What’s happening with NHS phalloplasty and metoidioplasty?

An important note: Whilst it has coincided with the COVID-19 pandemic, the withdrawal of access to NHS phalloplasty or metoidioplasty surgeries was unrelated to the pandemic. Read this page to develop an understanding of the ongoing issues.

What is phalloplasty?

Phalloplasty (otherwise known as phallo) is a type of surgery used to create a penis. This is a multi-stage surgical process, typically consisting of at least 3 operations. It is most commonly sought by trans men and by some non-binary people assigned female at birth, but some cis (not trans) men might also access phalloplasty surgery if they have had a serious injury. Read more about phalloplasty.

What is metoidioplasty?

Metoidioplasty (otherwise known as meta) is a type of surgery which uses a person’s existing genital tissue to create a penis. This is a multi-stage process. Meta is a surgical process specifically for trans men and non-binary people assigned female at birth. Read more about metoidioplasty.

More information about the processes involved in both types of surgery is available in the Gender Dysphoria National Referral Support Service’s booklets on phalloplasty and metoidioplasty.

What was the NHS provision for phalloplasty and metoidioplasty before the COVID-19 pandemic?

Transition related surgeries are centrally funded by NHS Specialist Commissioning. Prior to the COVID-19 pandemic, St Peter’s Andrology Centre were the only team contracted by the NHS (across England, Scotland, Wales and Northern Ireland) to perform either phalloplasty or metoidioplasty. St Peter’s are a private team operating out of private hospitals in London, and the NHS paid them to do so. Patients accessing the first stage of their transition related surgeries from St Peter’s at the start of 2020 had typically waited a year from the point of referral, but this was longer in some cases depending on individual factors. At the start of 2020, those patients waiting for the second or third stages of their surgeries were told that they could expect to wait approximately 6 months for their next operation.

What’s happening with NHS phalloplasty and metoidioplasty?

After the NHS withdrew for the contract for phalloplasty and metoidioplasty from St Peter’s Andrology Centre, they waited 15 months to tell those impacted. Whilst a phalloplasty and metoidioplasty service is now available again, multiple issues remain. Read the timeline of events and click the hyperlinks to read the letters sent to some (but not all) of the impacted patients to gain an improved understanding of the situation.

March 2020 – All non-emergency surgeries are cancelled due to the Covid-19 pandemic.

31st March 2020 – The contract between St Peter’s Andrology and NHS England expired.

August and September 2020 – A small number of patients accessed NHS phalloplasty and metoidioplasty with St Peter’s Andrology.

October 2020 – Planned NHS phalloplasty and metoidioplasty surgeries were cancelled.

January 2021 – Other transition related surgeries were taking place despite national lockdown, phalloplasty and metoidioplasty were not.

April 2021 – Some patients on the phalloplasty and metoidioplasty waiting lists were told by their Gender Dysphoria Clinic doctors that the NHS had withdrawn the phalloplasty and metoidioplasty contract from St Peter’s Andrology. TransActual wrote to NHS Specialist Commissioning to ask for more information. There was no response.

May 2021 – Patients had not received official notification from NHS Specialist Commissioning about the issues with phalloplasty and metoidioplasty commissioning. TransActual contacted NHS Special Commissioning again and received a polite “we’ll get back to you soon” e-mail. Patients who had contacted St Peter’s Andrology Centre to ask about the situation were sent a statement about the situation. The statement was reported in Pink News.

28th May 2021 – TransActual received a response from NHS Specialist Commissioning, who also sent a letter to some (but not all) of the patients impacted by the withdrawal of the phalloplasty and metoidioplasty contract. Read the May 2021 letter, which states that patients ought to expect an update in July 2021. Whilst the letter signposts patients to sources of mental health support, the only NHS-led trans specific support suggested was from the Gender Dysphoria Clinic. Hundreds of the patients impacted have long since been discharged from their Gender Dysphoria Clinic and do not have access to this support. TransActual asked NHS Specialist Commissioning what support could be made available for these patients and whether any measures could be taken to send patients overseas for their surgeries – we received no response.

