Gender dysphoria or incongruence
Gender Identity Healthcare Protocol for Scotland NGICNS Endocrine and Fertility Preservation guidance
Masculinising endocrine treatment
Testosterone
Tostran 2% gel
Testogel 16.2mg/g gel
Testavan 20mg/g transdermal gel
Testavan 20mg/g transdermal gel refill
Testogel 40.5mg/2.5g transdermal gel sachets
Testosterone undecanoate
Roxadin 1000mg/4ml solution for injection vials
Testosterone mixed ester
Sustanon 250mg/1ml solution for injection ampoules
Prescribing Notes:
- Different formulations provide different doses – caution if switching between preparations.
History Notes
30/07/2026
Regional formulary chapter launched.
Feminising endocrine treatment
Step 1: Estradiol. Transdermal patches, gel, spray, or oral tablets. The most cost-effective product should be prescribed.
Estradiol
Estradiol 25micrograms/24hours transdermal patches
Estradiol 50micrograms/24hours transdermal patches
Estradiol 75micrograms/24hours transdermal patches
Estradiol 100micrograms/24hours transdermal patches
Sandrena 500microgram gel sachets
Sandrena 1mg gel sachets
Oestrogel Pump-Pack 0.06% gel
Lenzetto 1.53mg/dose transdermal spray
Estradiol 1mg tablets
Estradiol 2mg tablets
Step 2: with or without androgen suppression.
Leuprorelin
Prostap SR DCS 3.75mg powder and solvent for prolonged-release suspension for injection pre-filled syringes
Prostap 3 DCS 11.25mg powder and solvent for prolonged-release suspension for injection pre-filled syringes
Triptorelin
Decapeptyl SR 3mg powder and solvent for suspension for injection vials
Decapeptyl SR 11.25mg powder and solvent for suspension for injection vials
Decapeptyl SR 22.5mg powder and solvent for suspension for injection vials
Goserelin
Zoladex 3.6mg implant SafeSystem pre-filled syringes
Zoladex LA 10.8mg implant SafeSystem pre-filled syringes
Spironolactone
Spironolactone 25mg tablets
Spironolactone 50mg tablets
Cyproterone
Cyproterone 50mg tablets
Prescribing Notes:
- For prescribing Gonadotrophin-releasing hormone (GnRH) analogue (any medicinal product that consists of or contains goserelin, leuprorelin acetate or triptorelin), please refer to Scottish Drug Tariff Part 12 Schedule 2 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’.
- Note the MHRA Drug Safety Update (June 2020) Cyproterone acetate: new advice to minimise risk of meningioma.
History Notes
30/07/2026
Regional formulary chapter launched.