Recognising the humans at the heart of the trans healthcare crisis
- Steffi Evans
- Jun 30
- 12 min read
“You don’t have to understand to be understanding”: how gender-affirming care in the UK is failing the trans community
Written in partnership with Kate Webber
With a global rise in anti-trans rhetoric, trans people are facing increased persecution, surging demonisation, and a rolling back of hard-fought rights.[1–3] Trans people are our colleagues, our family, our friends and neighbours - and they are facing a healthcare crisis.
There's not a single set path for trans people; some people will go through surgeries, while others will decide not to. As is the case with all healthcare, each individual needs the support that's right for them. However, for those who do opt for gender affirming healthcare, it can be a long and hard road.
In this article, we aim to amplify the voices of those affected, by speaking to members of the trans community, Jay and Beth, and ally Anne, who has been providing gender-affirming care since the 90’s. Join us in seeking a better understanding about the journey a trans person undergoes as they transition, and the far-reaching impacts that are the result of shortcomings in the trans healthcare system.
Many thanks to the members of the trans community and their allies who agreed to be interviewed for this article, and to Global Butterflies for their support.
Content warning: this article below themes which may be triggering for some individuals, including gender dysphoria and suicide.
Names have been changed.
Accessing gender-affirming care: the first step of a thousand-mile journey
A trans person’s journey to realising their gender is long and highly complex. For Beth, the realisation that something felt different came at a young age: “I knew that I was a girl at the age of 4 or 5. I was being taken around the boys section of a clothes shop by my Mum, and I remember thinking ‘oh, this isn’t the right section for me, but in a few years my hair will be longer, and I’ll be in the girls’ side’”. It wasn’t until she was in her early 20s that she officially came out as trans and immediately went onto the NHS waitlist for an initial consultation with a healthcare professional. However, this would only be the beginning in a process she describes as “frustrating, long, and arduous”.
Beth’s experience echoes that of many other trans individuals. In the UK, the target waiting time between seeing a GP and having a first appointment at a gender identity clinic is 18 weeks – but in reality, the average waiting time is closer to 5 years or longer. [4,5] In fact, as of August 2022, more than 26,000 people were waiting for their first appointment at an NHS gender clinic, and 90% of those people had been waiting for longer than the 18-week target.[6] In real terms, depending on where you are in the country, if you applied to access hormones at the age of 18, you could be waiting until you were 26 before you finally received an NHS prescription.[7]
The problem has only been getting worse. Data obtained by the BBC last year showed that the average waiting time for that first specialist appointment has at least doubled between 2018 and 2024, and as much as quadrupled in some parts of the UK.[5] And that’s just accessing hormones or hormone blockers – further gender affirming care such as vocal training, electrolysis, and gender confirmation surgery (also known as ‘top’ or ‘bottom’ surgery) come with their own long waits.
Jay spoke with us about his transition. His wait for that first appointment was 3 and a half years, but he now faces triple that for the next stage in his NHS care. Historically, only one team in the UK have performed phalloplasty, and they were leased by private healthcare services to the NHS. However, in 2020 that contract was not renewed[8], meaning that all phalloplasties and related transmasculine surgeries have been on hold or delayed for years. In some cases, leaving transmen stranded in the middle of their transition, which can take multiple surgeries to complete.[8] What this means for people like Jay is that he is now on a waitlist to be on the waitlist!
What this means for people like Jay is that he is now on a waitlist to be on the waitlist!
The problems in the system aren’t only felt by the trans community. We spoke to Anne, an electrolysis technician who has been working with trans people since 1991. “Accessing care has always been challenging”, she tells us. The NHS are so difficult to deal with in every aspect, both as a provider and as a client. The conversation always starts with ‘don’t hold your breath’ because it takes so long to get everything done. I wish there was someone to say at the beginning ‘it’s important, we care, but it will be slow’ instead of the impersonal email that people do get. There’s a lack of communication.”
Prove it: how do you convince your doctor to give you the support you need?
Once a person is finally in front of a healthcare professional, being prepared is critical. After years of waiting for a first appointment, it’s not enough to arrive and be yourself, assuming that people will take your word for it – it's essential to come equipped with the right information. After all, if their appointment doesn’t go well, a trans person will have missed out on their chance of accessing care.