June 2021 Vic Parsons publishes a follow up piece in Pink News.

July 2021 – TransActual contacted NHS Specialist Commissioning as well as the Gender Dysphoria National Referral Support Service (GDNRSS) to ask for an update. None was available. Freddy McConnell interviews one of people impacted by the situation as part of a piece for Vice on the UK’s trans healthcare crisis.

2nd August 2021 – TransActual received confirmation from NHS Specialist Commissioning that they are in the late stages of the tendering process for the phalloplasty and metoidioplasty contract.

26th August 2021 – Some (but not all) patients on the phalloplasty and metoidioplasty waiting lists received a letter from GDNRSS informing them that the tendering process for the phalloplasty and metoidioplasty contract is in the late stages of the tendering process. Read the August 2021 letter.

29th August 2021 – Dr Jack López produced a summary report of his research, which detailed the impact of the withdrawal of access to phalloplasty and metoidioplasty on their research participants.

1st September 2021 – Hundreds of trans men and non-binary people have now been waiting years to progress with phalloplasty or metoidioplasty. Some people have been waiting years for repairs to complications that have left them in pain. Many of the people impacted report an increase in their levels of dysphoria and a decline in their mental health. As one man told us, “we’ve been left in limbo.”

2nd September 2021 – 178 of those impacted wrote an open letter to Sajid Javid, and representatives of the patient group hand delivered the letter to the Department of Health and Social Care.

10th September 2021 – NHS Specialist Commissioning have confirmed that a contract has been awarded to a provider and that impacted people will be contacted soon.

21st September 2021 – GNDRSS have written to patients to confirm that New Victoria Hospital has the contract to provide phallo and meta. They also state that they are working to establish further surgical capacity. Neither NHS Specialist Commissioning nor GDNRSS have given any information on timescales or on who the surgical team will be. UPDATE: New Victoria Hospital responded to an inquiry from a patient to confirm that Mr Christopher, Professor Ralph and Mr Rubin have been given contracts to operate on NHS phallo and meta patients.

28th September 2021 – TransActual have been passed the response to an FOI request which shows that St Peter’s Andrology’s NHS contract ended on 31st March 2020.

17th October 2021 – TransActual release the findings from a survey of people on the NHS waiting list for phallo and meta. The findings enabled us to model the likely waiting times for those on the list. The report indicates that it would take at least 3 years and 8 months for the surgical team to clear the current waiting list. This means that a person referred for phallo or meta today would wait nearly 4 years to for the first stage of their surgeries. Read the report in full.

28th October 2021 – GDNRSS have confirmed that surgeries are expected to re-commence in December 2021. The surgical team are currently in the process of reviewing patient records and prioritising the waiting list. Patients will be sent an update in the next few weeks.

26th November 2021 – Patients have been sent a letter confirming that surgeries will re-commence in December 2021. Read the letter.

2nd December 2021 Vice published an article about those impacted by the phallo and meta debacle.

2nd December 2021 – An individual from the waiting list has been told that some prioritisation has now taken place and 65 priority patients will soon be offered a surgery date. These priority patients are those awaiting urgent surgery and will shortly be contacted to arrange pre-operative assessments. In the meantime, those not on the urgent list are being given dates for phone consultations in order to update their medical notes.

3rd December 2021 – Individuals waiting for stage 2 or 3 surgery have received a letter from New Victoria Hospital. They anticipate that these surgeries “will commence from March 2022 and will take around two years for all cases to be operated on.

7th December 2021 – New Victoria hospital have confirmed that the phallo/meta service will be called New Victoria Hospital Gender Dysphoria Surgical Service.

7th February 2022 – TransActual can confirm that a number of people have now had NHS phalloplasty and metoidioplasty related surgeries at New Victoria Hospital.

