Does the National Gender Service really believe that hormone blood tests don’t indicate risk?

Does the National Gender Service really believe that hormone blood tests don’t indicate risk?

Back when I was starting Hormone Replacement Therapy (HRT), I asked my GP for the blood tests which my medical team had requested and that are key for doing HRT safely. My GP didn’t say no. But they did string me along with how blood tests they’d previously done without issue were now “complicated” due to me being trans. Ultimately I had to switch to a new GP who, thankfully, has been much more accommodating.

This is not an uncommon story. These days it seems like almost every week I run into yet another trans person who has been denied blood tests by their GP and now needs to somehow find a new GP who will hopefully not be transphobic.

One of the recurring themes in these denials is the National Gender Service (NGS) advising GPs not to do hormone blood tests, which was recently covered in the Dublin InQuirer.

Here’s an excerpt from a July 2023 letter that the NGS sent to a GP but, interestingly, not to the patient themselves:

Similar was said by Dr. Karl Neff, Consultant Endocrinolgoist and Clinical Lead of the NGS, in a reply to a TD in May 2023 indicating that hormone concentrations aren’t for risk stratification or risk management:

In case you’d be under the impression this a new thing, here’s an excerpt from a letter from the NGS to a patient which was CC’d to their GP from 2020:

The specific claims here are that the NGS believe there’s no risk associated with hormone levels being too high or too low in trans people, such monitoring is not essential, and that GPs shouldn’t do it.

Now, I could point to the at least five places on the NGS’s own website where it says that hormone blood tests are needed for their own patients; or at least ten places in the international clinical guidelines that the NGS claim to follow that say that hormone blood tests are needed to ensure the right dosing and mitigate risks such as thromboembolic disease, liver dysfunction, hypertension, and loss of bone mineral density.

In this instance, however, I shall defer to the writings of medical professionals who one would hope would be experts on trans healthcare and endocrinology: The National Gender Service.

Them Bones, Them Bones, Need Oestrogen

First up we have the already-mentioned Dr. Neff who also wrote the current NGS policy around DEXA scans, which is a type of X-Ray used to check bone mineral density if you’re worried about osteoporosis. The policy itself seems pretty standard. I’d like to direct you to this excerpt:

This is very odd. Dr. Neff was telling a TD that there’s no risk management associated with hormone concentrations. Yet here we have Dr. Neff writing a policy saying that if your hormone concentrations are too low for too long, then you need to get a DEXA scan.

That almost sounds like managing a risk.

Bold Statements

Second up are the Recommendations for Endocrine Care of the NGS from July 2023, which I would infer the NGS Consultant Endocrinologists were involved with.

Two excerpts are of note, one for those on estradiol:

And one for those on testosterone:

This is once again very odd. Dr. Neff was telling a TD that there’s no risk stratification associated with hormone concentrations. Yet, here the NGS policies are emphasising to their staff and patients that hormone concentrations being too high is a risk for thromboembolic disease.

That almost sounds like a stratified risk.


I am but a simple enby. It is not for me to doubt Dr. Karl Neff when he said “we act in the best interests of our service users and patients and that’s how we’ll always work” earlier this year on Newstalk. Clearly I am misunderstanding the situation.

Accordingly, the only possibility is that the NGS staff have the purest of intentions when they tell GPs to deny blood tests for their trans patients. It’s definitely for our benefit. And in no way putting us at risk of osteoporosis or thromboembloic disease.

After all, there is a series of articles covering how very normal the NGS’ creation, operation, and political activism is.

Jes (she/it) is not a cis nor trans medical professional, but a secret third thing.

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