Many trans people turn to their community for support, sometimes swapping advice with fellow transgender people online to help them extensively prepare their stories and evidence, often on secret, password-protected servers, to prevent anti-trans advocates from accessing these spaces and causing harm.
Preparation for that first appointment involves gathering extensive ‘evidence’, including years' worth of documents with your changed name (from the certificate of
the name change to all your bank statements, bills, or work documents), photos of you presenting as your gender over the years, and any document referring to you by your gender as opposed to your assigned sex at birth. As Jay tells us, “I have to prove who I am and what I am”.
Even then, this evidence may not be enough. In some cases, trans individuals resort to stereotyping their gender identity to convince the HCP in front of them that they have truly been living their lives as their identified gender. For example, trans men may say they’ve always loathed the colour pink and really like football, when they actually hate it.
Ironically, this ends up reducing gender to old and tired stereotypes and fails to recognise that every person is different.
When policies fall short, the impact can be devastating
Tragically, frustration isn’t the only consequence of exceedingly long wait times, Many trans people experience gender dysphoria – clinically significant distress when a person’s assigned birth gender is not the same as the one with which they identify[9] – long before their first GP appointment, let alone before seeing a specialist. In its most severe form, the condition can drive people to self-harm and suicide.
According to one study, almost 1 in 2 young trans people have attempted to take their own life, compared to nearly 1 in 10 of a similarly aged cis-gender population.[10] "After 3 failed suicide attempts”, Beth tells us, “I decided that I would transition. I knew that if I attempted suicide a fourth time, that would be it, so I might as well transition and see if things get any better”. Anne, who estimates that she has treated somewhere between 300–400 people, is also painfully aware of this: “sometimes I see a client for the consultation, and I’ve never seen them again – I wonder if they have survived”.
Gender-affirming care is, quite literally, lifesaving – but by no means guaranteed.
The problems we’ve heard in transgender care don’t seem to be likely to improve anytime soon. With increasing referrals and a lack of specialist training, waitlists are only becoming longer, and in some cases, treatment is even being withdrawn. A 2024 investigation by the Independent found that increasingly, NHS patients were being told their GP practices could no longer supply hormone treatments, often because their GP said they didn’t feel qualified to provide the care or that they lacked the resources to do so. Yet others cited a lack of policy or personal beliefs.[11] Can you imagine a GP saying that in any other case?
Gender-affirming care is, quite literally, lifesaving
So, what does this lack of policy or reluctance look like for the people affected? “You have to be your own advocate… you have to be your doctor”, said Jay. “I once had to call my GP saying I need this dose, this hormone, this amount, because they just don’t have the training”. When asked why he thinks this is, Jay tells us “Doctors and a lot of people find it uncomfortable. If people find it uncomfortable, they want to ignore it. Doctors say they aren’t trained, but that doesn’t stop them with other care types. They just don’t want to touch it”.
Funding their own futures, the price for a trans person to be themselves is high
Between waitlists, dysphoria and other issues with accessing NHS care, it’s no wonder that many in the trans community end up seeking private healthcare. While this is a solution for some, it comes at significant personal cost.
Facing the potentially devastating consequences of her own gender dysphoria, Beth turned to the private system to access her gender-affirming care. “The whole process for surgery was from 2017 to 2024 and would have been even longer without private healthcare! All considered, all the private healthcare including electrolysis, private prescriptions, and diagnoses, was around £15,000. Breast augmentation surgery is not available on the NHS, and that’s another £7,000”.
Even going part private and part NHS provides its challenges. As we were told by Global Butterflies, an organisation that helps businesses to be more trans and LGBTQIA+ inclusive, “another problem is that if you fund your transition to save NHS resources, they may punish you at the end by not prescribing hormones because you actually went Private”.
These are just the direct costs of treatment. Each surgery comes with recovery time away from work (and certain procedures may require multiple surgeries), potentially impacting income and employment.
