Between striking nurses and ambulance workers, twelve or more hour waits in A&E, and patients getting passed from service to service with no actual care provided, a lot of people are seeing what a non-functioning National Health Service can look like. A sight we are all to familiar with when trying to access trans healthcare on the NHS.
To be clear, I love the idea of the NHS. Nationalised healthcare should be a human right and attempts to destroy it should be seen as a direct attack on all marginalised people, especially working-class, trans, and disabled people. I have family members who work in hospitals and I know that they and many others like them do their best to make the service work.
Unfortunately, not everyone does. And better funding for trans healthcare on the NHS isn’t enough to get us equal respect and care.
The most obvious and most talked-about element of how trans healthcare on the NHS fails us is through the Gender Identity Clinics. But while they’re a special kind of awful, this failure has never been limited to just the GICs.
Every trans person who interacts with the trans healthcare on the NHS has their own story; this is mine. I wish I could say that I hope it’s an outlier or an anomaly, but I think that would be naive.
When I first sought out medical transition in August 2016, I chose a GIC more than four hours’ travel from my home because of the estimates for the waiting list that I’d found online. This one was shorter than the estimates for clinics closer to me at only two years wait instead of four. I was willing to spend over £60 on train tickets to wait twenty-four months for trans healthcare on the NHS, because that was the best option I had.
Though the GIC itself told me it would be a thirteen month wait when they accepted my referral, the online estimate of two years was much more accurate. Even before I’d received any care, it was clear that other trans people knew more than the professional services supposed to look after us.
I waited twenty-seven months for my first GIC appointment. By the time they saw me, I’d legally changed my name and been out to everyone I knew for over a year. It was tough, but I didn’t feel like I had a choice. I couldn’t stay closeted and even if I had been able to bear it, doing so might have made it harder to convince the GIC that I was truly trans.
When I finally got to the top of the waiting list, I was so excited, but I knew better than to think I’d feel supported or cared for with trans healthcare on the NHS. And I was right.
GIC appointments feel less like healthcare and more like an exam which you can pass or fail. In this session, I was quizzed about my mental health, childhood, sex life and sexuality, and adherence to gender roles by a man who had total control over whether I’d ever be allowed to medically transition, then sent on my way. But I passed the test: he wrote a letter saying I was allowed to be trans, and I was a step closer to medically transitioning.
It would be another sixteen months before I had my second appointment. I was asked the same types of questions all over again by a different clinician, but at the end of the session, she was willing to send me for a blood test, diagnose me with gender dysphoria, and recommend I be started on Testosterone.
It was April 2020 when I finally got my prescription in my hands. It had taken nearly four years of trying to access trans healthcare on the NHS for me to get to this point. For everyone referred later than me, this wait is only getting longer.
Obviously, coronavirus caused some delays. But at least, in January 2022 when I was finally seen again to discuss top surgery referrals, I was able to have the appointment over Zoom and not have to pay for the travel. This appointment seemed to go better than the other two, and I hoped that 2022 might be the year I finally had the surgery I’ve been actively wanting for over six years.
But it wasn’t to be. In June of 2022, when I moved house and updated my details with the GIC, I asked about the status of my referral.
They’d never sent the letter.
I’d spent six months waiting for nothing. And they didnt seem particularly sorry. It was clear to me that it didn’t matter to them that I’d spent six extra months binding every time I left the house, hating my body, feeling like all of me was on hold. They didn’t care.
I spent a lot of time feeling hopeless about the rest of my medical transition, and sometimes I still do. How could I feel like I’m making progress towards where I want to be when I demonstrably wasn’t? I still don’t know when I’ll get top surgery. I’ll be twenty-five this year and I’ve been trying to get it through via trans healthcare on the NHS since I was eighteen.
How much of my youth am I giving up because of the painfully long waits, and what do I have to do to make the NHS and those in control of it care?
Then there’s the fact that facial masculinisation surgery isn’t available with trans healthcare on the NHS for those of us who don’t or can’t get facial changes from T. I had jaw surgery as a teenager and the metal plates fixed into my face prevent it from being reshaped hormonally, so being perceived as a man in my regular life is still a rarity. When it comes to my transition, at least, I have to go private for what I see as a non-negotiable and essential part of it. I can fundraise and save for FMS, but that, too, feels like an impossibly far-off goal.
But, in my experience, the GIC is not the only place where trans healthcare on the NHS is inadequate.
Back when I was a teenager and out to almost no-one, I tried to bring up my gender to the clinician I was seeing at CAMHS, only to be told I wasn’t allowed to discuss it or be called by my chosen name because “we don’t do that here”. I was passed around from person to person until finally, one man was willing to actually use my name.
Though I don’t know this for sure, I’ve since found out that my early discharge – six full months before my eighteenth birthday – might have been because no other clinician was willing to see me when that counsellor left.
I had to split myself into boxes to access any support. I had to go to LGBTQ+ charities if I wanted to talk about anything to do with my identity as a queer trans person. But they weren’t as equipped to deal with my mental health. And even though the dysphoria and inability to come out at that time was part of why my mental health was so poor, I couldn’t bring that part of me to ‘standard’ mental health services.
I wasn’t even an adult yet, but I was told loud and clear that I would have to patchwork my healthcare together and could never receive the same quality care as a cis person. And this has been proven every time I’ve tried to access mental health care since, to the point where it’s easier to just not engage at all.
Is it any wonder that so many of us have difficult relationships with mental health?
It’s not just more specialised services which treat us with apathy, though. Even General Practitioners, who should be able to treat everyone, can cause issues.
To be referred to a GIC for trans healthcare on the NHS, you usually have to ask a GP. I felt lucky that it only took three appointments for my GP to refer me to a GIC. That’s why I stayed listed as living with my mum for healthcare purposes, even when doing so was inconvenient. Despite the fact I’d moved out of my mum’s house to a town just over an hour away in 2017, I didn’t dare change GPs to one nearer to me in case it delayed my GIC referral or ended in it being cancelled. Fundamentally, I couldn’t trust the NHS.
I was only nineteen when I moved for university, but I already knew how easy it was for trans healthcare on the NHS to fail us and I didn’t want to take any risks. So any time I needed or wanted to see a doctor, I had to travel back to my mum’s.
I made the choice to change GPs and register with one closer to me in June 2020, just before my twenty-second birthday. I had my T prescription and my diagnosis of gender dysphoria through the official NHS routes. I thought it would be fine. But just because a GP is marked as ‘LGBT friendly’ or having an ‘interest’ in trans healthcare doesn’t mean they or their practice will do a good job.
I was with this practice for two years. Only one GP in that practice was willing to see me as a trans patient, and during that time, I received no blood monitoring work, despite repeatedly asking for it and having bloods taken twice; apparently he didn’t know how to interpret bloods for trans people, and usually only worked with private providers who would handle that part.
Twice, my title was changed from Mr to Ms.
And when they issued me with a new NHS number, they managed to eradicate my previous record instead of redacting information as they’re supposed to, then lied and told me that removing all my past health records is standard practice. Instead, they just listed my COVID-19 vaccines, current medications, and – the cherry on the shit cake – wrote “Problems: transgender” as my only medical issue, leaving out my diagnosed anaemia, autism, and depression.
I still haven’t quite managed to recover all of my medical records.
But they prescribed my T and that made me afraid to try to go elsewhere. No other local GP was listed as ‘LGBT friendly’. If this was what ‘friendly’ looked like, how bad would unfriendly be? In the end, I only left because I was forced to after moving outside of their catchment area.
When I was forced to register with a new GP, I went through the same waiting period of nearly two months as any other patient. But because I’m trans, once I finally got an appointment, I was told that the practice couldn’t take me on. They told me that they don’t prescribe or monitor HRT for trans people, or do any form of shared care for us. I was given a one-off prescription for my antidepressants (but none for my testosterone) and told to try a different practice.
They were unable to tell me which practices would be willing to provide trans healthcare on the NHS for me. So I had to go back to the start and, thanks to delays during the Christmas period, spend a full five months with no access to healthcare.
I had been hoarding my HRT specifically because I knew how easily it could be taken away from me, but still resorted to skipping doses. If I only applied my gel every 2-3 days, I could make it last longer. So that’s what I did.
My fears had been confirmed. ‘LGBT friendly’ trans healthcare on the NHS just meant willingness to let me be trans.
And the worst part is that I feel lucky that my second gamble worked out, and my new GP is willing to both prescribe T and monitor my bloods – things which probably should be the bare minimum. I’ve been with the new practice since January 2023 and just had my bloods done, so I should have my levels assessed for the first time… After twenty-one months on T. In theory, T levels should be checked every three to six months.
I want to be hopeful that I’ll receive the bare minimum of healthcare now. I want to be hopeful that I’ll be allowed to reach a point in transition where I feel comfortable. And I want to feel safe in the knowledge that my healthcare won’t be ripped out from underneath me. But I’ve been burned so many times.
That’s not even getting into how the Tory attacks on trans healthcare on the NHS and the NHS in general have the potential to tear away services from trans and cis people alike. The current and proposed policies are a different kind of apathy, one which tells people who can’t afford private care that they don’t matter.
It’s hard to be hopeful right now, on both a personal and wider level. But joining movements supporting the NHS feels like the only way to guarantee we keep our reluctantly-given scraps. And perhaps, now wider cis society is getting a taste of what an NHS that doesn’t care about you and doesn’t properly care for you looks like, they might be more inclined to stand in solidarity with us.