The Surrey Heartlands Integrated Health System Area Prescribing Committee (APC) has agreed that topical testosterone should be prescribed generically, ideally using Drug Tariff descriptions.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review (The Cass Review).

For current patients:
Please continue to prescribe in line with any agreed shared care protocols in place (see guidance in primary care prescribing for people who access gender identity services).

For new patients:
Puberty blockers: Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence (see link).

Gender affirming hormones: There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing.