As of February 2023, the waiting list for an initial appointment with England’s most popular NHS-commissioned Gender Identity Clinic (GIC), The Tavistock and Portman NHS Foundation Trust, stands at an impressive 12,296 people. Those currently being offered their first sessions at Tavistock were originally referred in 2018, nearly five years ago, yet only 41 new patients were seen in February. At its ongoing pace, it would take the clinic nearly 25 years to clear its backlog. That’s without accounting for new referrals, of which there are many‒ Tavistock’s waiting list has grown by a shocking 115% since 2019.
This clinic isn’t alone in its overwhelm. Demand for these services has increased rapidly over the last seven years or so, with overall GIC referrals increasing by 40% between 2016 and 2020, and an estimated 25,621 people waiting for an initial appointment as of last year. There are only seven adult GICs in England, with Tavistock alone covering the entire south of the country, which is causing life-threatening delays in trans people accessing gender-affirming care.
22-year-old Joe* was informed this month that his next appointment with the GIC will take place in July, 19 months after his last appointment, and 13 months late. He was initially put on the waiting list for the Gender Identity Development Service (GIDS) ‒ Tavistock’s children’s unit‒ when he was 16, and was transferred onto the adult list during his wait. Over the last seven years, he has only had three appointments with the GIC.
He describes his time at the clinic as “arduous and long”. His years on the waiting list consisted of missed experiences, turbulent family relationships, and a gruelling battle with an eating disorder, all of which he believes “definitely” would have been avoided, had he been seen earlier.
“It’s just a really shit system with even shitter people behind it,” he says of the organisation. “It’s like they don’t even ask for trans people’s opinions when they make these things.”
He isn’t alone in his frustration. Riley, who was first referred to the GIC over four years ago, still hasn’t received any information regarding when her first appointment will take place.
Discussing wait times within the NHS, she says: “I think it’s a fucking travesty. If you realistically want to get any kind of [gender-affirming] healthcare your options are to go private, self-medicate, or suffer.”
Self-medicating‒ in this context, self-administering hormone replacement therapy‒ is the only viable option for many trans people in the UK, as Riley acknowledges. This involves purchasing gender-affirming hormones from (often unreliable) online sources, deciding your own dosage, and either self-injecting, taking tablets, or applying gels. A survey conducted by the charity TransActual found that a quarter of its respondents had undertaken the practice at some point.
In spite of its frequency, the decision to self-medicate isn’t taken lightly. Many only do so in conjecture with regular blood tests from their healthcare provider, and often using guidance from other trans people online. They’re also very aware of the risk involved‒ they just feel they’ve been left with no choice but to take it.
Riley says that the biggest drawback of self-medding was that she was “shooting in the dark”, and as a result, initially administered a low dosage to avoid any potential harm to herself. However, taking the treatment into her own hands meant she was able to begin medically transitioning within a few weeks rather than a few years, meaning she was able to “actually feel comfortable in [her] own skin for the first time.”
Eventually, she chose to access gender-affirming care via a private gender clinic after losing hope in being seen by the NHS. Seeking treatment this way can be incredibly expensive: an average first consultation at the private network Gender Care costs around £300, whilst GenderGP charges an initial sum of £195 on top of its £30 monthly subscription fees. Neither of these totals include the cost of medical procedures or prescriptions.
However, the same TransActual survey found that the average waiting time for an initial private appointment is more than nine times shorter than the average wait through the NHS. For many, this time difference can be life-saving.
Emily, who chose to forgo seeking treatment via the NHS altogether, was prescribed gender-affirming hormones within several months of self-referring to a private gender clinic. She says that this was one of the best things she has ever done for her wellbeing, and admits that if she hadn’t received this care when she did, she “probably would’ve killed [herself], is the brutal truth of it.”
Although her first prescription came swiftly, it coincided with a national HRT shortage, which has left her self-medicating in spite of the substantial fees she pays her provider. In that regard, she acknowledges that whilst she is very lucky to be able to afford private care, it isn’t doing very much for her currently. The most she has used it for in recent times is to book a set of blood tests, which set her back £359.
These hardships‒ waiting lists, hormone shortages, self-medication, and extortionate private fees‒ arise from what many trans people have come to realise is a deeply flawed system, one in which their access to gender-affirming care is only granted on the basis of a gender dysphoria diagnosis, and can be denied or withdrawn arbitrarily at any point.
The solution is to implement an informed consent model for trans patients. The basis of almost all healthcare in the UK, this model works when your healthcare provider informs you of all relevant information about a treatment, and you use this information to consent to that treatment. Removing the need for diagnoses from specialist gender clinics would cut waiting lists, make self-medicating unnecessary, and above all else, place agency back into trans people’s own hands.
However, with hostility towards the trans community rising exponentially in the UK, most trans people are not hopeful that these reforms will ever come.
“There are a lot of people who desperately need help, and support, and medication, yet the British state does nothing except put us under the heel of its boot and grind us into the pavement,” Emily concludes solemnly. “They’re perfectly fine with thousands of people killing themselves as a result of not being able to get the help and support they need.”
Joe adds: “They just don’t give a shit about us. They haven’t ever given a shit, and at this rate, they never will.”
* Name has been changed.