more effective and have an even lower risk profile than bicalutamide. These are:

• Apalutamide
• Darolutamide
• Enzalutamide

Of these, enzalutamide appears to be beginning to be used as part of feminising GAHT, at a dose of 160 mg daily, and the drug is approved by NICE at this dose.

Apalutamide has been approved by NICE at a dose of 240 mg daily.

Darolutamide, the newest of the meds, has been approved at a higher dose of 600 mg twice daily.

Each of these has its own risks and side effects that should be reviewed and taken into account. Enzalutamide purportedly "shows no risk of elevated liver enzymes or hepatotoxicity", but both it and apalutamide list a low possible risk of seizures.

Anti-oestrogens

There are anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

We wish we could be more positive about them here, but we wouldn't recommend any of them for anyone wishing to block oestrogen production or an oestrogenic puberty.

Look to the GnRH antagonists that aren't blocked (like relugolix), or consider the option below.

Monotherapy

It's very notable that the extended ban still does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is still nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormones.

This is due to the HPG axis, which works by negative feedback.

For people with testes taking feminising GAHT, sufficient estradiol indirectly puts testes into sleep mode.

For people with ovaries taking masculinising GAHT (aka masculinising hormone therapy), sufficient testosterone likewise puts ovaries into sleep mode.

For those taking testosterone, please do be careful not go above recommend peaks, as otherwise testosterone aromatisation will kick in and convert the excess into estradiol.

Aromatase is localized in the endoplasmic reticulum where it is regulated by tissue-specific promoters that are in turn controlled by hormones, cytokines, and other factors. It catalyzes the last steps of estrogen biosynthesis from androgens (specifically, it transforms androstenedione to estrone and testosterone to estradiol).

Please note that DHT (dihydrotestosterone) (aka androstanolone) -- a powerful androgen synthesised irreversibly from testosterone -- is not aromatised into any forms of oestrogen. Whilst not widely available, it can be used as an alternative to testosterone for masculinising GAHT.

Level ranges for monotherapy

Please note that the figures quoted below are the typical figures for trans adults. Even WPATH SOC8 seems to have no defined ranges for trans youth, just same vague dosage suggestions adapted from the Endocrine Society Guidelines under "Appendix C GENDER-AFFIRMING HORMONAL TREATMENTS" within "Table 3".

Feminising GAHT

For feminising GAHT in adults, monotherapy typically requires maintaining an oestradiol trough of ~734 pmol/L (200 pg/mL). It varies from person to person, so some folks might need as little as ~367 pmol/L (100 pg/mL) or as high as ~918 pmol/L (250 pg/mL).

You'll know if their oestradiol trough is sufficient if their testosterone level is <=2.4 nmol/L, though <=3 nmol/L is often still considered to be within the high-end of normal range. Please note that the target range varies wildly, with ranges such as 30-100 ng/dL (~1.04 to ~3.47 nmol/L) and <50 ng/dL (~1.73 nmol/L).

(On a sports tangent, the flawed Court of Arbitration for Sports (CAS) arbitrarily assigned a maximum testosterone level of 2 nmol/L in 2019 in relation to Caster Semenya. Please note that Semenya took CAS to the ECtHR over their regulations and won in July 2025.)

Please note that there's a lot of scaremongering over oestradiol level. The NHS typically demands you be within 400 to 600 pmol/L... despite the fact that the NHS considers normal, safe ranges during menstruation to be:

• Mid-luteal: 180 to 1068 pmol/L
• Peri-ovulatory: 349 to 1590 pmol/L

Broadly-speaking, an oestradiol range that is considered safe in the long-term for monotherapy is 200 to 400 pg/mL (~734 to ~1469 pmol/L). If you wish to be more cautious, then you could aim for 200 to 300 pg/mL (~734 to ~1101 pmol/L).

Masculinising GAHT

For masculinising GAHT in adults, the targets vary and keep changing.

On the previous 2024 version of Tavistock and Portman guidance ("Treatment of Gender Dysphoria in Trans masculine People v12.4.1"), the levels were listed as follows when using the prescription testosterone medication Sustanon 250 mg/mL every 2-4 weeks:

• a rather-low testosterone trough of ~10-12 nmol/L "on the day of the injection just before it is administered";
• a peak of ~25-30 nmol/L "one week after the injection".

The latest version of guidance we've found is Treatment of Gender Incongruence in Transgender men, Transmasculine and Non-
binary People (Assigned Female at Birth) v13.1 from April 2025. If anything, it's even shittier now, aiming for a trough range of 8-12 nmol/L!!!

The aim of therapy is to achieve trough testosterone levels at the bottom
of the normal male range (8-12 nmol/l) on the day of the injection, just
before it is administered, and to achieve peak testosterone levels in the
high normal male range but less than 30 nmol/l one week after the
injection.

For context, international guidance is 300 to 1,000 ng/dL (~10.4 nmol/L to ~34.7 nmol/L).

The NHS trough aim allows for a narrow testosterone range that is right at the very low end of tolerability and actually goes below it. Please note that low testosterone levels are associated with low mood and low energy.

