The Gender Identity Clinic Waitlist
I have often written about the obstacles trans people face when accessing healthcare, and when it comes to transitional healthcare, the situation is not any different - if not worse.
The waitlist for Gender Identity Clinics, compared to any other wait time in the UK, is the longest. And even without taking into account the impact the pandemic had on it, it’s against NHS Guidelines as well.
While the guidelines say 18 weeks is the limit from referral to treatment, the current wait time is closer to five years, three on average.
If we look at statistics around mental health, regardless of age, we’re presented with an alarming scenario: a recent study commissioned by Just like Us reports that only 35% of transgender young people feel optimistic about the future. Stonewall studies studies show that 48% of trans people have attempted suicide at least once, 84% have had suicide ideation. More than 55% have been diagnosed with depression, and considering the systemic issues in getting a mental health diagnosis, it’s likely that data doesn’t accurately represent the extent of the problem.
While not all trans people intend to pursue medical transition, for those who want, the long wait is an incredible source of anxiety and stress. Stonewall reports 47% of trans people, almost half, state that the long wait is preventing them from accessing the medical treatment they need. 45% don’t have the means to afford private healthcare or the travel expenses to use the NHS. 24% don’t know how to access the services they need and 62% of people who have finally received the treatment needed report they are unsatisfied with the wait, and the survey is dated before the pandemic, when the average wait was “only” 18-24 months.
Personally I have been able to transition privately, and it’s been a huge privilege. I underwent top surgery a few weeks ago, and started HRT 8 months ago. Both had been pushed back due to the pandemic, and the uncertainty was unbearable at times.
But as I mentioned, I know I speak from a privileged position, so I interviewed some non-binary and transgender people who are still on the GIC waitlist.
One of the biggest arguments against trans people accessing transitional healthcare on an informed consent basis is that they would risk regretting it, and that such big decisions should be thought through. In reality, cisgender people never face the same amount of barriers even when it comes to the same treatment.
Women who need a breast reduction don’t need years worth of referrals. Puberty blockers have been used for decades on cisgender children who entered puberty too early. And the reality is that even before coming out to anyone, even before admitting it to ourselves, we spend a very long time exploring our gender identity. By the time we assess whether it’s safe to socially transition, and then whether we can safely medically transition, and we get in touch with the GP for a referral, years might have already passed.
Jamie, a 24-year-old non-binary person, recalls what getting the referral was like.
“First of all is the initial struggle of getting a doctors appointment to even discuss it, which in the area I was living in at the time proved difficult”, they explained. “Second, the doctor I saw had never done this referral before - she was open about that to me, to her credit, and admitted she needed help from her colleagues. It was nonetheless stressful though, that at an already extremely anxiety-inducing appointment, the doctor kept nipping out to ask questions to her seniors, and seemed to have no confidence in what she was talking about. And even when I thought I was done, after a couple of weeks, I was called back in for a second appointment…”
As I mentioned earlier, the pandemic hasn’t made the process any easier.
Roan, age 24, has been struggling to consistently schedule blood tests as required. As soon as the pandemic hit, Roan knew that transitional care would be the first service to be delayed. And getting “lost” in the system becomes easier as well. When Roan first got referred, the GP made a mistake and sent the referral to the wrong GIC, instead of Northampton and London as requested.
Jamie has been on the waitlist since 2019, and never got updates since then. They learned about the wait time being increased online, instead of being notified by the clinic.
“I checked that the GP had sent it off. Now I can only assume I’m on the everlasting waiting list.” I asked about their reaction to it, and they expressed frustration.
“I had an idea it would be a long while - I actually told my GP of this and she was horrified, she had no idea. There’s no other service on the NHS you’d wait so long for, to my knowledge. To hear it was 5 years, it was devastating. Demand is growing and services aren’t meeting demand, so I wouldn’t be surprised if the time got longer in the coming years. There’s not enough services, not enough budget given to trans healthcare.”
And often it’s not only a matter of waiting, but people end up having to plan their whole lives around it.
“The pandemic has lengthened waiting times for all trans health services, and this has given me the huge internal struggle to decide if I wait for an appointment, or attempt to pay out of pocket for a private surgery”, Jamie explains.
“All my healthcare appointments have been delayed or disrupted due to the pandemic. It’s much more anxiety inducing to have appointments over the phone. I have also put appointments off due to not having a private space at home to call someone for a health appointment, since I’m not out to everyone.
I am seriously considering going private, due to the waiting times for nhs treatment. It feels impossible for me to wait more than five years to get gender affirming treatments. The downsides are huge: the main one being I would spend my life savings. I would love to be able to spend the money I have saved on travel, a home, a wedding, or future study. But this surgery is essential for me to be able to function. Right now I feel like I’m waiting for my life to start.”
But even people who were able to start their transition privately feel overwhelmed seeing how trans healthcare has taken a backseat during the pandemic.
Ben, a 22-year-old trans man, comments that “It angers me! Gender affirming care literally saves lives - to make people wait this long is so dangerous”. Even if he was “lucky” to “only” wait two and a half years before being seen at the newly formed Welsh Gender Service, his mental health took a hit during the pandemic.
“The lack of social interaction during this "second puberty" had made it feel as though nothing has happened and people won't believe me. I've had a medical professional claim that I shouldn't have my gender marker as male.”
Luke, a 20-year-old trans man, tells me about his experience after getting his referral in 2018. After talking to me he even apologised, because he realised he had a lot of resentment about this situation he had never really had the chance to process.
“After getting a confirmation of the referral from the GIC, around 8 months afterwards - the longest time I’ve waited for any confirmation - I’ve heard nothing from them since. No updates or support guides, only a waiting list that gets longer with every year. I think when I was referred back in 2018 I was told the wait for a first appointment would be in 1-2 years, but it’s now been 3 years and it still doesn’t look like I’ll get an appointment anytime soon.
However, I was extremely fortunate to be able to medically transition privately. When I heard that the current wait for the GICs is 5 years, part of me wanted to laugh because it’s not surprising in the least and it’s actually laughable that they’re able to get away with it. But mostly it just makes me feel sick knowing how much and how many people will suffer because of it. I feel so so bad for all the trans and non-binary people who can’t afford to transition privately, because I know how it feels and I can’t bear to think about what my life would be like if I hadn’t been able to transition privately and still had to deal with the same struggles I was going through at the time of my referral.
At this point, going private is essentially the only “viable” option. And it shouldn’t be the case, especially in a country that prides itself on having free healthcare. I truly hope that the waiting list issues are actively dealt with and fixed soon, because it’s not excusable to allow so many people to suffer for so long with absolutely no support.”
While most of my dysphoria is social, so waiting wasn’t that distressing when the pandemic started, it’s incredibly hard to be hopeful about the future.
Jamie echoes that: “It’s hard to feel optimistic over a five year wait potentially getting a little smaller - it’s still miles away from acceptable. The point of hope I cling to is that as these issues are more discussed in the mainstream, there is more pressure on the government to take the concerns of trans people seriously, and give us the healthcare we need.”
Trans healthcare and transitional services aren’t a lifestyle choice, in lots of cases they’re emergency healthcare. Putting this pressure onto a demographic already affected by discrimination within healthcare, and at high risk of suicide ideation and depression is incredibly dangerous. We are living through a crisis people aren’t hearing about, but just because those voices are silent, it doesn’t mean they’re not there.
Written by Ramses Olivia
Ramses (ramses.uk) is a transgender activist, writer, and educator whose focus is improving transgender visibility in all fields. He works with charities, brands, and companies to improve diversity and inclusion policies, and is currently working on resources for children and parents to start conversations about gender diversity.
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