'I Am Only Half a Person' – 6 Trans People on the NHS Waiting List Crisis

If you didn’t know any better, you would think it’s pretty easy to access healthcare on the NHS if you’re transgender. 

Widespread reporting in the UK makes it appear that the problem is, if anything, an excess of gender-affirming treatment, with allegations that doctors and clinics routinely overprescribe hormones and puberty blockers.  

This couldn’t be further from the truth. There are more than 13,500 people on waitlists for NHS gender identity clinics (GICs) in England alone, with patients at the only clinic in the South West waiting up to five years. 

The NHS has said that an initial appointment for hormone therapy and surgery should be made within 18 weeks, but the LGBT Foundation says that people now wait an average of a year-and-a-half before they are seen, and many fear that COVID-19 is only making the situation worse. 

Over the summer, VICE photographer Bex Wade spoke to six young people about their struggle to access healthcare. Between them, they have waited a total of 16-and-a-half years to be seen by the NHS. Some feel they have no choice but to bear the financial burden of going private. Others are self-medicating with drugs bought on the internet – a fraught and potentially risky process that the NHS itself advises against.

As James Factora notes for VICE, the stakes are high: “When done right, many transition-related treatments, including hormone replacement therapy (HRT) or gender-affirming hormone therapy, are associated with overwhelmingly positive outcomes in terms of both physical and mental health. What’s actually dangerous is denying trans and non-binary people the right to bodily autonomy and potentially life-saving health care.” 

Teddy, 21, a caterer from Birmingham, waited three-and-a-half years before receiving an email from their GIC. High Wycombe student Archie, 17, has waited for two-and-a-half years and is yet to receive even that. “I feel almost like I’m part of a society that doesn’t give a shit about me,” he says. “What I want cis people to know is that trans healthcare isn’t optional.”

VICE: When did you come out as trans? And when did you first try to get seen by the NHS?
Teddy: I came out as non-binary, specifically genderqueer, first when I was 14. After some more questioning, I felt that I was a transgender man and came out when I was 16. A few days after my 17th birthday, I went to my GP and asked to be put on the waiting list to access gender services and receive treatment, hormones and surgery.

How long have you been waiting?
Since first going to the GP and asking to be put on the waiting list and then actually receiving any contact from any gender clinics, it was a period of three and a half years. From physically being able to start HRT, I was a few days shy of four years since my original GP appointment asking to access treatment when I was 17. I still have not received any timeframe about when I will be able to have top and lower surgery, despite being on testosterone for seven months.

What impact is the wait having on you?
I really struggled with my mental health when I was 17 to 18 years old, knowing that I would still have to wait another two to three years to get any sort of appointments or treatment or HRT was making me feel hopeless. I felt like I wasn't able to be my true self. Even now, despite my mental health being significantly better, I still struggle. The gender clinic I am receiving treatment from barely contacts me. I have a brief 15 minute phone call every four months where I'm made to feel like I'm being a burden for asking questions about my treatment, then I'm left in the dark. I have learned more about HRT and surgeries from other trans people online than from the actual medical professionals I am supposed to be in contact with. 

Not knowing when I will be able to receive top surgery is constantly on my mind, especially with the NHS being so backlogged with operations due to continuous underfunding from the government, and now the COVID crisis. Of course, I want people to access their life-saving surgeries first before I am considered for top surgery, but I'm being burnt out. I'm even thinking of going privately for surgery but it will be a few years of saving before I can afford it. Right now, I feel like I am only half a person.

What do you think about the state of trans healthcare in the UK?
There is a real crisis happening and a lot of trans people are in danger. It's easy to get disheartened because our community is left to fend for ourselves most of the time. The issues that affect queer and trans people, such as homelessness, addiction, assault and suicide will only continue to rise if our needs aren't met. People will suffer. It feels like our current government is actively endangering trans people by continuing to underfund and cut vital resources.

I think what cis people should understand is that trans people are everywhere. Transness has always existed and will continue to thrive because we are so strong, but we need help. We're normal people, we have the same needs, wants and desires as everyone else. We just need that support that other communities receive. We need cis people to help us fight because we're dying out here. Being trans is a beautiful thing, we just want to live. We just want to be happy.

VICE: How long ago did you come out and start seeking help on the NHS? 
Sid: I came out as trans in late 2017 and waited until 2018 to finally pluck up the courage to speak to my GP. My initial GP didn't even know how to refer me and had never encountered a trans patient before, so I had to do a lot of education there. There is no GIC where I live or in the closest city of Birmingham, so I have had to be referred to the GIC in Nottingham. The fact that the second biggest city in the country doesn’t even have a GIC is really telling about the state of trans healthcare and how little the government prioritises it. 

How long have you been waiting for treatment? 
Three years now.

And how’s that affected you?
It feels like my life is on pause, honestly, until I am able to get top surgery. I have to bind everyday, which can be very painful after a long period of time and many years. It affects my work life, social interactions and relationships, I feel like I need this healthcare to be free. I have started fundraising for my top surgery on GoFundMe because I don’t think I will be seen by the GICs for a long time still, and I don’t have the money to go private.