In relation to arbitrarily taking a blood test 1 week after administration, please note that Sustanon 250 tends to peak within a few days, then steadily falls. (Put something like "sustanon 250 level curve" into your preferred search engine and look for image graphs: you'll soon see what we mean.) It's just nonsense endocrinology!

For Nebido 1000 mg (4 mL), the testosterone trough range is 10 to 15 nmol/L, which is low, but not as ridiculously bad as the guidance for Sustanon 250.

With testosterone gel (testogel), the guidance is very odd. They aim for a target range of 15 to 20 nmol/L, which is fairly decent... but they want this to be tested 4 to 6 hours after application, rather than at trough... which kind of makes their guidance dumb AF.

To give you a real-world comparison, our testosterone level before starting feminising GAHT was ~18.6 nmol/L in our late 30s. Given that our voice had broken at age 10 and fully dropped by age 11, we are fairly sure our testosterone level was much higher than 18.6 nmol/L back then!

You'll typically know if your kid's testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Benefits of monotherapy

Monotherapy completely avoids the need for any kind of puberty blocker, anti-androgen, or anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

With feminising GAHT, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) typically applied to the thighs or abdomen, but could in theory be achieved by sufficient patches applied twice weekly. Transdermal methods can benefit from being applied on the upper buttocks, but this will not be convenient or comfortable for everyone. Injections are sadly not available on prescription, and implants will be very, very expensive and only privately prescribed.

For masculinising GAHT, monotherapy can be easily achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon). However, the injection recommendations are all for adults, so these may be harder to adjust.

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://web.archive.org/web/20250416012633/https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/ 

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

We've already written up a shorter post with links to other resources here.

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help from the community :TransHeart:​ :HeartHands:

Here is a non-exhaustive list of organisations who may be able to offer you some immediate support:

• Mermaids
• Gendered Intelligence
• Switchboard National LGBTQIA+ Support Line

You can find more info resources and support on this Gender Construction Kit page.

And here are some other websites / people you may want to look up:

• Trans Kids Deserve Better
• Trans Kids Deserve To Grow Up
• Dee Whitnell (Founder of TransKidsDeservetoGrowUp)
• Queer AF
• Nancy Kelley (Executive Director of DIVA Magazine) and big supporter of trans youth
• Anne (aka Anne Health Limited), which has a helpline and offers trans+ gender-affirming healthcare 

Edits: Apologies for all the typos. We're trying to gradually get rid of them all 😅 Further apologies for the minor formatting edits as we notice issues.

Edits 2025-08-19:

• Added additional details for why we cyproterone acetate isn't recommended, including details from Wiki Trans (French resource).
• Added a link to a later post we've made to other resources.
• Updated some masculinising info based on most-recent NHS guidelines, mostly to show how dumb the guidance is.
• Fixed at least one dead link.
• Added in a note about switching terminology to GAHT.
• Added a note at the end about our plurality.

#TransKidsMatter #TransYouthAreLoved #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #TransKids #ProtectTransKids #trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransLiberationNow #TransRightsAreHumanRights #TransRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRHAgonists #GnRHAntagonists #GnRHAnalogues #AntiAndrogens #AntiEstrogens #AntiOestrogens #SERM #spironolactone #CyproteroneAcetate #bicalutamide

¹ We're plural (median, blurian)

 
(Please note that we've¹ defaulted to the British English spellings of oestrogen and oestradiol instead of estrogen and estradiol, as this issue affects those in the UK. In general, we use and prefer the versions without the leading, silent O.

Also, GnRH means gonadotropin-releasing hormone. You'll see us writing it a lot followed by "analogue", "agonist" or "antagonist". Those are all types of "puberty blockers".

Lastly, GAHT means gender-affirming hormone therapy. We prefer using this to HRT -- hormone replacement therapy -- which is a broader term.)
 

Original puberty blockers ban

Back on 2024-05-31, we wrote a post in response to the transphobic emergency restrictions for new prescriptions of puberty blockers to trans youth by the then health minister.

Our original post explaining that in more detail can be found here, but we have now unpinned it and replaced it with this post to ensure everyone has the most up-to-date info.
 

New government hopes dashed

It was hoped that the new government would not extend the ban, but as soon as they announced Wes "Weasel" Streeting (a highly vocal transphobe and self-loathing gay man) as the new Health Secretary, he pretty much immediately announced his intention to extend the temporary ban, with an aim to making it permanent.

Per this post by TransActual, it's not like Weasel and his advisors weren't made aware of all the negative impacts an extension would have, as "he was told about it when meeting with the representatives of LGBTQ+ organisations".

Even more darkly-farcical is that the justification Weasel used for continuing the targeted medical discrimination against trans youth is that it's being done "to avoid serious danger to health", which is not only contrary to the information provided by those LGBTQ+ organisations, but completely contrary to:

• increasing international condemnation of the Cass Review, which was the primary justification for the order;
• all valid scientific studies over decades, which were excluded by the Cass Review because they weren't "double blinded controlled studies" (which is medically unethical);
• even the frickin' BMA criticising and planning to review the Cass Review.

