Information for Referrers and Professionals
Making a referral
NHS Arden and GEM manage all referrals to NHS Children and Young People’s (CYP) Gender Services on behalf of NHS England and the CYP Gender Service Providers.
Information on how and who can make a referral is below, along with a guide for using the portal. However, if you have a query that you have not been able to find an answer in the information provided then please contact us using the email address at the bottom of the page.
As of 1 December 2024, the commissioned CYP Gender Service providers are:
North-West: Alder Hey Children’s NHS Foundation Trust; and Manchester University NHS Foundation Trust
South-West: University Hospitals Bristol and Weston NHS Foundation Trust
London: Great Ormond Street Hospital for Children NHS Foundation Trust; and Guy’s and St Thomas’ NHS Foundation Trust; and South London and Maudsley NHS Foundation Trust
Who can make a referral?
Referrals for patients from England
Referrals can only be made by NHS CYP mental health or NHS paediatric services for children and young people under the age of 18.
GPs looking to refer a patient will need to refer to one of the above services, dependent on which services are most appropriate for the patient’s needs. Referrals cannot not be accepted from any other source including primary care.
Guidance for secondary care services has been published here.
Referrals for patients from Wales
Referrals of children and young people in Wales will only be accepted if made by Child and Adolescent Mental Health Teams with prior approval from NHS Wales Joint Commissioning Committee.
Who can be referred?
Referrals to the NHS CYP Gender Service can be made for a child or young person who is registered with a GP in England or Wales, and who is showing symptoms of gender incongruence or dysphoria, up to the age of 18.
If a young person who is 17 years and 9 months will not be seen by their 18th birthday, they will be removed from the waiting list due to “ageing out” and advised to seek advice from their GP on the appropriateness of a referral to an Adult Gender Service. Should the GP make a referral to the adult Gender Service, then the original referral date to the children and young people’s service is honoured by the Adult Gender Service.
Therefore, as a practical measure, referrals are discouraged for individuals who are within 3 months of their 18th birthday, and a referral made to an adult Gender Service when they are 18.
Advice for referrers
Guidance for referrers has been published by NHS England.
Please carefully consider the appropriateness of a referral using the guidance before making a referral. Not everyone who identifies with a gender other than their natal sex, or whose gender expression is different from what others might expect of them, will need to be seen by the NHS CYP Gender Service. Please refer to the guidance available in the link above if you are unsure.
The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist. (Cass Review, April 2024)
Referring professionals must discuss the referral with the family / carer of the child / young person to provide detailed referral information and gain their consent.
Clinical responsibility remains with the referrer and the local professional network until the patient is seen by the NHS CYP Gender Service.
Advice on completing the forms
The electronic referral form is available via the portal below. Referrals via email can no longer be accepted for English referrals but they can be accepted if the referrer is in Wales.
The referral form requests both the information required for the NRSS to manage the waiting list, and the information required by the CYP Gender Services. The form asks for details about different aspects of the child or young person’s life -referrers should provide as much information as possible in the relevant sections.
To help us deal efficiently and effectively with referrals, the following referrals will not be accepted:
- Referrals not using the electronic referral form via the portal (except for Wales).
- Referrals from any source other than NHS paediatric services or NHS mental health services for children and young people.
It is important that all methods of contact are provided for the parent/carer patient and for the patient if they are 16 and over. Please advise the patient and their parent/carer that any changes in contact information, legal name, address, or GP Practice should be notified to us by them whilst they are waiting to be seen. This can be done online by the patient or parent at Change Your Contact Details, or via email to agem.cyp-gnrss@nhs.net to ensure that we can contact the patient without delay.
Referral portal and guide
Please read the electronical referral form guide before using the system.
Referral Form Guide (PDF, opens in a new tab)
It is necessary to complete all the requested information to start the process and receive a link to complete the form. The referrer’s email address and a work or personal mobile number are required to enable multifactual authentication. The mobile number shared for authentication can be updated to a landline number if required after the authentication process.
- The individual/referrers email address to receive the link to fill out the form.
- The individual/referrers mobile telephone number
- Patient’s NHS Number
- Patient’s First Name
- Patient Surname
- Patient’s DOB
This will enable the portal to check the referrer’s email address to confirm that it is an NHS digital email address.
