Comparison of UK adult GICs trans feminine HRT oestradiol target ranges, July 2021

Discussion in online trans* support groups and on this subreddit indicates that low oestradiol levels are believed to result in sub-optimum feminisation for trans* women, especially with regard to breast development. Here is a collation of all UK GICs’ estradiol target ranges for trans* women so that if people have a choice of GICs they can be referred to, they can – if desired – take this factor into account when deciding which GIC to ask their GP to refer them to.

There is significant variation in oestradiol ranges between GICs, e.g. Daventry seems to primarily apply a range of 150-200 pmol/l; Newcastle upon Tyne states they primarily apply a range of 450-600 pmol/l; Cardiff applies a range of 350-750 pmol/l. Generally, more recently drafted protocols tend to have higher midpoints and higher maximums, there seeming to have been a trend to increase range minimums and maximums (and hence also range midpoints) over the last decade.

I lack information on target ranges applied by the three NHS pilots (56 Dean Street, London; CMAGIC, Cheshire & Wirral, Liverpool; Indigo, Manchester), so if anyone can add information about these GICs’ target ranges, it would help complete the list.

Also listed for completeness are private HRT providers. Most UK private endocrinologists also work at NHS GICs so I have listed these affiliations because that seems likely to influence the target ranges that they each may apply. I lack information on target ranges applied by GenderGP, London Transgender Clinic and YourGP, so if anyone can add information about those private HRT providers’ target ranges, it would help complete the list.

NHS GICs: date of protocol, target range in pmol/l

• Daventry / Northamptonshire (2013) 150-400; implied that target range is primarily 150-200 EDIT: current patient feedback states 300-700 age <50; 200-400 age 50-60; 200-300 age >60

• Laurels / Exeter (2012) 200-600 [but current patient reports 350-750]

• Leeds (Undated) 350-700 age <40; 300-600 age 40-50; 200-400 age >50

• Newcastle upon Tyne / Walkergate (2015) 300-600; stated that target is primarily 450-600

• Nottingham (2018) 400-600

• Sheffield / Porterbrook (2018) 300-600 age <50-55; lower end of range if age >50-55 EDIT: current patient feedback states okay with 700- 750 if <45-50 and liver function oakay.

• The Gender Identity Clinic / Tavistock & Portman / London / Charing Cross (Pre-2007) 400-600

• NHS Scotland (all four Scottish GICs: Chalmers / Lothian / Edinburgh; Grampian / Aberdeen; Highland / Inverness; Sandyford / Glasgow) (2012) 300-400

• NHS Wales / Welsh Gender Service / Cardiff (2019) 350-750

• NI Brackenburn / Belfast (2013) 300-400

• NHS England Pilot: 56 Dean Street, London: no information

• NHS England Pilot: CMAGIC, Cheshire & Wirral, Liverpool: no information EDIT: various reports: 400-600, or 500-600 with an absolute upper maximum of 700

• NHS England Pilot: Indigo, Manchester: no information

Private HRT providers: names of endocrinologists, NHS GIC affilliation with that GIC’s target range in pmol/l

GenderGP no information on target ranges EDIT: various figures: 150-800, or 351-800

GenderCare

• Dr. Jonny Coxon - The Gender Identity Clinic / Tavistock & Portman / London / Charing Cross GIC (400-600)
• Dr. Peter Hammond – Leeds GIC (350-700 age <40; 300-600 age 40-50; 200-400 age >50)
• Dr. Kim Sun Leong - CMAGIC, Cheshire & Wirral, Liverpool - 400-600
• Dr. Richard Quinton, Newcastle upon Tyne / Walkergate (300-600; stated that target is primarily 450-600)
• Dr.Leighton Seal - The Gender Identity Clinic / Tavistock & Portman / London / Charing Cross (400-600)

London Transgender Clinic no information on target ranges EDIT: 400-700

Northern Gender Network

• Dr. Peter Hammond – Leeds GIC (350-700 age <40; 300-600 age 40-50; 200-400 age >50)

The Gender Doctors

• Dr. Peter Hammond – Leeds GIC (350-700 age <40; 300-600 age 40-50; 200-400 age >50)
• Dr. Kim Sun Leong - CMAGIC, Cheshire & Wirral, Liverpool (400-600)

YourGP no information on target ranges.

Sources for this data are in two posts below.