It's not that Weasel doesn't understand this: it's that he either doesn't care or actively wants to hurt trans youth by making it as difficult as possible for them to medically transition :PleadingFace: 😞
 

The temporary ban extension explained

The news page on on the government is coldly entitled Puberty blockers temporary ban extended, as if it's no big deal. It links to the original ban and to the new-and-worsened "The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024" that's replacing it.

This order extends the duration of the original ban until 2024-11-26, but also increases its scope. The original order did not apply to Northern Ireland and allowed EU professionals to prescribe. This small loophole gave a glimmer of hope for supportive parents of trans youth, who could essentially:

• Get a prescription via a private online gender service from an EU medical professional.
• Travel to Northern Ireland to pick up the prescription.
• Travel back home to use it to support their trans kid.

The government clearly discovered this, as the new order has 2 very clear statements on the news page:

It also prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland for any purposes to those under 18.

The government has also extended the order to cover Northern Ireland, following agreement from the Northern Ireland Executive, to come into effect from 27 August 2024.
 

Temporary ban extension number 2 😞

On 6th November 2024, a 2nd extension to the temporary ban was created, which will come into force on 27th November 2024 and last until the end of 31st December 2024.

Fortunately, it was only a time extension: not an expansion of the meds being blocked.

Indefinite ban

We bleeping hate this country. On 11th December 2024, an indefinite ban was imposed by the scumbags in power, under the false guise of safety. This will come into force from 1st January 2025 :FaceExhaling:

And now for the good news 🥰

GnRH antagonists

Weasel isn't as smart as he thinks he is. Under Article 2, they've continued to define GnRH analogues as:

a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin

It's been this way since the original temporary ban was introduced by the previous government and nobody has updated the wording.

Whilst technically calling them analogues isn't incorrect, all of the medications listed above are actually more-specifically GnRH agonists.

Just like the original order, they've ignored GnRH antagonists, as these don't tend to be typically prescribed for trans+ GAHT, despite being just as safe and effective, with the same low-risk profile.

GnRH agonists and antagonists are both types of GnRH analogues. It's just that, for some reason, the agonists tend to be prescribed rather than the antagonists.

The wiki page on GnRH antagonists even specifically states in the Other uses section:

GnRH antagonists could be used as puberty blockers in transgender youth and to suppress sex hormone levels in transgender adolescents and adults, but have not been studied in this context.

We've checked through the list of GnRH antagonists listed on NICE ("National Institute for Health and Care Excellence") as being able to be prescribed, and the following ones could be legally prescribed by any willing UK medical professional without infringing on the order:

• Cetrorelix (Wiki) (NICE) (EMC)
• Degarelix (Wiki) (NICE) (EMC)
• Ganirelix (Wiki) (NICE) (EMC)
• Relugolix (Wiki) (NICE) (No EMC page, but NICE has some details here)

The drugs would be being used off-label, but so are all the existing meds for trans people anyway! There are no officially-licensed medications for trans people in the UK. It's all outside of their prescription guidelines.

We actually had to sign 2 consent forms to request feminising GAHT (aka feminising hormone therapy), 1 of which genuinely reads:

I confirm I understand feminising hormones are not licenced for the treatment of Gender lncongruence; however, I am happy to receive this treatment.

That's not an outdated form either. It's what we had to return to the East of England Gender Service (EOEGS) in May 2024.

Elagolix appears to be starting to be used at 150 mg daily or 200 mg twice daily, but does not appear to be approved for use by NICE.
 

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens (steroidal and non-steroidal)

For those who want to block testosterone, the other options are broadly steroidal anti-androgens or non-steroidal anti-androgens. They're typically grouped together under anti-androgens.

Of these, the prescribable options are:

• spironolactone (NICE)
• cyproterone acetate (NICE)
• bicalutamide (NICE)

Why no mention of 5-alpha-reductase inhibitors like finasteride or dutasteride? Because all they do is reduce the conversion of testosterone into dihydrotestosterone (DHT). They're technically considered anti-androgens, but both have some pretty common side effects, haven't been shown to be effective for trans healthcare, and interact badly with micronised progesterone.

Spironolactone

Spironolactone has tonnes of common, negative side effects and is a weak anti-androgen at best. The fact that it's still even prescribed to trans people to block testosterone is probably solely because it's cheap. Even its Wiki page states:

Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.

Cyproterone acetate

Cyproterone acetate, even at low daily doses (6.25-12.5 mg), isn't particular great either. It's a progestin (a synthetic progestogen), has a fair number of common side effects, and can cause liver issues. It can even cause depression and negatively impact breast development if taken from the start of feminising GAHT.

The only safe progestogen for feminising GAHT is bioidentical micronised progesterone, and only after at least 6 months and having reached stage 3 on the Tanner Scale. It's best to avoid progestins at all costs, due to their inherent risks.

Bicalutamide

Now we come to the oft-overlooked and demonised bicalutamide, even though one of its key uses, as listed on its wiki page, is:

as a puberty blocker and component of feminizing hormone therapy for transgender girls and women

Bicalutamide is a first-generation non-steroidal anti-androgen and works in a different way to other anti-androgens. It actually increases testosterone production slightly, but then converts the excess into oestradiol (E2) and blocks androgen receptors. It's kind of an invisible blocker, as any blood tests will show a higher testosterone level, but androgenic effects will stop, due to the blocked receptors.