What’s more, costs have been steadily increasing. One clinic’s costs increased by almost 60% between 2011 and 2023, and increasingly trans people have had to come up with alternative sources of income to pay for their care, including crowdsourcing their funding.[7] Between 2021 and 2022 in Scotland for example, there was a 65% increase in trans people fundraising to cover their medical care.[7]
But taking on these costs isn’t always just needed to bypass waitlists. The NHS only funds a limited number of procedures to support transitioning. While what is available varies between trusts and clinics, most NHS services are limited to hormone treatment, hair removal (limited to 8 sessions), counselling, referral for bottom surgery and mastectomy, and perhaps speech therapy. The service doesn’t fund things like breast augmentation or body contouring, or facial feminisation or masculinisation surgery, the latter of which can cost in the region of £30,000.[7,12]
While the fact that these are not available on the NHS is a burden from a financial perspective, the reason why is a source of added frustration – they are perceived as being purely cosmetic. But with the rise in transphobia these kinds of procedures can be just as important – with trans people wanting to feel confident in their “passing” ability, being able to blend in is important for their own safety and wellbeing.[7]
Transitioning isn’t the end of the battle for trans people
Striving to live as yourself in a world where some wish to misrepresent trans identities as somehow freakish can feel dehumanising, exhausting and dangerous. And it’s certainly not a lifestyle choice. No transgender person undertakes transitioning lightly. “Being transgender is very hard,” Jay told us. “It’s a difficult life. There are so many places in the world I can’t go to, because I could get hurt or killed”. Jay isn’t alone in these worries, the National LGBT Survey reported that over half of trans people have tried not to be openly trans because of how people behave towards them.[13]
It’s clear that transitioning is a long journey of self-realisation, fighting against societal and systemic prejudices every step of the way. And even after starting a transition, or feeling as though you’ve nearly completed transitioning, the struggle doesn’t end. For a community as closely knit as trans people, the hate they see day in, and day out exerts its own toll.
“So many people think you don’t have the right to exist or live. I turn on the news and see stories of my rights being taken away,” Jay told us. Beth agrees. “The general hate to my existence that I have to experience every day, whenever I read any news article talking about trans people, or random commenters online, any hateful tweets, or any comments that paint me as a threat are so dehumanising”.
Overcoming this kind of social stigma isn’t easy, but finding a way to continue living despite it is something members of the trans community work hard at. “You have to be positive, if you fall into despair, you won’t get back up,” Jay told us. “But I believe that people are inherently kind. It’s tiring trying to educate people, but we need to.”
What trans allyship should look like: lead with kindness, empathy, and positivity
When asked what they wish cis-gendered people knew about the trans experience, Jay and Beth said understanding is important. “You don’t have to understand to be understanding,” Jay told us. “My parents couldn’t understand why I want to be a man – you don’t have to understand it, you just have to be OK with it”.
“My parents couldn’t understand why I want to be a man – you don’t have to understand it, you just have to be OK with it”.
At the end of the day, the trans community simply want to be seen and treated as human. As Beth put it: “I want people to know that you and I have more in common in terms of the things that affect our daily lives than you and the people who are running things. We would both like to get through the day, go to work, get paid, have a coffee, love, exist, access the spaces we want and need without causing anyone harm, go about our daily lives, and contribute to our families, communities, and the wider country to make the world a better place”.
Ally Anne, who has been supporting the trans community through her work as an electrolysis technician for decades, has a similar perspective. “I can’t understand why it’s anyone else’s business whether someone is trans or not, and I can’t understand the hate. They just want to get on with their life and feel like they belong”. She hasn’t let the discrimination that has plagued the community change her outlook or allyship though, “I’ve had non-trans clients saying, ‘I don’t know if I can come knowing the people you treat.’ I show them where the door is”.
Asked further for her advice for businesses and how they can be more inclusive, she’s emphatic: “Do it! Just absolutely do it! Don’t be afraid. There are no monsters, they are sweet, sweet, very vulnerable people.”
The future of trans health
Ultimately, much is left to be achieved in trans healthcare. While strides have been made, the system remains fundamentally flawed, and the trans community has been – and continues to be – failed. There are no easy answers for how to improve it. Calls for funding are frequent, but pouring money into a broken system won’t fix things.
