Transgender people face waiting times of up to seven years for an initial appointment with the NHS, according to the latest data.
Thousands on the waiting list have turned to crowdfunding to afford gender-affirming care privately. For others, the desperation of waiting can lead to tragic outcomes.
This City News investigation has contacted transgender people, their doctors, families and campaign representatives. We’ve found out how these waiting times have impacted young trans people emotionally and financially.
Trans healthcare ‘in crisis’
Gender-affirming healthcare can include oestrogen or testosterone HRT, as shown here in gel form
People questioning their gender identity and hoping to access therapeutic or medical intervention face a lengthy journey ahead of them. Currently, they must get a referral by a GP to a specialist gender clinic, of which there are a handful across the country.
According to NHS data, those having their first appointment in England last year had waited an average of 7 years. And the delay has been increasing – at Charing Cross clinic in London, the average wait time has ballooned from 11 months in 2018 to five years and one month in 2023. Even when a patient has been seen, the waiting times between appointments can often be between 6 months and 1 year.
It’s not a surprise that campaign group Trans Actual report that over half of transgender people go private to access hormones or surgery. The NHS and the Department for Health and Social Care have not responded to requests for comment. The NHS has previously said the waiting times are due to a shortage of surgeons and staff, as well as an increase in referrals.
Chay Brown has been campaigning to improve trans people’s access to healthcare on the NHS.
Chay Brown is the head of operations for Trans Actual. He says that most trans people coming out now “quickly realise this isn’t going to be available for me unless I go private. People get into debt to go privately, or sell the house […] because the waiting is just unbearable, for such a lot of people.”
Chay says there has “absolutely” been a rise in crowdfunding to cover transition-related medical costs: “Trans Actual started off in 2017, and we’ve always had funding Sundays”. Once a week they’d share trans people fundraisers on their social media platforms. “In the first couple of years all the asks were coming from overseas, mostly the United States. Whereas now, almost all the asks are coming from within the UK, [it’s a] massive increase.” Crowdfunding is now so common that popular site GoFundMe has an entire page dedicated to advising trans people in the UK how to raise medical funds.
Elio’s Story
Elio Leon says not being able to medically transition has worsened his depression and anxiety
Elio is one of over 30,000 British people currently waiting for a direst appointment with NHS gender services. He’s been on the waiting list since he came out 2 years ago, and has decided to turn to private healthcare after feeling that NHS support “just isn’t going to happen.”
It’s not an easy decision. Private access to gender hormones known as HRT can still take months, and requires several specialist appointments with private psychiatrists and endocrinologists that often total hundreds of pounds per sessions. Meanwhile the double mastectomy Elio wants, known as ‘top surgery’, costs between £7,000 and £11,000. As a barista earning just above minimum wage, the financial drain is a big cause for worry.
While he’s working Elio wears a binder under his clothes to flatten his chest, but says this is uncomfortable, occasionally painful, and can only be worn for 8 hours max to prevent the risk of permanent damage. He’s hoping that accessing hormones and later surgery will help him ‘pass’ more as male in daily life. Like many trans people, Elio suffers from depression and anxiety, which he say worsens when he experiences gender dysphoria, for example on his period.
Elio is one of the beneficiaries of the Norwich Trans Fundraiser, a drag nightlife event aiming to raise money for local trans people to support their medical transition. It sounds niche, but there are dozens of events like it across the country, including weekly fundraiser club nights at Dalston Superstore in East London.
Dr Lo Marshall, a researcher of LGBT+ culture at UCL, says there’s been an increase in nightlife fundraisers for trans healthcare. In their view, “[the increase] is coming for a number of obvious reasons, including a chronic underfunding of healthcare for trans people.” Dr Marshall was also keen to point out that tans people experience housing and employment discrimination as well as other economic barriers, which can compound the difficulties of affording private healthcare treatment.