Its common side-effects are actually positive effects for many seeking feminisation (e.g., breast growth; decreased libido; reduced body hair growth) alongside blocking androgen receptors. This is, however, worth taking into consideration for someone who may want to block androgenic effects, but not particularly feminise, as this would not be best for them.

Bicalutamide does have a common chance of raising liver enzymes, so it's absolutely vital to monitor closely and get regular liver function blood tests.

Why vital? Because seeing elevated liver enzymes is an indicator of liver cells breaking down at an unusual rate, which can be an early warning sign of liver toxicity (toxic hepatitis). Further tests can then be run to confirm.

The liver is very capable organ in terms of recovery and regeneration, so stopping bicalutamide early if further tests are positive for liver toxicity will stop further damage and increase the likelihood of the liver repairing any slight damage caused.

And now we come to the reason why it's not more-commonly used: there have been 10 published case reports of liver toxicity reported to the FDA Adverse Event Reporting System (FAERS) in the USA, from which there were 2 deaths. As far as we can tell from reading the links into this, none of these were trans people (of any age) taking a low daily dose of 25-50 mg.

In other words, the fear of bicalutamide is disproportionate to the actual real-world risk, especially for trans patients taking low doses.

This is what the bicalutamide comparison section has to say:

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison....Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.... In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.

Bicalutamide is the best alternative for most, but not all, trans youths wishing to block testosterone and achieve some bonus feminisation before being prescribed oestradiol. It has a lower risk profile overall than cyproterone acetate, but due to extremely rare risks of liver toxicity and lung diseases, many medical practitioners won't prescribe it 😞

Second generation non-steroidal anti-androgens

There are some promising second generation non-steroidal anti-androgens which may both be more effective and have an even lower risk profile than bicalutamide. These are:

• Apalutamide
• Darolutamide
• Enzalutamide

Of these, enzalutamide appears to be beginning to be used as part of feminising GAHT, at a dose of 160 mg daily, and the drug is approved by NICE at this dose.

Apalutamide has been approved by NICE at a dose of 240 mg daily.

Darolutamide, the newest of the meds, has been approved at a higher dose of 600 mg twice daily.

Each of these has its own risks and side effects that should be reviewed and taken into account. Enzalutamide purportedly "shows no risk of elevated liver enzymes or hepatotoxicity", but both it and apalutamide list a low possible risk of seizures.

Anti-oestrogens

There are anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

We wish we could be more positive about them here, but we wouldn't recommend any of them for anyone wishing to block oestrogen production or an oestrogenic puberty.

Look to the GnRH antagonists that aren't blocked (like relugolix), or consider the option below.

Monotherapy

It's very notable that the extended ban still does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is still nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormones.

This is due to the HPG axis, which works by negative feedback.

For people with testes taking feminising GAHT, sufficient estradiol indirectly puts testes into sleep mode.

For people with ovaries taking masculinising GAHT (aka masculinising hormone therapy), sufficient testosterone likewise puts ovaries into sleep mode.

For those taking testosterone, please do be careful not go above recommend peaks, as otherwise testosterone aromatisation will kick in and convert the excess into estradiol.

Aromatase is localized in the endoplasmic reticulum where it is regulated by tissue-specific promoters that are in turn controlled by hormones, cytokines, and other factors. It catalyzes the last steps of estrogen biosynthesis from androgens (specifically, it transforms androstenedione to estrone and testosterone to estradiol).

Please note that DHT (dihydrotestosterone) (aka androstanolone) -- a powerful androgen synthesised irreversibly from testosterone -- is not aromatised into any forms of oestrogen. Whilst not widely available, it can be used as an alternative to testosterone for masculinising GAHT.

Level ranges for monotherapy

Please note that the figures quoted below are the typical figures for trans adults. Even WPATH SOC8 seems to have no defined ranges for trans youth, just same vague dosage suggestions adapted from the Endocrine Society Guidelines under "Appendix C GENDER-AFFIRMING HORMONAL TREATMENTS" within "Table 3".

Feminising GAHT

For feminising GAHT in adults, monotherapy typically requires maintaining an oestradiol trough of ~734 pmol/L (200 pg/mL). It varies from person to person, so some folks might need as little as ~367 pmol/L (100 pg/mL) or as high as ~918 pmol/L (250 pg/mL).

You'll know if their oestradiol trough is sufficient if their testosterone level is <=2.4 nmol/L, though <=3 nmol/L is often still considered to be within the high-end of normal range. Please note that the target range varies wildly, with ranges such as 30-100 ng/dL (~1.04 to ~3.47 nmol/L) and <50 ng/dL (~1.73 nmol/L).

(On a sports tangent, the flawed Court of Arbitration for Sports (CAS) arbitrarily assigned a maximum testosterone level of 2 nmol/L in 2019 in relation to Caster Semenya. Please note that Semenya took CAS to the ECtHR over their regulations and won in July 2025.)