Solving the problems the community faces is no easy task. Trans healthcare is highly involved and complex and requires a multidisciplinary approach encompassing everything from mental health support to multiple surgical specialisms, endocrinology, primary care, speech therapy, hair removal, sexual health services, fertility and more.
But hope is not lost. Many people continue advocating for a better and more inclusive healthcare system for the trans community, and despite setbacks people continue to fight for health equity for trans people. The groundwork is there, but change must be made. After all, being yourself is a great thing, and the world is richer for it; what’s not great is when the support systems you need aren’t in place, and some parts of society aren’t accepting.
Beth summed it up perfectly: “the system doesn’t provide half of the things people need and is ludicrously unfit for purpose. But when it works and provides the things that are needed… it’s lifechanging.”
“The system doesn’t provide half of the things people need and is ludicrously unfit for purpose. But when it works and provides the things that are needed… it’s lifechanging.”
If you have been affected by the issues discussed here, help and support are available. Whether you identify as LGBTQIA+ or want to be a better ally, here are some trusted resources:
MindOut – LGBTQ mental health support
Stonewall – UK’s leading charity for LGBTQ+ rights
Switchboard – A national LGBTQ+ helpline offering listening and support
Mermaids – Supporting transgender and gender-diverse youth
Galop – Support for LGBTQ+ people facing abuse and violence
LGBT Foundation – Community-based services and info
TransActual UK - A trans-led and -run organisation focused specifically on working for trans adults in the UK, advocating for and empowering trans people in the areas of healthcare and legal protections
References
ILGA Europe. Alarming surge in transphobic speech across Europe sparks concern for EU elections. 2024. Available online: https://www.ilga-europe.org/press-release/alarming-surge-in-transphobic-speech-across-europe-sparks-concern-for-eu-elections/.
Pengelly, M. Trump rolls back trans and gender-identity rights and takes aim at DEI. The Guardian. 2025. Available online: https://www.theguardian.com/us-news/2025/jan/20/trump-executive-order-gender-sex.
Equality Network. UK Supreme Court rolls back trans rights. 2025. Available online: https://www.equality-network.org/uk-supreme-court-rolls-back-trans-rights/.
National Health Service. Guidance. Consultant-led treatment: right to start within 18 weeks. 2022. Available online: https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks.
BBC. Life on an NHS transgender waiting list. 2024. Available online: https://www.bbc.co.uk/news/uk-england-68588724.
The King v NHS Commissioning Board. 2023. EWHC 43 (Admin). 16 January 2023. Para 33. Available online: https://drive.google.com/file/d/14-1-DVhATxD5t2rcaWeJdXZ29Ms_7dvT/view.
Novara Media. For Trans and Non-Binary People, the Choice Is Between Private Healthcare or Years of Waiting: Our options? Get rich, spend years languishing on a waiting list or crowdfund our care. 2023. Available online: https://novaramedia.com/2023/03/23/for-trans-and-non-binary-people-the-choice-is-between-private-healthcare-or-years-of-waiting/.
TransActual. What’s happening with NHS phalloplasty and metoidioplasty? 2024. Available online: https://transactual.org.uk/whats-happening-with-nhs-phallo-and-meta/.
Human Rights Campaign. Sexual Orientation and Gender Identity Definitions. Undated. Available online: https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions.
The LGBTQ Foundation. Hidden Figures: LGBT Health inequalities in the UK. 2020. Available online: https://lgbt.foundation/wp-content/uploads/2023/12/Hidden-figures-LGBT-health-inequalities-in-the-UK.pdf.
The Independent. GPs halting transgender patients’ hormone treatment or refusing prescriptions, investigation reveals. 2024. Available online: https://www.independent.co.uk/news/uk/home-news/gp-nhs-transgender-hormone-treatment-b2658721.html.
TransActual. How to access medical transition. 2024. Available online: https://transactual.org.uk/medical-transition/.
Gov.uk. National LGBT Survey: Summary report. 2019. Available online: https://www.gov.uk/government/publications/national-lgbt-survey-summary-report/national-lgbt-survey-summary-report.
Comments