Welcome to the Northern Region Gender Dysphoria Service (NRGDS). We’ve put a range of information and resources together to try and answer your questions and help you to find sources of support and guidance.
Links to this support and guidance are included “In this section”
If you still can’t find an answer to your question or you would like to provide feedback on the service, please email us at: NRGDS@cntw.nhs.uk
Testosterone shortage
NRGDS is aware that there is a shortage of some preparations of testosterone, which is likely to affect our service users.
If your usual treatment is not available, please check with other pharmacies in the area first, as another pharmacy might have the treatment you need in stock. Unfortunately, some services users will have to change to a different treatment to ensure they continue to receive testosterone. Stopping testosterone could lead to increased gender dysphoria, unpleasant physical effects (similar to the menopause) and deterioration in mental wellbeing, in the short to medium term. For some people, particularly those who do not have functioning ovaries, there can be serious effects of not taking sex hormone treatment over the longer term (e.g. years) such osteoporosis (thinning of the bones).
It is not possible to cover all of the potential situations or solutions. However, the following information should provide alternative treatment strategies for most trans masculine and non-binary (assigned female at birth) service users who are unable to source their usual testosterone treatment.
If you (or one of your patients) are currently prescribed Sustanon and this is not available, an alternative is Testosterone Enantate, which is a testosterone injection that can be used at the same dose and interval as Sustanon. If Testosterone Enantate is not available, a gel preparation may be needed for an interim period. If transferring from an injection (Sustanon, Testosterone enantate or Nebido) to a gel, the gel should be started on the day an injection is due. A starting dose of Tostran gel 40mg once daily is acceptable and the dose can be adjusted depending on blood test results.
Information about equivalent doses of gel preparations is available here
Nebido is a longer acting testosterone injection. If you wish to consider swapping to this, please contact your clinician at NRGDS to discuss. If you are not currently under the care of NRGDS, please speak to your GP. They may wish to contact a local specialist endocrinology service to for advice (see below).
If you take an alternative preparation for more than one month, please ask your GP to carry out blood monitoring of testosterone, full blood count, LFTs and SHBG in order to review the dose. We advise rechecking bloods because the way that each preparation is absorbed can vary and it is important to ensure adequate treatment and avoid unwanted side effects. The timing of blood tests is important; for all gels, a sample should be taken 4-12 hours after putting the treatment on. For all injections, a sample should be taken on the same day an injection is due, just before the injection is given.
We recommend that anyone taking a different treatment because of problems with availability, reverts to their usual preparation as soon as it becomes available. However, some people might be satisfied with an alternative treatment and wish to continue. If this is the case, please discuss your treatment with your GP or clinician at the NRGDS.
If you are currently under our care and your GP has any concerns or queries, they can contact the service. If you are not currently under the care of the service, advice can be sought from local specialist endocrinology services. In the North East of England, the regional specialist is Dr Richard Quinton, who is based at the Royal Victoria Hospital. In other areas, the Gender Identity Clinic local to you should be able to advise on the best endocrinology service to contact:
How to find an NHS gender dysphoria clinic
Additional hormone guidance for clinicians can be found here
Oestrogel shortage
We have been made aware that there is a shortage of Oestrogel which is likely to affect our service users. The way that each preparation is absorbed varies. We have been advised that, whilst this is the case, the approximate equivalent doses are as below:
Equivalent doses
We recommend that you revert to Oestrogel as soon as it becomes available again. If you are on an alternative preparation for more than one month then please ask your GP to check your Estradiol level to make sure the dose does not need to be adjusted.
GCLS Survey
This report is part of ongoing wider research on patient reported outcome measures (PROMs) and their applications to transgender health services. The research aims to investigate PROMs’ potential to assess the quality of care given by transgender services, from the perspective of service users. As of yet, no conclusions have been drawn on the GCLS or the research project at large due to its ongoing nature. This report has been published on the NRGDS website in the interests of transparency.