Please note that there's a lot of scaremongering over oestradiol level. The NHS typically demands you be within 400 to 600 pmol/L... despite the fact that the NHS considers normal, safe ranges during menstruation to be:

• Mid-luteal: 180 to 1068 pmol/L
• Peri-ovulatory: 349 to 1590 pmol/L

Broadly-speaking, an oestradiol range that is considered safe in the long-term for monotherapy is 200 to 400 pg/mL (~734 to ~1469 pmol/L). If you wish to be more cautious, then you could aim for 200 to 300 pg/mL (~734 to ~1101 pmol/L).

Masculinising GAHT

For masculinising GAHT in adults, the targets vary and keep changing.

On the previous 2024 version of Tavistock and Portman guidance ("Treatment of Gender Dysphoria in Trans masculine People v12.4.1"), the levels were listed as follows when using the prescription testosterone medication Sustanon 250 mg/mL every 2-4 weeks:

• a rather-low testosterone trough of ~10-12 nmol/L "on the day of the injection just before it is administered";
• a peak of ~25-30 nmol/L "one week after the injection".

The latest version of guidance we've found is Treatment of Gender Incongruence in Transgender men, Transmasculine and Non-
binary People (Assigned Female at Birth) v13.1 from April 2025. If anything, it's even shittier now, aiming for a trough range of 8-12 nmol/L!!!

The aim of therapy is to achieve trough testosterone levels at the bottom
of the normal male range (8-12 nmol/l) on the day of the injection, just
before it is administered, and to achieve peak testosterone levels in the
high normal male range but less than 30 nmol/l one week after the
injection.

For context, international guidance is 300 to 1,000 ng/dL (~10.4 nmol/L to ~34.7 nmol/L).

The NHS trough aim allows for a narrow testosterone range that is right at the very low end of tolerability and actually goes below it. Please note that low testosterone levels are associated with low mood and low energy.

In relation to arbitrarily taking a blood test 1 week after administration, please note that Sustanon 250 tends to peak within a few days, then steadily falls. (Put something like "sustanon 250 level curve" into your preferred search engine and look for image graphs: you'll soon see what we mean.) It's just nonsense endocrinology!

For Nebido 1000 mg (4 mL), the testosterone trough range is 10 to 15 nmol/L, which is low, but not as ridiculously bad as the guidance for Sustanon 250.

With testosterone gel (testogel), the guidance is very odd. They aim for a target range of 15 to 20 nmol/L, which is fairly decent... but they want this to be tested 4 to 6 hours after application, rather than at trough... which kind of makes their guidance dumb AF.

To give you a real-world comparison, our testosterone level before starting feminising GAHT was ~18.6 nmol/L in our late 30s. Given that our voice had broken at age 10 and fully dropped by age 11, we are fairly sure our testosterone level was much higher than 18.6 nmol/L back then!

You'll typically know if your kid's testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Benefits of monotherapy

Monotherapy completely avoids the need for any kind of puberty blocker, anti-androgen, or anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

With feminising GAHT, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) typically applied to the thighs or abdomen, but could in theory be achieved by sufficient patches applied twice weekly. Transdermal methods can benefit from being applied on the upper buttocks, but this will not be convenient or comfortable for everyone. Injections are sadly not available on prescription, and implants will be very, very expensive and only privately prescribed.

For masculinising GAHT, monotherapy can be easily achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon). However, the injection recommendations are all for adults, so these may be harder to adjust.

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://web.archive.org/web/20250416012633/https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/ 

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

We've already written up a shorter post with links to other resources here.

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help from the community :TransHeart:​ :HeartHands:

Here is a non-exhaustive list of organisations who may be able to offer you some immediate support:

• Mermaids
• Gendered Intelligence
• Switchboard National LGBTQIA+ Support Line

You can find more info resources and support on this Gender Construction Kit page.

And here are some other websites / people you may want to look up:

• Trans Kids Deserve Better
• Trans Kids Deserve To Grow Up
• Dee Whitnell (Founder of TransKidsDeservetoGrowUp)
• Queer AF
• Nancy Kelley (Executive Director of DIVA Magazine) and big supporter of trans youth
• Anne (aka Anne Health Limited), which has a helpline and offers trans+ gender-affirming healthcare 

Edits: Apologies for all the typos. We're trying to gradually get rid of them all 😅 Further apologies for the minor formatting edits as we notice issues.

Edits 2025-08-19:

• Added additional details for why we cyproterone acetate isn't recommended, including details from Wiki Trans (French resource).
• Added a link to a later post we've made to other resources.
• Updated some masculinising info based on most-recent NHS guidelines, mostly to show how dumb the guidance is.
• Fixed at least one dead link.
• Added in a note about switching terminology to GAHT.
• Added a note at the end about our plurality.

#TransKidsMatter #TransYouthAreLoved #TransKidsDeserveToGrowUp #TransKidsDeserveToThrive #TransKids #ProtectTransKids #trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransLiberationNow #TransRightsAreHumanRights #TransRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRHAgonists #GnRHAntagonists #GnRHAnalogues #AntiAndrogens #AntiEstrogens #AntiOestrogens #SERM #spironolactone #CyproteroneAcetate #bicalutamide

¹ We're plural (median, blurian)

Injected 0.15 mL (6 mg) of estradiol enanthate into our left thigh 💉 :TransFemHeart:​

No pain again today. Teeniest leakage and spot of blood, but nothing really at all. Unicorn plaster applied over it... 'cos we're a bad-ass like that 🩹🦄🤘

We've past 32 months now on feminising HRT.

