From a series of FOIs sent by Exeposé, data reveals that 16,649 individuals waiting for their first NHS gender dysphoria appointment are between the ages of 18-25. Through a comparison of the specialist NHS gender dysphoria clinics across England, the Tavistock and Portman clinic in London has the highest number of 18-25 year-olds on the waiting list, at 7,073 people.
Sometimes known as a Gender Identity Clinic, Gender Dysphoria Clinics (GDCs) are provided by the NHS to provide medical and psychological support for people wishing to transition. There are a range of medical services that can be provided by these clinics, based on location, including hormone blockers, gender-affirming hormones and gender-confirming surgery. Counselling for gender dysphoria and speech therapy is also often offered for patients of GDCs.
Gender dysphoria is not a mental health condition, and is not limited to/may not be experienced by all transgender people. Nevertheless, provisions offered by GDCs can be indispensable for many transgender individuals, as without treatment, gender dysphoria can catalyse mental health conditions such as depression, particularly without the necessary means to transition, as they face incongruence with their identified gender and the way they look. GDCs specifically function to address these issues, facilitating the treatment that is needed for many trans and nonbinary people.
Provisions offered by GDCs can be indispensable for many transgender individuals, as without treatment, gender dysphoria can catalyse mental health conditions such as depression
Exeposé focused on the 18-25 age demographic, as it encompasses many university students who identify as transgender. According to AdvanceHE’s 2021 report, the proportion of students disclosing a transgender identity doubled over a year, from 0.6% to 1.1% of the total student population, across the 84% of UK universities that submitted reports.
For 18-25 year-old trans people, access to a gender dysphoria clinic can be vital, even more so due to new draft guidance that advocates for a move away from ‘gender-affirming’ care model for under 18s. Instead of supplying medical interventions such as hormone blockers (except in very specific cases), the guidance upholds the use of only psychological treatment for most children experiencing gender dysphoria, as the “co-existing mental health, neuro-developmental and/or family or social complexities” should be assessed before even recommending social transition. Currently, the Gender Identity Development Service for under 17s is not taking any new referrals. If this guidance becomes formalised, this could vastly change the experience of young trans people, and mean that the first chance of specialist NHS treatment or receiving hormones would begin at 18.
New draft guidance[…] advocates for a move away from the ‘gender-affirming’ care model for under 18s
To receive treatment from an NHS GDC, transgender people can self-refer, but it is advised to gain a referral from a GP or other medical professional, as they can provide detailed medical history to be assessed by the clinic. It is important to note that this referral phase is not a diagnosis, but instead a referral for a diagnosis, and only after diagnosis can medication and treatment be provided.
Referrals can be the initial barrier to accessing NHS services, as one student reports that they were reluctant to go to a GP because they identify more as non-binary. They worried that they would be dismissed in their wants for gender-affirming care such as hormones and top surgery due to this identification, so they instead said they are a trans man to “avoid excess questions.” Another student expressed the “stigma around non-binary identities”, with questions around why a person wants to access care, as it “can be gatekept… by transphobic healthcare practitioners.”
A significant number of referrals are for 18-25 year-olds, with a total of 1429 people in this demographic being referred in July/August (based on available data). The number of referrals has also increased across all clinics in England – from 2013 to 2018 alone, overall referrals increased by 240%, to around 7500 adults waiting for care. The number of referrals has continued to grow, though some referrals became harder to administer due to the pandemic.
For over 17s, medical professionals are expected to refer patients directly to GDCs without prior referral to mental health services. However, access to NHS GDCs are severely inhibited due to extremely lengthy waiting times for an initial appointment.
There are only eight specialist GDCs in the country, which only contributes to this backlog. With the exception of the Nottingham clinic (which has a waiting time of one year, ten months), all other GDCs in England have waiting times of over four years. Notably, the longest wait time is for the GDC in Exeter, the Laurels, which has a wait time of seven years, with the last people receiving their first appointment having been referred to the service in July 2016. When considering the age demographic of 18-25, this means that someone referred to the Laurels aged 18 could be turning 26 before having their first appointment.
Notably, the longest wait time is for the GDC in Exeter, the Laurels, which has a wait time of seven years, with the last people receiving their first appointment having been referred to the service in July 2016.
These waiting times were not always as lengthy. According to testimony from another student, when they were referred in 2015, waiting times were around six to eight months. In contrast, they found that their friends who have tried to access NHS care more recently “have been waiting two and four and a half years for their first appointment”
The initial waiting times also do not factor in the time to receive prescriptions for hormones, a key resource for most people’s transition. Currently, at the Laurels, there is a 12 month wait time for hormones, meaning a trans person would be waiting eight years altogether to receive treatment. There is also a very significant wait for hormones at the Newcastle clinic of almost two years, meaning the total wait time for appointments and hormones is 109 months, which equates to over nine years.
The extensive waiting lists for all NHS GDCs mean that some trans people resort to self medication. As puberty blockers and gender-affirming hormones require a prescription, without an appointment, trans people are restricted from receiving these needed provisions. Instead, hormones and blockers can be found on the black or grey market, which trans people can use to alleviate gender dysphoria and aid in their transition. However, this of course comes with risks: medication should be tailored to a patient’s needs, and the balance of hormones is monitored through blood tests, to ensure a successful transition and maintenance of health. Moreover, as testosterone often comes in an injectable format, there can be risks in administration of the hormone, both in injuring yourself or others if the sharps are not disposed correctly.
There is also another alternative – private gender service clinics. The wait times for these clinics are much shorter, with the longest wait for a first appointment being around nine months. However, appointments range from around £200 – £600 each, private hormone medications can cost around £300 for a three-month supply and surgery costs significantly more, with facial masculinisation starting at £8,600 at the London Transgender Clinic.
Other than significantly reduced waiting times, an unnamed student also expressed how private healthcare can be more convenient, as their “friends got over six months notice for their top surgeries”, whilst notice for their NHS surgery was only two months. They explained how this allowed their friends to “plan their life around” the surgery, through having more notice.
However, the costs of private gender care create significant barriers, with students expressing inability to access private care due to the fees, whilst others had to save up for many years to pay for the treatment. “I knew from the age of 13 that I would need to save money in order to ever get any kind of gender affirming care. It is messed up that I should have to spend the money that others could use to put down a deposit on a house or a car” states one student, claiming that they have saved £10,000 for private gender services. Other students explain that many trans people have to rely on “crowdfunding or a family benefactor” to pay for treatment.
I knew from the age of 13 that I would need to save money in order to ever get any kind of gender affirming care. It is messed up that I should have to spend the money that others could use to put down a deposit on a house or a carAnonymous student
For those who have been able to receive their first appointment with an NHS service, 434 patients are young adults, aged 18-25. When compared to the number of 18-25 year-olds on the waiting list, it reflects the difficult reality that the large majority of trans people in need of public care are waiting for, rather than receiving, NHS treatment.
In the investigation, Exeposé reached out to the NHS England media team for comment on these extensive waiting lists, yet declined to comment, claiming “we’re only able to respond to press enquiries from mainstream media outlets.”
Data reflects how there is a current crisis in access to transgender healthcare in England. Conditions are in significant need of improvement to assure the health, wellbeing and rights of transgender people across the country. Every respondent of the Exeposé journo request reflected a need for change, with access to public healthcare underpinning this.
If you would like to learn more about the impact of waiting times for gender-affirming healthcare, and what universities can do, see this article in features.