The weight of waiting
Dr Kathy McKay is researching the wellbeing outcomes of young people on the waiting list for NHS gender services
As well as the financial element, one of the major consequences of the long waiting times is the impact on mental health. Trans Actual’s 2021 report found that 87% of those on the waiting list for hormones said the delay was impacting their mental health.
Chay Brown described his own experience before his surgery, saying non-transgender people “wouldn’t understand” how distressing gender dysphoria can be: “I could barely shower, because I could barely shower I could barely leave the house. I covered up all my mirrors with cloth, with just a bit at the top so I could see my face.”
Chay’s experience resonates with wider research into mental health disparities amongst trans people. Dr Kathy McKay is a psychiatrist based at the Tavistock Gender Clinic. She’s head of the LOGIC study, a long-term research project looking at the mental health and wellbeing outcomes of gender-questioning young people currently on the waiting list.
Aside from the issue of healthcare inequality, Dr McKay explains that there are “higher rates of anxiety, higher rates of depression; there’s a vulnerability amongst gender-questioning young people. Which is understandable because it’s a stressful thing!
“One of the things the young people and parents did tell us was that, it wasn’t so much the length of the waiting list but not knowing how long they would have to wait, or if they would be seen at all.
“Those young people who’d been on the list for a more significant amount of time, 2 or 3 years where they haven’t heard anything […] there was a real sense of not being able to see a future self. As someone who’s happy and thriving, or doing well, even just existing.”
Dr McKay’s research has also worked with the families of young people struggling with gender dysphoria. “One of the mothers told me that she saw the distress her child was in and she was so worried. Because she said, well, my child is so distressed, how do they grow up to be a happy adult? What does that look like?”
‘That’s not care, that’s a holding cell’
Caroline says her daughter’s death has inspired her to campaign to improve healthcare and mental health support for trans people
For some, the distress of gender dysphoria combined with healthcare delays and existing mental health struggles can be too much to bear. Dr Caroline Litman is a former NHS psychiatrist and mother of Alice Litman. In May 2022 Alice took her own life at the age of 21 after waiting over a thousand days for a gender clinic appointment. Caroline says that if Alice were alive today, she still would not have been seen. “That’s not care of any description, is it”, Caroline asks. “That’s just a holding cell.”
After Alice’s death, Caroline and her family fought for a detailed inquiry into the circumstances surrounding Alice’s care. The inquiry found that Alice’s death was preventable, and that the long NHS waiting times for gender-related care contributed to her death.
Caroline says there is “a real systemic lack of understanding about trans healthcare in the NHS”, and say while Alice was alive she had to raise several complaints and even threaten legal action after failings in her care. She described the waitlist as “devastating”. Although she were able to afford private routes for healthcare for Alice could access hormones. However the private company issuing the prescription was based abroad and Caroline says that the process of poorly managed, unsupervised and medically ineffective.
“Eventually we talked to Alice about getting private surgical intervention, because that’s what she ultimately wanted. And then she discovered that the private waitlist had also got incredibly long because of the knock-on effect of the NHS. So she felt very despondent when she found that out, not long before she died.”
Alice Litman was 21 when she took her own life
Since Alice’s death, Caroline and her family have turned to campaigning in the hopes of improving healthcare access and outcomes for transgender people. Caroline says she’s lobbying to improve awareness and specialist training regarding trans patients. Her other aim is to “increase awareness of the waiting list and reduce the waiting list, and improve access to healthcare for trans people.”
“Alice was never a political beast when she was alive,” Caroline reflects. “She didn’t want me to make a fuss, and I respected that. And some people say, well, why are you doing it now then? And I say she shouldn’t have killed herself.
“And hopefully she’d be proud of me. I think she’d be proud of me. Obviously I’d rather have her back in a heartbeat, but if there’s anything I can do to help families like mine, and children like Alice, then that’s what drives me.”
The Norwich Trans Fundraiser
Drag artist Liv Presents helped raise over £1000 for the healthcare costs of trans people in Norwich
The desperation of the trans community to seek care is clear. But equally moving is the care the community have for each other. Back in Norwich, drag performers have travelled for miles to attend the fundraising night for Elio. Many of the performers backstage, adorning themselves with plastic jewels and shimmering glitter, are themselves transgender.
Drag queen and event organiser Liv Presents said this is the second year the show has run, after fundraising to support surgery costs for a local drag artist last year.
Still, Liv acknowledges there was a tension between wanting to fundraiser for friends and peers to be able to start their medical transition, whilst believing that such treatments should be available on the NHS. “We do think sometimes, why are we doing this, we shouldn’t have to be doing this”, she explains.
“But if we don’t do this then people wait longer and people suffer. And I hope one day we don’t have to do the show anymore, because it’s funded.”
Elio enjoying the fundraising gig for him , saying it was “a blast”
For Elio, the fundraising night has given him the boost he needs to begin his medical transition. The evening raised over £900 from ticket sales alone, which he says is “incredible”. First of all, he says he’s going to book a meeting with a private gender psychiatrist to get a formal diagnosis of gender dysphoria so he can begin hormone treatment. In the medium term, he says he wants to start saving and holding more fundraising events so he can afford top surgery. “I’ve found a surgeon in Turkey who used to work for the NHS and moved out to Turkey to make the surgery more accessible”. The procedure will cost around £6,000, which Elio says is about half of what he’d be charged to have it in the UK.
Elio says he grateful for the event organisers and the wider LGBT+ community and allies for helping him make the first steps in his transition:
“I really think it’s a really good way to bring the community together and make the experience of fundraising less isolating, because it can feel so difficult sometimes. And then to know that there are so many other people in the same boat; I mean, it’s really sad, in one respect.
“But at the same time, it’s amazing to have this community that are willing to be there for you. To say, I’ve got your back, let’s do this together.”
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Standfirst
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HeadlineWaiting, Funding, Dancing: The Crisis in Trans Healthcare
Short HeadlineThe Crisis in Trans Healthcare
StandfirstFacing waiting lists up to 7 years, trans people in the UK have turned to club nights and crowdfunding
Transgender people face waiting times of up to seven years for an initial appointment with the NHS, according to the latest data.
Thousands on the waiting list have turned to crowdfunding to afford gender-affirming care privately. For others, the desperation of waiting can lead to tragic outcomes.
This City News investigation has contacted transgender people, their doctors, families and campaign representatives. We’ve found out how these waiting times have impacted young trans people emotionally and financially.
Trans healthcare ‘in crisis’
Gender-affirming healthcare can include oestrogen or testosterone HRT, as shown here in gel form
People questioning their gender identity and hoping to access therapeutic or medical intervention face a lengthy journey ahead of them. Currently, they must get a referral by a GP to a specialist gender clinic, of which there are a handful across the country.
According to NHS data, those having their first appointment in England last year had waited an average of 7 years. And the delay has been increasing – at Charing Cross clinic in London, the average wait time has ballooned from 11 months in 2018 to five years and one month in 2023. Even when a patient has been seen, the waiting times between appointments can often be between 6 months and 1 year.
It’s not a surprise that campaign group Trans Actual report that over half of transgender people go private to access hormones or surgery. The NHS and the Department for Health and Social Care have not responded to requests for comment. The NHS has previously said the waiting times are due to a shortage of surgeons and staff, as well as an increase in referrals.
Chay Brown has been campaigning to improve trans people’s access to healthcare on the NHS.
Chay Brown is the head of operations for Trans Actual. He says that most trans people coming out now “quickly realise this isn’t going to be available for me unless I go private. People get into debt to go privately, or sell the house […] because the waiting is just unbearable, for such a lot of people.”
Chay says there has “absolutely” been a rise in crowdfunding to cover transition-related medical costs: “Trans Actual started off in 2017, and we’ve always had funding Sundays”. Once a week they’d share trans people fundraisers on their social media platforms. “In the first couple of years all the asks were coming from overseas, mostly the United States. Whereas now, almost all the asks are coming from within the UK, [it’s a] massive increase.” Crowdfunding is now so common that popular site GoFundMe has an entire page dedicated to advising trans people in the UK how to raise medical funds.
