Four trans women on the dire state of transgender healthcare

Trans women are women. This year’s International Women’s Day theme is ‘choose to challenge’, and today on Dazed, we’re challenging the TERFs. In 2020, the UK government scrapped urgent reforms to the Gender Recognition Act, and a global pandemic continues to cut many trans people off from vital healthcare, all while trans-exclusionary radical feminists spout anti-trans rhetoric. On IWD, we celebrate trans strength and resilience.

In recent years, the UK government has rolled back a number of vital trans rights, consequently affirming and galvanising the transphobic British press and vocal TERF ‘activists’, as well as putting the lives of trans people in danger.

In September 2020, the government published its long-awaited response to the 2018 consultation on the Gender Recognition Act (GRA), effectively scrapping urgent reforms. The decision means that trans people will still need a mental health diagnosis of gender dysphoria in order to self-identify their gender or change their birth certificates. 

Then, in November, the High Court ruled that children under 16 are unable to “understand and weigh the long-term risks and consequences of the administration of puberty blockers”, hindering young trans people from accessing “life-saving treatment”.

These dire announcements came amid a worsening global pandemic, which has seen trans people further cut off from crucial services, the cancellation of surgeries, appointments, and treatments, as well as interruption to hormone provision. All this in addition to the already chaotic state of healthcare for trans people, who are subjected to stagnant, years-long waiting lists for Gender Identity Clinics (GICs).

Here, Dazed hears from four trans women about their plight of accessing healthcare in the UK, and how the pandemic has highlighted how broken the system already is.

CARA, 32, GLASGOW

“Since moving to Scotland a few years ago, the GIC ’lost’ my referral form and magically found it again when my GP came through with proof that they’d accepted it, meaning I wouldn’t have to join at the bottom of the waiting list. Despite that, the pandemic has seen what will be my new GIC still offer no appointments, and so I haven’t had access to an endocrinologist in years. I’ve got no idea if my hormone levels are fine, or if I’m dangerously low or high with anything. Not being able to speak to a doctor about it is fuelling my paranoia even more – though I’m trying not to think about it too much!

Every few months, I chase my GIC by email and they reply saying, ’Nothing yet’. Communication has been dire. I’ve had to have private electrolysis in the absence of NHS referral, and although they’re communicating clearly about what will be possible and when, the rolling lockdowns have had an obvious effect on what they can legally do. It does have an impact on your mental health when your entire sense of physiological self is subject to the whims of an invisible virus. I have a good GP who has continued my hormone prescription throughout all of this, so I’m not as affected as I could’ve been, but I still have no access to surgical referrals or hair removal services under the NHS because of the pandemic delaying everything.

Access to basic things like hormones is still super patchy; GPs act like they’re some unknown medication when they’re prescribed for trans people – a problem that doesn’t arise for anyone else. The politicisation of our healthcare needs had led to a moral panic, and that includes medical practitioners. We have to let our local sisters know which GP is going to be cool, and which is going to deny you continuation of care. This just feeds into the forcibly clandestine nature of trans healthcare, when what it really needs is to be brought out into the open and normalised so we can just get on with our lives in peace.”

JANE, 25, LONDON

“At the beginning of the pandemic, I was self-medicating hormones from Inhouse Pharmacy, like I’d been doing for years, but due to the pandemic, my orders got severely delayed, which meant there were times when I had no hormones. I eventually managed to get an appointment with a GIC via Zoom, and was able to get an NHS hormone prescription. From then on, it’s been pretty smooth sailing – aside from the cancellation of my laser appointments, which has made my facial hair situation worse than it was during treatment. Having to shave regularly has been pretty depressing, especially as I know that if the pandemic hadn’t happened, I’d be done with my (course of treatment) by now.

UK trans healthcare is in a terrible condition right now. The most important thing to do is to reduce wait times in accessing transition-related care, as people are waiting as long as five years in some parts of the country to even get a first appointment. The NHS needs to go towards either informed consent or at least make more GICs. 

(On the bright side), there’s definitely been a lot of community spirit when it comes to health – I've seen people send each other leftover oestrogen if someone is running low, as well as crowdfunders for surgery.”

ALEXA, 20, BELFAST

“Prior to the onset of the pandemic, healthcare access for trans people of all genders in Northern Ireland has been incredibly poor. Our gender identity services have been in crisis for around three years now, with the only adult GIC in Northern Ireland going through most of those years without accepting any new patients. The pandemic has only made this worse – from an inability to access blood tests through your GP, to having surgeries cancelled, treatment plans delayed, and having issues accessing and administering existing HRT prescriptions. It’s been a patchwork operation – some people are still having regular check-ups and being supported by their clinicians, while others are calling and asking us to help them get their injections on time because they can’t get through to anyone.

For the past three years of a stagnant waiting list, the only way trans people have been able to get information about what’s happening is by calling the GIC and asking where on the list they are. There was no communication regarding why the list had stopped, or what work was ongoing to address the issues. The Department of Health commissioned a review into these services about a year ago (following significant pressure), and we’ve been consistently appalled by the lack of engagement and appropriate communication with trans communities through the course of that review.

Unsurprisingly, the wellbeing of trans communities has taken a massive toll. Mental health issues are skyrocketing, and people are feeling trapped without seeing any progress in their transition. We’ve seen a lot of folks forced to go private or self-medicate as the only options to further their transition – the pandemic then had an impact on their ability to have that care monitored effectively as well. Combine all these issues with the loneliness and isolation that everyone is experiencing now – as well as the potential that trans folks may be living with unsupportive family members or housemates – and we have a real crisis.

Decisions are being made for us, not by us. The entire trans healthcare system in the UK is unfit for purpose; it is not built to meet our needs, support us, nor provide us with the care we need in a timely manner that complies with human rights. It’s built to control us and maintain the power of cis people over our bodies, identities, lives, and healthcare. We urgently need trans voices at the centre of trans care.”

“We’ve seen a lot of folks forced to go private or self-medicate as the only options to further their transition – the pandemic then had an impact on their ability to have that care monitored effectively as well” – Alexa

NICOLA, 43, LINCOLNSHIRE

“I was in both a fortunate and unfortunate place in my GIC journey at the beginning of 2020. I was initially referred in autumn 2017 and had my first NHS GIC assessment in January 2019 (though I’d been on hormones since April 2018). My second GIC assessment was in November 2019 – (bear in mind that) referral to treatment is meant to be 18 weeks or less, but over two years after referral, I still didn’t have a diagnosis from the NHS, nevermind a treatment plan. 

So, in theory, just as things were kicking off with the pandemic, I should have been having an appointment for the GIC to formally take over my care, as well as possibly my first surgical referral. Instead, after several months of radio silence from the GIC, then several months of remote appointments but no ‘significant’ appointments, finally the GIC took over my care at the end of January 2021. However, they still haven’t written to my GP with the report, meaning I realistically won’t be referred for surgery until at least four years after the initial GIC referral. Fortunately, my hormone prescription has not been interrupted as my GP acknowledged that ongoing monitoring is essential care.

Yet more delays have not helped my mental health, and if I was not in the fortunate position to both afford private consultant care and have a GP who’s happy to prescribe and do bloods on the NHS, I’m unsure if I would be able to be at work. The current state of the GIC provision in the UK for all trans people is hampered by two things: the ball being dropped with workforce planning in the run up to national commissioning in 2013, and the fact that GICs choose to operate in a way that’s deliberately obstructive at times.”