What are you doing to get by while you wait? 
I've been lucky to find a GP on the NHS who is trans herself – she has been amazing and supportive and has been able to prescribe me a bridging prescription which has helped immensely with my gender dysphoria. GPs are able to prescribe hormones for trans people, but many don't due to a lack of education and blatant transphobia. According to the General Medical Council, if GPs don’t feel comfortable prescribing they must refer people to an endocrinologist, which has a shorter waiting time than a GIC. Having a GP who is understanding and educated on trans issues has been transformational in terms of how I’ve coped with this all.

What would you like cis people to know about trans healthcare?
The current system is completely overwhelmed and outdated, with an exponentially increasing demand for these services and no real plans from the government about how they are going to resolve this and help us. I want people to understand that this healthcare is essential for people. This is a whole community being failed on a massive scale. People’s mental health massively suffers when they can’t access this healthcare and it means we are losing members of our community because the government is failing. To exist as a trans person and see how your identity and healthcare not only isn’t prioritised but is not understood or even acknowledged, is just exhausting. 

VICE: When did you come out? And how long ago did you first try to get seen by the NHS? 
Rat: I came out as trans when I was 20 and immediately that week I went to the NHS for help. I got a letter straight away about my referral, but they then said it would be a wait of 12 to 16 months until the next step. So then I tried private healthcare and spoke to GenderGP and paid like, £400 for them to turn round and say “yeah, you’re trans”. They then told me I either had to pay a fuck tonne of money for meds, which are way above market value, or you can get your doctor to sign for shared care and the NHS will pay for your meds. I literally couldn’t get my doctor to sign it, it took like six months. Every time they said they’d sign it, they said they’d lost the form, and I’d take it back and they still wouldn’t sign it. So I gave up and then just stated buying shit off the internet, cause it’s all you can do.

How long have you been waiting so far? 
Four years.

How has that affected your life?
I think if I hadn’t been out there seeking my own DIY healthcare, I’d probably be really fucked up about it. Like, right now it’s almost like a joke. It’s just hilarious how inept the system is. The fact that they told me “12 to 16 months” – four years ago.  

What kind of treatment are you hoping to get? 
I’m still waiting for some surgeries. I want to get an orchidectomy [to remove the testicles] and things like that. I’m almost scared now of going to the NHS, because I’ve heard so many fucked up stories about them taking meds away from people and stuff. But now that I’ve been doing this for four years and I know what works for me and have all my bloods sorted, I think, ‘What if I go there now and then [they] force me to start again?’ I’m kind of ambivalent towards the whole NHS thing now cause they’ve been so fucked to everyone, everywhere.

What are you doing to cope in the meantime? 
I’ve gone down the DIY route. What am I going to do? Wait four years of testosterone poisoning and then to be told that I have to keep on waiting? It’s just not feasible.

What do you think about trans healthcare in the UK? What would you tell cis people about it?
The state of it is that you wait forever or you pay a lot of money. Sometimes even paying a lot of money doesn’t get you the healthcare that you need, so you’re still waiting and you’re still not getting anything. It’s as if people think the NHS is like you just go and you get healthcare, but you just don’t. You go and they tell you “no” and then they tell you to wait and that’s it. 

I just want cis people to understand that there’s pretty much no healthcare. There is nothing out there for trans people. We just have to go do shit ourselves so much now. Four years ago, we were waiting a year – now most trans people I know just don’t even bother because we know it’s not going to be there. If I even bothered to sign up now, I’d probably be seen in like six years because the wait time just keeps ballooning. There just is no care unless you have a fuck load of money. 

VICE: When did you come out as trans? And when did you first try to get seen by the NHS? 
Kate: I came out two years ago, when I was 12. I first tried to get seen about a year and a half ago.

What impact is the wait having on you?
It just makes me anxious, considering I could have been seen, had the wait been only a month or so, before puberty and the counsellors could have helped me work through that.

What treatment are you hoping to receive? 
HRT.

What are you doing to cope in the meantime? 
Just muddling through and reminding myself that it’s far harder for many adults, teens and kids.

What do you think about the state of trans healthcare in the UK? What would you like cis people to understand about it?
I think cis people often perceive the wait as nothing to worry about, seeing as waiting isn't likely to effect your physical health, but I hope that one day cis people will begin to realise that waiting for something so life-changing and affirming can be detrimental to people’s mental and often physical health over time.

VICE: When did you come out as trans? And when did you first try to get seen by the NHS? 
Enxi: I came out as trans over the first lockdown. It was pretty much during lockdown that I realised that couldn’t run from this any more. I think I knew when I was about 12 or 13 but thought, ‘no this can’t be me, this can’t be my life, my parents would never accept it.’ But during lockdown I just knew I couldn’t be a boy anymore or I’d have become a statistic. 

