There are no NHS or NICE guidelines in the UK, and there is no formal medical education in medical schools or in postgraduate deaneries. Core competencies for doctors working in this field do not exist in the Royal College Curricula. GenderGP does not adhere to NHS protocols which are outdated and result in delays which can be harmful to trans youth. We operate according to best practice Guidelines which favour a stage not age approach. There may be compelling reasons as to why a young person who is completely aligned with their gender identity might benefit from having puberty induced at an age as young as 12.