We've been on a waiting list to starting receiving basic care from an NHS gender clinic for over 37 months... but still haven't even been prescribed HRT from them :FaceExhaling: 🤦‍♀️

What we're basically saying folks is that you shouldn't wait on the NHS to start a medical transition. They will keep you waiting for years, gatekeep your care, and try to slow down your transition by starting "low and slow", which is just bogus science and ethically cruel.

#TransHRT #OpenHRT #DIYHRT #HRT #transition #trans #transgender #TransFem #enby #NonBinary #injection #injections #TransHealthcare #healthcare #queer #LGBT+ #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #TransRightsAreHumanRights #TransRights #TransLiberation #TransLiberationNow #DesegregateTransHealthcare #InformedConsent

(Please note that we've defaulted to the British English spellings of oestrogen [estrogen] and oestradiol [estradiol], as this currently affects those in the UK.)

Puberty blockers ban

As many of you may already be aware, as one of their last acts in power, the government has placed restrictions on new prescriptions (NHS or private) of puberty blockers for trans people under 18.

https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers

The affected medications are ones that contain:

• buserelin
• gonadorelin
• goserelin
• leuprorelin acetate
• nafarelin
• triptorelin

It should be noted that that this is not a complete list of such medications, commonly referred to as gonadotropin-releasing hormone agonists.

• Gonadotropin-releasing hormone agonists
• Available forms

Additionally, there are similar drugs referred to as gonadotropin-releasing hormone antagonists. These have the same outcomes and low risk profiles as the banned medications, but have notably not been included in the ban.

• Gonadotropin-releasing hormone antagonists
• Available forms

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens

One notable alternative for trans fem kids is bicalutamide. It's not a perfect drug, as it has a rare chance of causing liver issues, so needs regular monitoring, but it can stop masculinisation by blocking androgen receptors in the body. It also has comparatively few common side effects vs other medications like spironolactone or cyproterone acetate, which are less ideal anti-androgens.

Anti-oestrogens

There are alternative anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

Monotherapy

It's very notable that the ban does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormone.

For trans fems, monotherapy typically requires maintaining an oestradiol trough of around 750 pmol/L. It varies from person to person, so some folks might need as little as 350 pmol/L.

You'll know if their oestradiol trough is sufficient if their testosterone level is 2.4 nmol/L or lower, though up to 3 nmol/L is still considered within the high-end of female range.

For trans mascs, a testosterone trough of around 10-12 nmol/L is generally considered the aim when using prescription testosterone medications like Nebido or Sustanon, with a peak around 25-30 nmol/L.

You'll typically know if their testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Monotherapy completely avoids the need for a puberty blocker, an anti-androgen, or an anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

For trans fems, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) applied to a high-absorption area, but could in theory be achieved by sufficient patches applied twice weekly. Injections and implants are sadly not available on prescription.

For trans mascs, monotherapy can be achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon).

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help :TransHeart:​

Edits: Minor changes to language use and to add additional information.

#trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransKids #TransKidsDeserveToThrive #ProtectTransKids #TransLiberation #TransLiberationNow #OpenHRT #TransRights #TransRightsAreHumanRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRH #GnRHAgonists #GnRHAntagonists #AntiAndrogens #AntiEstrogens #AntiOestrogens

(Please note that we've defaulted to the British English spellings of oestrogen [estrogen] and oestradiol [estradiol], as this currently affects those in the UK.)

Puberty blockers ban

As many of you may already be aware, as one of their last acts in power, the government has placed restrictions on new prescriptions (NHS or private) of puberty blockers for trans people under 18.

https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers

The affected medications are ones that contain:

• buserelin
• gonadorelin
• goserelin
• leuprorelin acetate
• nafarelin
• triptorelin

It should be noted that that this is not a complete list of such medications, commonly referred to as gonadotropin-releasing hormone agonists.

• Gonadotropin-releasing hormone agonists
• Available forms

Additionally, there are similar drugs referred to as gonadotropin-releasing hormone antagonists. These have the same outcomes and low risk profiles as the banned medications, but have notably not been included in the ban.

• Gonadotropin-releasing hormone antagonists
• Available forms

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens

One notable alternative for trans fem kids is bicalutamide. It's not a perfect drug, as it has a rare chance of causing liver issues, so needs regular monitoring, but it can stop masculinisation by blocking androgen receptors in the body. It also has comparatively few common side effects vs other medications like spironolactone or cyproterone acetate, which are less ideal anti-androgens.

Anti-oestrogens

There are alternative anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

Monotherapy

It's very notable that the ban does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormone.

For trans fems, monotherapy typically requires maintaining an oestradiol trough of around 750 pmol/L. It varies from person to person, so some folks might need as little as 350 pmol/L.

You'll know if their oestradiol trough is sufficient if their testosterone level is 2.4 nmol/L or lower, though up to 3 nmol/L is still considered within the high-end of female range.

