There are no UK NHS published guidelines for the care of transgender people. The Gender Identity Development Service provides NHS care to UK trans youth according to Service Specifications. This is their own protocol which differs widely from those used by centres of excellence in transgender healthcare internationally. GenderGP does not operate according to NHS policies which have been found to be lacking in many areas by the Women and Equalities Committee report on transgender equality from 2016, as well as failing in standards set by the Care Quality Commission. When an adolescent patient, who is transgender, is ready to embark on the second stage of treatment, gender-affirming hormones are used to induce pubertal changes that match their gender identity. It is best practice to introduce these when the young person is ready rather than on an age-based criteria. This is standard in centres of excellence across the world, and allows young people to develop in line with their peers. Research shows the benefits of this approach. Outside of the NHS protocols, the requirement for at least a year on blockers does not exist. In many patients this is a harmful and unnecessary step, delaying treatment and imposing a medical menopause. Counselling and psychiatric care is not mandatory and should be available on a case by case basis, as needed to assist the person on their gender journey.