Elio’s Story
Elio Leon says not being able to medically transition has worsened his depression and anxiety
Elio is one of over 30,000 British people currently waiting for a direst appointment with NHS gender services. He’s been on the waiting list since he came out 2 years ago, and has decided to turn to private healthcare after feeling that NHS support “just isn’t going to happen.”
It’s not an easy decision. Private access to gender hormones known as HRT can still take months, and requires several specialist appointments with private psychiatrists and endocrinologists that often total hundreds of pounds per sessions. Meanwhile the double mastectomy Elio wants, known as ‘top surgery’, costs between £7,000 and £11,000. As a barista earning just above minimum wage, the financial drain is a big cause for worry.
While he’s working Elio wears a binder under his clothes to flatten his chest, but says this is uncomfortable, occasionally painful, and can only be worn for 8 hours max to prevent the risk of permanent damage. He’s hoping that accessing hormones and later surgery will help him ‘pass’ more as male in daily life. Like many trans people, Elio suffers from depression and anxiety, which he say worsens when he experiences gender dysphoria, for example on his period.
Elio is one of the beneficiaries of the Norwich Trans Fundraiser, a drag nightlife event aiming to raise money for local trans people to support their medical transition. It sounds niche, but there are dozens of events like it across the country, including weekly fundraiser club nights at Dalston Superstore in East London.
Dr Lo Marshall, a researcher of LGBT+ culture at UCL, says there’s been an increase in nightlife fundraisers for trans healthcare. In their view, “[the increase] is coming for a number of obvious reasons, including a chronic underfunding of healthcare for trans people.” Dr Marshall was also keen to point out that tans people experience housing and employment discrimination as well as other economic barriers, which can compound the difficulties of affording private healthcare treatment.
The weight of waiting
Dr Kathy McKay is researching the wellbeing outcomes of young people on the waiting list for NHS gender services
As well as the financial element, one of the major consequences of the long waiting times is the impact on mental health. Trans Actual’s 2021 report found that 87% of those on the waiting list for hormones said the delay was impacting their mental health.
Chay Brown described his own experience before his surgery, saying non-transgender people “wouldn’t understand” how distressing gender dysphoria can be: “I could barely shower, because I could barely shower I could barely leave the house. I covered up all my mirrors with cloth, with just a bit at the top so I could see my face.”
Chay’s experience resonates with wider research into mental health disparities amongst trans people. Dr Kathy McKay is a psychiatrist based at the Tavistock Gender Clinic. She’s head of the LOGIC study, a long-term research project looking at the mental health and wellbeing outcomes of gender-questioning young people currently on the waiting list.
Aside from the issue of healthcare inequality, Dr McKay explains that there are “higher rates of anxiety, higher rates of depression; there’s a vulnerability amongst gender-questioning young people. Which is understandable because it’s a stressful thing!
“One of the things the young people and parents did tell us was that, it wasn’t so much the length of the waiting list but not knowing how long they would have to wait, or if they would be seen at all.
“Those young people who’d been on the list for a more significant amount of time, 2 or 3 years where they haven’t heard anything […] there was a real sense of not being able to see a future self. As someone who’s happy and thriving, or doing well, even just existing.”
Dr McKay’s research has also worked with the families of young people struggling with gender dysphoria. “One of the mothers told me that she saw the distress her child was in and she was so worried. Because she said, well, my child is so distressed, how do they grow up to be a happy adult? What does that look like?”
‘That’s not care, that’s a holding cell’
Caroline says her daughter’s death has inspired her to campaign to improve healthcare and mental health support for trans people
For some, the distress of gender dysphoria combined with healthcare delays and existing mental health struggles can be too much to bear. Dr Caroline Litman is a former NHS psychiatrist and mother of Alice Litman. In May 2022 Alice took her own life at the age of 21 after waiting over a thousand days for a gender clinic appointment. Caroline says that if Alice were alive today, she still would not have been seen. “That’s not care of any description, is it”, Caroline asks. “That’s just a holding cell.”