For trans mascs, a testosterone trough of around 10-12 nmol/L is generally considered the aim when using prescription testosterone medications like Nebido or Sustanon, with a peak around 25-30 nmol/L.

You'll typically know if their testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Monotherapy completely avoids the need for a puberty blocker, an anti-androgen, or an anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

For trans fems, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) applied to a high-absorption area, but could in theory be achieved by sufficient patches applied twice weekly. Injections and implants are sadly not available on prescription.

For trans mascs, monotherapy can be achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon).

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help :TransHeart:​

Edits: Minor changes to language use and to add additional information.

#trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransKids #TransKidsDeserveToThrive #ProtectTransKids #TransLiberation #TransLiberationNow #OpenHRT #TransRights #TransRightsAreHumanRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRH #GnRHAgonists #GnRHAntagonists #AntiAndrogens #AntiEstrogens #AntiOestrogens

(Please note that we've defaulted to the British English spellings of oestrogen [estrogen] and oestradiol [estradiol], as this currently affects those in the UK.)

Puberty blockers ban

As many of you may already be aware, as one of their last acts in power, the government has placed restrictions on new prescriptions (NHS or private) of puberty blockers for trans people under 18.

https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers

The affected medications are ones that contain:

• buserelin
• gonadorelin
• goserelin
• leuprorelin acetate
• nafarelin
• triptorelin

It should be noted that that this is not a complete list of such medications, commonly referred to as gonadotropin-releasing hormone agonists.

• Gonadotropin-releasing hormone agonists
• Available forms

Additionally, there are similar drugs referred to as gonadotropin-releasing hormone antagonists. These have the same outcomes and low risk profiles as the banned medications, but have notably not been included in the ban.

• Gonadotropin-releasing hormone antagonists
• Available forms

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens

One notable alternative for trans fem kids is bicalutamide. It's not a perfect drug, as it has a rare chance of causing liver issues, so needs regular monitoring, but it can stop masculinisation by blocking androgen receptors in the body. It also has comparatively few common side effects vs other medications like spironolactone or cyproterone acetate, which are less ideal anti-androgens.

Anti-oestrogens

There are alternative anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

Monotherapy

It's very notable that the ban does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormone.

For trans fems, monotherapy typically requires maintaining an oestradiol trough of around 750 pmol/L. It varies from person to person, so some folks might need as little as 350 pmol/L.

You'll know if their oestradiol trough is sufficient if their testosterone level is 2.4 nmol/L or lower, though up to 3 nmol/L is still considered within the high-end of female range.

For trans mascs, a testosterone trough of around 10-12 nmol/L is generally considered the aim when using prescription testosterone medications like Nebido or Sustanon, with a peak around 25-30 nmol/L.

You'll typically know if their testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Monotherapy completely avoids the need for a puberty blocker, an anti-androgen, or an anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

For trans fems, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) applied to a high-absorption area, but could in theory be achieved by sufficient patches applied twice weekly. Injections and implants are sadly not available on prescription.

For trans mascs, monotherapy can be achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon).

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help :TransHeart:​

Edits: Minor changes to language use and to add additional information.

#trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransKids #TransKidsDeserveToThrive #ProtectTransKids #TransLiberation #TransLiberationNow #OpenHRT #TransRights #TransRightsAreHumanRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRH #GnRHAgonists #GnRHAntagonists #AntiAndrogens #AntiEstrogens #AntiOestrogens

(Please note that we've defaulted to the British English spellings of oestrogen [estrogen] and oestradiol [estradiol], as this currently affects those in the UK.)

Puberty blockers ban

As many of you may already be aware, as one of their last acts in power, the government has placed restrictions on new prescriptions (NHS or private) of puberty blockers for trans people under 18.

https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers

The affected medications are ones that contain:

• buserelin
• gonadorelin
• goserelin
• leuprorelin acetate
• nafarelin
• triptorelin

It should be noted that that this is not a complete list of such medications, commonly referred to as gonadotropin-releasing hormone agonists.

• Gonadotropin-releasing hormone agonists
• Available forms

Additionally, there are similar drugs referred to as gonadotropin-releasing hormone antagonists. These have the same outcomes and low risk profiles as the banned medications, but have notably not been included in the ban.

• Gonadotropin-releasing hormone antagonists
• Available forms

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens

One notable alternative for trans fem kids is bicalutamide. It's not a perfect drug, as it has a rare chance of causing liver issues, so needs regular monitoring, but it can stop masculinisation by blocking androgen receptors in the body. It also has comparatively few common side effects vs other medications like spironolactone or cyproterone acetate, which are less ideal anti-androgens.

Anti-oestrogens

There are alternative anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

Monotherapy

It's very notable that the ban does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormone.

For trans fems, monotherapy typically requires maintaining an oestradiol trough of around 750 pmol/L. It varies from person to person, so some folks might need as little as 350 pmol/L.

You'll know if their oestradiol trough is sufficient if their testosterone level is 2.4 nmol/L or lower, though up to 3 nmol/L is still considered within the high-end of female range.

For trans mascs, a testosterone trough of around 10-12 nmol/L is generally considered the aim when using prescription testosterone medications like Nebido or Sustanon, with a peak around 25-30 nmol/L.