I went to the NHS pretty much as soon as I came out as trans. They said they would put me on a waiting list and then I started looking into how long the waiting list was and how long it would take me. I kind of had an idea already as I knew a lot of trans femmes and that’s all they were talking about. Overall, the NHS haven’t done anything towards my transition.

How long have you been waiting? 
It’s been almost 18 months so far.

What impact is the wait having on you?
I’m 24 now and I’ve already starting to feel my age a bit. Seeing all these gorgeous trans girls who transitioned at the age of 16 has been making me feel like I missed out on all that. It’s like I’m running out of time and I just want to do it all as soon as possible to make up for lost time. I’ve ended up having to look into private options like Gendercare and GenderGP, but the consultation still requires a wait and that route is incredibly expensive. I used up a lot of my hard-earned savings just to pay for the initial consultation. 

I also found the questioning at the consultation to be very invasive. I guess I understand this, but I very much feel that the system is populated by cis, often male, doctors who are essentially gatekeeping trans healthcare from us; arbitrarily deciding whether or not we have dysphoria and forcing us to prove the fact that we have dysphoria, when ultimately they’re cis male doctors and have no idea how it feels to be trans. It feels a very exploitative and an unequal power dynamic.

What kind of treatment are you hoping to receive? 
HRT – hormones. Laser hair removal is another huge priority but I’ve heard that can take up to seven years on the NHS.

What are you doing to cope in the meantime? 
I’m doing things DIY, which is an extremely common option for trans girls. If you go on websites like Reddit, you can find thousands of DIY threads with trans girls exchanging info, exchanging contraband hormones, you can find the lot.  

In the meantime, I shave constantly. I have a million razor burns. Recently I plucked my entire upper lip – every last hair – because I was so sick of the five o’clock shadow and sick of being harassed in the street. I’m so scared for my own safety. That’s the thing, these things take so much time, but they are the things which can help us determine whether we pass as cis. This shouldn’t be the goal, but at the end of the day passing as cis keeps us safe. 

How do you feel about healthcare for trans people right now in the UK?
The thing about trans healthcare is that ultimately none of it was made for us at all. We’re just taking the leftovers of what was already there for cis people, and we just make it work. Estronol – that’s for menopausal cis women. Puberty blockers are for children or hormone imbalances or early onset puberty, and spironolactone is for testicular cancer. None of what we take is designed for us, so imagine how much better things could be if things were made for us. The same medications that we’re taking and are also prescribed to cis people only take weeks to be prescribed [to] them, whereas it takes us years. We’re not taking magical “trans pills”, we’re just taking the same as cis people for different purposes. 

VICE: When did you come out? And when did you first try to get seen by the NHS? 
Archie: About two and a half years ago. Pretty soon after I came out, I tried to get enrolled into GIDS [the NHS gender identity development service specialising in children].

How long have you waited so far? 
I’ve been on the waiting list for two and a half years now and I haven’t had so much as an email from them.

And how has that wait affected you?
It’s kind of hard to put into words. I feel almost like I’m part of a society that doesn’t give a shit about me. I feel like I’m underneath a government that doesn’t recognise me, that doesn’t care for even life-changing healthcare for me. It’s like.. I feel invisible. And it weighs on me, every single day that I go without the treatment that I need, and without the healthcare that I just need to get by every day. It’s painful. 

What treatment would you hope to get? 
I want hormone therapy and top surgery. But also best case scenario, someone to talk to while I go through that. Someone who knows what they’re talking about, a specialist or someone that can just reassure me, rather than having to go on YouTube or Google.

I’ve considered DIY treatment a lot – [like] earlier, when I was coming out and it was difficult for me to communicate to my parents that I needed hormones. I did have a little search round and see if I could [get] my hands on any stuff on the internet and then I just thought, ‘That’s a really stupid idea, I’ve no idea what I’m doing. I’m 16 years old, I can’t just inject some shit into my blood that I found on the internet.’ But it’s either trying that or you know, feeling like I don’t want to live every day. So what choice did I have?

What are you doing to cope in the meantime? 
Well, to put it short, I’m not. Every day is a struggle. I’m genuinely quite surprised I made it this far, but I’m just going to run with it, if you know what I mean. I have been very lucky – my school and my parents and my family have been really accepting, so they’ve really helped me cope. But it doesn’t feel like I’m coping very well – I’m definitely suffering a lot.

What do you think about the state of trans healthcare in the UK? What would you like cis people to know about it?
I mean, to sum it up in one word, it’s bollocks. It’s practically non-existent. It’s like people say it’s there just so they check a box, but in reality there’s fuck all.  

What I want cis people to know is that trans healthcare isn’t optional. I feel like a lot of cis people believe that things like masculinisation, feminisation, all these sorts of physical surgeries, hormone therapies – that it’s a choice, that it’s something that we can choose to go on and it’s not. It’s life-saving. It’s a tool that gives us the chance to look in the mirror and recognise ourselves through years and years of not knowing who we are. I think a lot of people are really lucky to be born without having that struggle. And just a little bit of empathy would be useful from time to time, from some cis people.

@bexwade