As waiting times for access to transition-related care in the UK spiral inexorably toward ten years, major and timely research from TransActual UK – the Transition Access Survey 2022 – shines a light on how the NHS is failing trans people on an industrial scale.
According to Chay Brown, Director of Operations for TransActual: “The picture drawn is one of pain, distress and heartbreak, as trans people increasingly find their access to life-saving treatment blocked for a host of bad reasons. These include lack of resource, transphobic practitioners, and an officious and bureaucratic system of gate-keeping that seems designed around disbelieving trans people, far more than enabling very necessary treatment.”
This is at odds with clear findings from the report that timely and well-supported access to treatment can be a life-saver.
According to one transfeminine respondent:
“It saved my life. It stopped me from [committing] suicide. If I hadn’t been able to access it, I wouldn’t be alive right now”.
Respondents were clear that the impact of transition went far beyond the simple physical. Many trans people – particularly on the feminine spectrum reported feeling safer leaving the house, with reduced instances of harassment or abuse common following HRT or surgery.
Despite this, there was widespread evidence of increased waiting times across the sector. Historic wait times for a first appointment (itself, months or years away from any treatment) range from four to five years. However, forecasts suggest a much worse picture, with ten year waits already built into the system.
This led to individuals reporting lives on hold, due to inability to plan, and as a result, increased issues with mental health. In addition, inability to transition through the NHS was leading individuals to pursue less safe pathways, from prolonged binding to purchase of HRT from unregulated suppliers on the internet.
This came from one agender respondent:
“I can’t make long-term plans because I honestly am not sure that I will survive the next however many years before I can access surgery, that is how unbearable it is to wait”.
In 2015, the House of Commons’ Women and Equalities Committee Select Inquiry on Transgender Equality, reported that “The NHS is letting down trans people”. The picture provided by this report suggests that the situation is not improving, but getting a lot worse.
For further information/to arrange interview:
Contact TransActual’s press office: email@example.com
The full report may be accessed here.
Transition Access Survey 2022: Key findings
- 88.4% (1,046) of all respondents had accessed HRT or intended to do so in the future;
- 90.4% of respondents had undergone or hoped to undergo transition related surgery;
- Most non-binary respondents wanted to or had undergone surgery (76.7%, 276) or HRT (66.1%, 238);
- Nearly two in three respondents (65.9%, 779) stated that concerns about waiting times had impacted their decision to begin medical transition;
- Just 14.8% (77) of those referred to a GIC after 2017 had attended a first appointment;
- Across all respondents seeking transition-related surgery:
- average waiting times for transition-related surgery were over three years (983 days, n=116) after the first GIC appointment
- average waiting times for hormones were nearly a year (325 days, n=284);
- many people had yet to receive a referral for hormones or surgery five to ten years after they first made the request;
- Nearly all respondents (86.9%, 814) stated that waiting to access hormones had negatively impacted their mental health: 83.8% (897) said the same of waiting for surgery;
- 78.0% (543) and 62.0% (663) respectively reported negative consequences for their physical health while waiting for hormones and/or surgery;
- 62.3% (667) reported negative consequences on their personal relationships due to waiting for surgery. 61.1% (572) reported the same for the wait for hormones;
- Average estimated cost for those who had incurred (private) transition costs was £5,573 (likely an under-estimate).
Transition Access Survey 2022: Key recommendations
Recommendations for NHS England, NHS Scotland, NHS Wales, and Health and Social Care Northern Ireland:
1. Improve data collection, monitoring, and transparency of waiting times for transition-related care and use this as a basis to create an action plan to resolve long waiting lists.
2. Review the Gender Dysphoria Service Specification to ensure necessary procedures and treatments are publicly available in a timely manner, without unnecessary obstacles.
3.. Work with Integrated Care Services to ensure mental health support is easily available to trans people at all stages of social and medical transition.
4. Establish and improve collaboration with the Royal College of GPs to ensure all GPs understand the needs and rights of trans people in the UK.
5. Work with the Royal College of Surgeons to proactively develop the workforce that can offer transition-related surgeries in the UK.
Recommendations for the Royal College of GPs and the Royal College of Surgeons:
6. Ensure that all GPs receive necessary training to be able to support trans people who are socially and/or medically transitioning.
7. Take urgent action to increase the number of surgeons able to offer transition-related surgeries in the UK.
The Transition Access Survey 2022 documents the results from an online survey based on 1,183 trans people from around the UK.
It sought to understand the types of transition-related medical procedures or treatments individuals had accessed and/or wanted to access and the impact of procedures or treatments on their lives. Questions also related to whether procedures had been accessed privately, through the NHS, or a combination (e.g., a bridging prescription for hormones) and any associated costs and waiting times.
Respondents came from a wide range of age and ethnic groups, encompassing 33 different gender identities, including 19.7% (228) who identified outside of the traditional gender binary.
They also reported a wide range of physical and cognitive disabilities and neurodivergence. Nearly one in three were autistic (32.5%, 385) and a majority reported having a mental health condition (56.4%, 667),
The high prevalence of a range of disabilities, neurodivergences, anxiety, and depression are important considerations, particularly given concerns that trans people may have difficulty accessing healthcare services beyond those relating to transition.
The full report may be accessed at transactual.org.uk/wp-content/uploads/TransitionAccessSurvey2022.pdf
It may also be accessed from legal deposit libraries. Ask for:
The Transition Access Survey 2022, by Dr Trent Grassian on behalf of TransActual UK
Published Trans Media UK