Medically Transitioning in Britain: A System Unfit for Purpose

Avery Warner discusses how the current system for transgender and non-binary people seeking to medically transition is harmful and not fit for purpose.

One major aspect of lives of transgender and non-binary people that hasn’t got the attention it needs is medical transitioning in Britain. Specifically, there’s been no attention on just how decrepit and harmful the current system is. Very few, if any, British trans and non-binary people will have had a positive experience of medically transitioning yet there is little pressure from the media or politicians for the NHS medical transitioning system to be reformed. Only Pink News reported on the lie from the minister for women and equalities Liz Truss that the government was opening three ‘new’ gender dysphoria clinics (GDC) back in September 2020, with these ‘new’ clinics actually being pilot schemes that had been ran by the NHS since early 2020.

There’s one common experience between practically everyone in the trans and non-binary community, so common that it can be summarised in two words: waiting lists. For transgender and non-binary people seeking to medically transition having to wait extraordinary amounts of time is all too common. Waiting lists can typically go back three years, sometimes even more, with these waiting times being stretched even further due to the COVID-19 outbreak. The NHS does actually have a target of 18 weeks yet nowhere in the UK is this target met. The waiting list for the West of England Gender Identity Service even hit the 193-week mark for its waiting list in August 2020. The situation is the same in Scotland and Wales, with Wales having only opened its first gender development clinic in 2019 after multiple delays. However, is appears that there is going to be little progress on this for the time being with Liz Truss proclaiming that the waiting lists for gender clinics would be cut by approximately 1,600 people which is only equivalent to slightly above 10% of the 13,500 people currently on waiting lists.

There are two other routes available however, both with further problems. The first is private care. For those who do use private healthcare for their medical transition the process is much faster, though it can still take up until a year depending on the company and the treatment needed such as hormone replacement therapy and surgery. Costs do also vary between companies but will certainly go into hundreds of pounds. For Gendercare the price of two appointments to get prescribed hormones cost £600, £300 for an initial assessment with a doctor and another £300 for a more in-depth appointment with an endocrinologist. This is assuming an additional appointment won’t be needed if the initial appointment isn’t conclusive in a diagnosis of gender dysphoria. These costs come on top of the transport costs needed to actually get to appointments (though appointments have been online since the COVID-19 outbreak began) with the few private healthcare clinics there are being mostly based either in London or Edinburgh requiring patients to travel from across the country to attend appointments. These high prices can lead to some trans people not being able to afford private healthcare and instead having to rely on the NHS or the second alternative route. And then there is the possibility (which the Gendercare website admits) that the GP can just refuse to give a prescription for hormones when private specialists recommended a prescription Thankfully this is rare, but it is still a possibility.

The second route trans and non-binary people can go down is doing DIY. This is commonly associated with homemade binders and breasts forms. However, the more relevant and harmful example of DIY is taking hormones without a prescription by purchasing them online. Taking these without medical supervision or the proper blood work being done can lead to serious and negative health effects like cardiovascular disease. This may sound like a completely unnecessary risk to cis people, but for trans people stuck waiting up to 4 years for help from the NHS and being unable to afford private care DIY can look like the only possible option. This became an even more attractive option when the NHS informed GPs that they should give bridging hormones to patients who had revealed that they were taking hormones without a prescription. This is the right choice, after all it helps lower the health risk, but doesn’t do anything to cure the root of the problem, long NHS waiting lists.

So what can be done to improve the process of medical transition for trans people in Britain? In terms of private care one helpful policy would be mandating GPs to make prescriptions for hormone treatment when recommendations are made from private healthcare clinics. The government could also fund or partially fund the costs of private healthcare for trans and non-binary individuals, allowing more people to have access to the private services and creating a larger incentive for more private clinics to open around the country. However, whilst these are possible policy solutions, there is a much better option available. Greater funding of GIC so they can recruit more staff and cut down on the waiting list as well as opening more GIC around the country to lessen the pressure on clinics currently. Steps are being made in the right direction with the trials being ran in London, Greater Manchester and Merseyside though more than those 3 will be needed. In particular more Gender Identity Development Services (GIDS) are needed with there currently only being one in England making it much, harder for those under 18 to get the care they need. Improvements in lowering the waiting lists for NHS services would also neutralise the problems with private care as it would massively reduce the need for it as its main benefit (shorter waiting lists) would no longer be beneficial. Shorter waiting times would also reduce the likelihood of DIY hormone treatment occurring as it will no longer take years to be able to get hormone replacement treatment. Whilst policies improving access to private healthcare would be a useful short-term policy, it would be so much better to improve the services provided by the NHS so there is no longer any need for private healthcare and transgender people can have easy access to make the medical transition that they want to make.

As a final note on how unfit the current system is, I haven’t even dipped into how hard it is to get surgeries or how harmful the system is for the mental health of trans and non-binary people.


Avery Warner is a first-year politics student at Durham University. She’s the LGBTQIA+ Officer at Durham University Labour Club and the LGBTQIA+ Officer at the Young Fabians North East Network.


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