In April 2017, Jules Guaitamacchi decided their gender dysphoria had become too crippling to cope with. Overwhelmed, they called a gender identity clinic only to be told that the waiting list had stretched to 16 months long. “I couldn’t wait,” they tell me, recalling a period of intense struggle with anxiety and depression. “I started getting progressively worse, and by September 2017 I had to stop working.”
Desperate for a solution, Jules began to self-medicate with testosterone before being bridged onto a prescription by their GP. The hormones helped; Jules soon returned to work on a mission to save for private treatment, but this process proved no easier. “I continued to hear nothing from a private clinic, so I messaged the clinician personally on Twitter to schedule a £220 private assessment in July. That led to a chest surgery consultation which cost me a further £100. In that consultation I was told surgery was £5,975.” Unable to source NHS help or access private treatment, Jules did what countless other trans patients have been forced to do: set up a GoFundMe.
A search of the word ‘transgender’ on the crowdfunding site brings up more than 6,000 worldwide results, not all of which are linked to medical transition. Some are created by trans people abandoned by hostile families; others are campaigns to raise money for funerals of trans murder victims. The majority of healthcare-related examples are based in the US for obvious reasons, but the hundreds of UK results seem to indicate that our healthcare system is struggling to cope.
It’s not the first time this claim has been made. In 2016, after a barrage of complaints from dismayed patients, NHS England stated an aim to reduce waiting times to less than 18 weeks. This hasn’t happened; in fact, waiting times have increased even further.
A spokesperson for Tavistock & Portman, whose youth service has also made headline news for struggling to keep up with demand, says that 330 referrals to its adult service were made last month alone – a 28 percent rise on 2017 figures. These numbers also reflect demand in the six other NHS gender identity clinics across the country; as a result, the current waiting time is somewhere between 18 and 24 months. They’re still trying to fix the problem, stating: “We are working with our service users to look at innovative ways to support this growing population, and to educate GPs and other health professionals on the issues trans patients may be facing.”
Waiting lists at private clinics have also increased, but their exorbitant costs leave trans people not wealthy enough to afford them struggling to pay. Crowdfunding can seem like the only option, and even these campaigns aren’t guaranteed to yield results: plenty of the campaigns listed have failed to attract any donations at all.
But there some success stories. Twenty-year-old student and trans advocate Alex Jones has managed to partly crowd-fund money for his transition; a recent campaign to earn £750 towards his top surgery just met its target. Earlier this year, 36-year-old Sophie Collings made headlines after an emotional essay attached to her fundraising page attracted more than £11,000 in donations within less than a week.
“None of the surgeries I need are available on the NHS,” she wrote, before detailing the transphobia she experienced on a daily basis: “I don’t pass as a woman, and that means constant public ridicule. Every time I’m misgendered it feels like being punched in the stomach. It shattered me.” Collings managed to raise the £21,500 she needed, but her words revealed that gender reassignment surgery can be seen as a necessity, or as a ticket to safety in an often hostile, transphobic world.
“People transition differently,” explains Jules, who identifies as non-binary and reiterates that there is no one fixed way to be trans. Not all trans people pursue surgeries, nor should they feel pressured to: “I only want top surgery, not bottom,” they state as an example.
“I also feel like testosterone has helped me feel more at ease in my own skin, and I do feel more comfortable presenting as masculine – but it doesn’t make me male, nor does it make me necessarily female. I’m a massive advocate for non-binary identities, because to assume we fit into just two categories is absurd.”
Unfortunately, officials often fail to recognise these facts. “I’ve heard horror stories of trans people going to clinics and being told that they don’t look ‘masculine’, or being questioned because they identify as non-binary,” Jules says, “Plenty of clinics are really problematic and binary in their views of trans people.”
Fundraising eradicates this need to jump through official hoops. It allows patients to set out their own needs and explain their own circumstances without needing to "prove" their trans-ness. This is currently the official process, although a reform consultation of the 2004 Gender Recognition Act could make it easier for trans people to legally change their gender without approval from a panel and a diagnosis of dysphoria.
Legal progress clearly is being made, but these changes are happening too slowly to make real difference to trans people in desperate need of treatment. Those waiting times can be crucial: when 23-year-old Synestra de Courcy committed suicide in 2015, she was just days away from a gender clinic appointment which could have saved her life. As the government struggles to keep up with a rise in demand for services, it’s at least reassuring to see fundraising sites become a vital tool for those who need them the most.