You'll typically know if their testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Monotherapy completely avoids the need for a puberty blocker, an anti-androgen, or an anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

For trans fems, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) applied to a high-absorption area, but could in theory be achieved by sufficient patches applied twice weekly. Injections and implants are sadly not available on prescription.

For trans mascs, monotherapy can be achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon).

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help :TransHeart:​

Edits: Minor changes to language use and to add additional information.

#trans #transgender #enby #NonBinary #agender #genderfluid #genderqueer #transition #TransKids #TransKidsDeserveToThrive #ProtectTransKids #TransLiberation #TransLiberationNow #OpenHRT #TransRights #TransRightsAreHumanRights #queer #LGBTQ+ #LGBTQIA+ #PubertyBlockers #GnRH #GnRHAgonists #GnRHAntagonists #AntiAndrogens #AntiEstrogens #AntiOestrogens

(Please note that we've defaulted to the British English spellings of oestrogen [estrogen] and oestradiol [estradiol], as this currently affects those in the UK.)

Puberty blockers ban

As many of you may already be aware, as one of their last acts in power, the government has placed restrictions on new prescriptions (NHS or private) of puberty blockers for trans people under 18.

https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers

The affected medications are ones that contain:

• buserelin
• gonadorelin
• goserelin
• leuprorelin acetate
• nafarelin
• triptorelin

It should be noted that that this is not a complete list of such medications, commonly referred to as gonadotropin-releasing hormone agonists.

• Gonadotropin-releasing hormone agonists
• Available forms

Additionally, there are similar drugs referred to as gonadotropin-releasing hormone antagonists. These have the same outcomes and low risk profiles as the banned medications, but have notably not been included in the ban.

• Gonadotropin-releasing hormone antagonists
• Available forms

Alternatives to puberty blockers

Whilst puberty blockers are considered the gold standard:

• They were mainly offered in place of gender-affirming hormone therapy in order to delay the medical transition of trans kids, in the hopes that they could be "persuaded" that they're not actually trans (i.e., conversion therapy).
• Other alternatives to these do exist and are commonly available.

Anti-androgens

One notable alternative for trans fem kids is bicalutamide. It's not a perfect drug, as it has a rare chance of causing liver issues, so needs regular monitoring, but it can stop masculinisation by blocking androgen receptors in the body. It also has comparatively few common side effects vs other medications like spironolactone or cyproterone acetate, which are less ideal anti-androgens.

Anti-oestrogens

There are alternative anti-oestrogens, particularly SERMs, but they typically have a lot of side effects and risks. As a rule, most don't come highly recommended.

Monotherapy

It's very notable that the ban does not ban any oestradiol (oestrogen) or testosterone prescriptions.

This means that there is nothing to stop supportive parents from helping their trans kids to get a private prescription for oestradiol or testosterone.

Furthermore, due to the way human bodies work, if you maintain a high-enough trough (lowest) level of either oestradiol or testosterone, the body will basically tell the gonads to stop producing that hormone.

For trans fems, monotherapy typically requires maintaining an oestradiol trough of around 750 pmol/L. It varies from person to person, so some folks might need as little as 350 pmol/L.

You'll know if their oestradiol trough is sufficient if their testosterone level is 2.4 nmol/L or lower, though up to 3 nmol/L is still considered within the high-end of female range.

For trans mascs, a testosterone trough of around 10-12 nmol/L is generally considered the aim when using prescription testosterone medications like Nebido or Sustanon, with a peak around 25-30 nmol/L.

You'll typically know if their testosterone trough is sufficient if their oestradiol level is under 150 pmol/L, though some folks may be up to around 180 pmol/L.

Monotherapy completely avoids the need for a puberty blocker, an anti-androgen, or an anti-oestrogen.

It also has the delightful side-effect of making your trans kid happy to be starting the puberty that they want to go through sooner, thus alleviating their feelings of gender dysphoria and allowing them to enjoy their lives, rather than continuing to wait on non-existent NHS healthcare.

For trans fems, monotherapy is most easily achieved by a daily high-dose of oestradiol in the form of oestrogel (oestrogen gel) applied to a high-absorption area, but could in theory be achieved by sufficient patches applied twice weekly. Injections and implants are sadly not available on prescription.

For trans mascs, monotherapy can be achieved by daily application of testosterone gel or cream, but is more easily achieved by testosterone injections (Nebido or Sustanon).

Blood tests

These can be done privately, completely avoiding the need for the NHS.

You can find more information here:

• https://genderkit.org.uk/resources/blood-testing/
• https://transactual.org.uk/medical-transition/hormone-therapy/

Where can we find more information about gender-affirming care by experts who actually want to help trans kids?

Although far from perfect, arguably the best sources currently are:

• WPATH Standards Of Care 8
• UCSF guidelines for gender-affirming care

What if I'm still confused about all this?

Ask for help. We're all in this together. Some of us know a lot about how broken trans healthcare is on the NHS right now, not just for trans kids but for trans adults too.

The key thing to remember is that you are never alone. All you have to do is reach out and ask for help :TransHeart:​

Edits: Minor changes to language use and to add additional information.

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