NHS England have announced that they are setting up a programme of work to develop a care pathway for adults who have previously medically transitioned and later detransition.
At TransActual we believe that everyone should have access to healthcare that meets their needs, so NHS care pathways should support all transition journeys as part of their provision. However, in the context of failing provision of the basic transition pathway, we are deeply concerned about the potential for abuse and the political motivations behind this move, especially as appropriate support for detransitioners could be achieved by making the existing transition pathway more flexible and holistic in its approach – as we have been advocating for years.
The vast majority of trans people do not detransition at all. For those that do, multiple reasons and circumstances influence them in making a decision to stop, pause or reverse some or all aspects of medical transition. For some this includes direct social and financial pressure from families, physicians or community leaders. Not everybody would consider stopping, pausing or reversing aspects of their medical transition as detransitioning.
NHS England are in the process of developing an updated service specification for adult gender services. Any suitable service specification must recognise that each person’s transition goals are different, that transition does not have to follow a pre-specified linear pathway and that different people need different levels of support at different times.
A good service specification would also specify a mechanism by which trans people can get back in touch with their clinic after discharge around any transition related issues, including issues relating to changed transition goals or (in the minority of cases) regret. We are still waiting for that updated service specification. We’re still waiting for the improvements to transition related care. We’re still waiting for action on waiting times. In some cases, we’ve been asking for these for years.
It is absolutely essential that each and every service specification for NHS gender-related services specify that conversion practices have no place in NHS services and that they simply do not work. Any specification must make it clear that discussions about detransition should be initiated by the service user themselves and that nobody should be coerced or compelled to have discussions or access therapies that they don’t want to have.
When thousands of people are on years-long waiting lists for NHS gender clinics and transition related surgeries, and when GPs are refusing to prescribe HRT to trans people (and in some cases, even register them as patients), we’d like to know why NHS England is prioritizing a care pathway for such a small patient group. Coming less than a fortnight after NHS England removed guidance on changing sex markers on NHS records from its website, alongside deep concerns about the potential impact of the current service specification review, we have little confidence that this work will lead to good outcomes even if it is well intentioned. That’s before you consider the widespread misinformation which inflates the number of detransitioners and assumes that young trans people are ‘victims of social contagion’ who will soon detransition.
NHS England claims to want to engage with people with experience of detransition during this work so that people’s lived experiences can shape this area of work. They need to hear what it is that causes people to detransition and what sort of support would be useful. You may not consider yourself someone who has detransitioned. If you meet any of the broad criteria of having paused or changed your transition pathway at any time, even if you didn’t tell your physician, your voice is needed here. If they don’t hear it from you, who will they hear it from? With that in mind, email us at policy@transactual.org.uk and we can send you more information.