Referrers from the CYP mental health or Paediatric teams will need to have an nhs.net or nhs.uk email address to be able to submit the information. A mobile number is also required for the authentication process to receive a numeric code. The mobile number can be changed on the form before it is submitted if a personal mobile is used.
Portal – please click the following link CYP Gender Service Referral Form Platform (opens in a new tab) or
If there are any issues with using the portal or the referral form, please email agem.cyp-gnrss@nhs.net. To help us understand what issue you are experiencing, please can you send a screenshot of the error message and detail the problem in the email.
Risk and safety
Children and young people experiencing gender incongruence or gender dysphoria can be particularly vulnerable and may experience a higher incidence of co-occurring mental health issues or adverse childhood experiences. At present there are long waiting times for the NHS Children and Young People’s Gender Services, and children, young people and their families may require support while they wait. It is strongly recommended that holistic and patient centred treatment plans are co-developed by the referrer and local professional network to ensure the needs of the young person are being met in the interim and that this is clearly communicated on the referral form.
An immediate pause on children or young person aged 16 -17 being initiated onto masculinising or feminising hormones by the specialist Children and Young People’s Gender Service was announced on Monday 9th March 2026.
This decision has been taken in response to the completion of extensive independent evidence reviews in relation to safety, risks, benefits and outcomes of this treatment.
More information on the evidence reviews can be found here https://www.england.nhs.uk/publication/consultation-feminising-and-masculinising-medicines-in-the-management-of-gender-incongruence-in-children-and-young-people-evidence-reviews/
The NHS had already placed restrictions on the prescribing of these medications, following the recommendations of the final Cass Report in 2024. Individuals would only be considered for these medications in cases where 'extreme caution' had been applied to clinical decision making, and where a national MDT had endorsed the recommendation for referral to an endocrinology team.
A 90-day consultation on a new draft policy has also been launched on Monday 9th March. More information on the consultation can be found here https://www.engage.england.nhs.uk/consultation/prescribing-masculinising-and-feminising-hormones/
We understand the uncertainty and anxiety that this action may cause if it was your expectation that you (or your child) would be referred to an endocrinology team for consideration of masculinising or feminising hormones.
The pause on the initiation of new prescriptions does not affect individuals who are already receiving NHS prescriptions for these medications. In these cases, prescribing may continue under the clinical supervision of an NHS-commissioned gender service.
All information regarding the latest advice from NHS England regarding hormones and the ban on puberty suppressing hormones can be found in the FAQ section of the website.
Children, young people, and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies.
In cases where CYP are accessing unregulated medicines, GPs and local health professionals are advised to consider what safeguarding protocols may be appropriate for the individual child or young person’s wider circumstances including the extent to which the parents / carers are able to protect or safeguard the child or young person. Safeguarding procedures may be necessary regardless of the endeavours and best intentions of the parents / carers in reducing risk of harm. Safeguarding protocols should be initiated immediately where the child or young person is at risk of immediate, serious harm. It would also be important for the GP or local health professional to explore what regulatory bodies may need to be informed if healthcare professionals registered with a UK professional body are prescribing medication contrary to NHS protocols.
Government ban on gonadotrophin-releasing hormone (GnRH) analogues (puberty suppressing hormones) made indefinite
As an outcome of Government legislation, the sale and supply of GnRH analogues to young people under 18 as a treatment option for gender incongruence, including through private prescription, is banned. Possession in breach of the ban is a criminal offence.
Information can be found at the bottom of the FAQ page Frequently Asked Questions
Contact us
If you have a query regarding referring a child/young person that still hasn’t been answered in the information above, please contact us by email at agem.cyp-gnrss@nhs.net.
Service Specification and Secondary Care Guidance
Helpful information is included below with guidance to CYPMH and Paediatric services regarding the support required for children and young people and gender.
Paediatrics guidance documents
Further guidance for healthcare professionals
RCGP: Transgender Care
RCPsych: Supporting transgender and gender-diverse people
BPS: Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity
NSPCC: Gender identity; Advice to help you understand what gender identity is and how to support a child
MindEd: Catalogue of resources
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