After Alice’s death, Caroline and her family fought for a detailed inquiry into the circumstances surrounding Alice’s care. The inquiry found that Alice’s death was preventable, and that the long NHS waiting times for gender-related care contributed to her death.
Caroline says there is “a real systemic lack of understanding about trans healthcare in the NHS”, and say while Alice was alive she had to raise several complaints and even threaten legal action after failings in her care. She described the waitlist as “devastating”. Although she were able to afford private routes for healthcare for Alice could access hormones. However the private company issuing the prescription was based abroad and Caroline says that the process of poorly managed, unsupervised and medically ineffective.
“Eventually we talked to Alice about getting private surgical intervention, because that’s what she ultimately wanted. And then she discovered that the private waitlist had also got incredibly long because of the knock-on effect of the NHS. So she felt very despondent when she found that out, not long before she died.”
Alice Litman was 21 when she took her own life
Since Alice’s death, Caroline and her family have turned to campaigning in the hopes of improving healthcare access and outcomes for transgender people. Caroline says she’s lobbying to improve awareness and specialist training regarding trans patients. Her other aim is to “increase awareness of the waiting list and reduce the waiting list, and improve access to healthcare for trans people.”
“Alice was never a political beast when she was alive,” Caroline reflects. “She didn’t want me to make a fuss, and I respected that. And some people say, well, why are you doing it now then? And I say she shouldn’t have killed herself.
“And hopefully she’d be proud of me. I think she’d be proud of me. Obviously I’d rather have her back in a heartbeat, but if there’s anything I can do to help families like mine, and children like Alice, then that’s what drives me.”
The Norwich Trans Fundraiser
Drag artist Liv Presents helped raise over £1000 for the healthcare costs of trans people in Norwich
The desperation of the trans community to seek care is clear. But equally moving is the care the community have for each other. Back in Norwich, drag performers have travelled for miles to attend the fundraising night for Elio. Many of the performers backstage, adorning themselves with plastic jewels and shimmering glitter, are themselves transgender.
Drag queen and event organiser Liv Presents said this is the second year the show has run, after fundraising to support surgery costs for a local drag artist last year.
Still, Liv acknowledges there was a tension between wanting to fundraiser for friends and peers to be able to start their medical transition, whilst believing that such treatments should be available on the NHS. “We do think sometimes, why are we doing this, we shouldn’t have to be doing this”, she explains.
“But if we don’t do this then people wait longer and people suffer. And I hope one day we don’t have to do the show anymore, because it’s funded.”
Elio enjoying the fundraising gig for him , saying it was “a blast”
For Elio, the fundraising night has given him the boost he needs to begin his medical transition. The evening raised over £900 from ticket sales alone, which he says is “incredible”. First of all, he says he’s going to book a meeting with a private gender psychiatrist to get a formal diagnosis of gender dysphoria so he can begin hormone treatment. In the medium term, he says he wants to start saving and holding more fundraising events so he can afford top surgery. “I’ve found a surgeon in Turkey who used to work for the NHS and moved out to Turkey to make the surgery more accessible”. The procedure will cost around £6,000, which Elio says is about half of what he’d be charged to have it in the UK.
Elio says he grateful for the event organisers and the wider LGBT+ community and allies for helping him make the first steps in his transition:
“I really think it’s a really good way to bring the community together and make the experience of fundraising less isolating, because it can feel so difficult sometimes. And then to know that there are so many other people in the same boat; I mean, it’s really sad, in one respect.
“But at the same time, it’s amazing to have this community that are willing to be there for you. To say, I’ve got your back, let’s do this together.”
Inside Success Union CIC claim to empower vulnerable young people, but allegations of underpayment and concerns over their fundraising practices are undermining their message.