8th February 2022 – TransActual released the results of a survey into the impact of the commissioning issues on those on the NHS waiting list for phalloplasty and metoidioplasty related surgeries.

16th February 2022 – An NHS response to a Freedom of Information Request has revealed that 1,944 people are on the waiting lists for NHS phalloplasty and metoidioplasty. This figure is higher than all previous estimates and indicates that, unless something is done about the situation, the waiting times for some people will be even longer than our forecast of 8 years.

12th March 2022 – TransActual have been passed an NHS response to a Freedom of Information request about the phallo and meta waiting list and about the future of NHS provision in this area. The response states that:

There are 967 people on a surgical waiting list for masculinising genital surgery. There are an additional 1003 people who are awaiting an appointment related to masculinising genital surgery, for example those waiting for a first outpatient appointment with the surgical team and those awaiting review for further surgery.”

With regards to the current provision:

New Victoria Hospital has performed 30 masculinising genital surgery procedures between the service start date of 13 December 2021 and 22 February 2022. This represents an average of approximately 14.5 procedures per month.

In reference to expansion of the service:

There is a contract in place between NHS England and New Victoria Hospital, who contract with three surgeons to undertake masculinising genital surgery. A fourth surgeon is currently being recruited to a fellowship at New Victoria Hospital funded by NHS England, to train to provide masculinising genital surgery.”
Two further providers have been recommended for award of contract as an outcome of the tender process, and NHS England regional teams are in the process of concluding final negotiations with the providers, which is expected to lead to confirmation of contract award by Spring 2022. One of these providers has identified four surgeons to be trained and the other will be adding a further three surgeons.”

TransActual welcome the news that work is underway to expand NHS phallo and meta provision. Assuming that the new services work at the same rate as the team at New Victoria Hospital, this means that a person being referred today might expect to wait 4 years for their first stage of phallo or meta. This is an improvement on previous forecasts, however 4 years is still too long to wait. Furthermore, those impacted by the commissioning issues have yet to receive an apology and NHS England is yet to commission specialist mental health support for those impacted.

For this reason, TransActual call on NHS England to:

  1. Apologise to those impacted by the commissioning issues;
  2. Commission specialist mental health support for those impacted by the situation;
  3. Offer funding for those seeking phallo or meta overseas so that waiting times for new referrals are reduced.

1st April 2022: Hysterectomy is typically provided as one of the surgical stages for phallo or meta. Hysterectomy as a stand alone procedure is not centrally funded by the NHS and trans patients seeking hysterectomy (even if they are in agony with gynaecological issues) face a postcode lottery. This leaves a lot of people without access to hysterectomy and unable to have a vaginectomy.

24th May 2022: Chelsea and Westminster Hospital have confirmed (in response to an enquiry by a Daily Mail journalist) that they will soon be offering lower surgery for trans men and non-binary people.

22nd July 2022: New Victoria Hospital have started contacting people waiting for stage 2 phalloplasty (and possibly meta) to offer them a stand-alone hysterectomy to prepare them for the rest of the stage 2 operation.

24th September 2022: Some patients have been contacted by GDNRSS about the possibility of receiving surgery at Chelsea and Westminster Hospital. This is for metoidioplasty without hysterectomy (so people that have already had a hysto or people that don’t want one). These surgeries will be done by the new team, which is headed by “an internationally known Gender Specialist Urologist”. TransActual view this development as a positive step in the right direction. If you’re on the waiting list and have had a hysto and/or don’t want one, make sure you’ve checked that GDNRSS know!

10th October 2022: A community member received a response to an FOI request which indicates that 139 phalloplasty and metoidioplasty surgeries took place at New Victoria Hospital between 1st January 2022 and 30th June 2022. This equates to approximately 23 procedures a month. NHS England’s indicative activity plan indicates an expectation of 472 procedures in the 2022/23 financial year, which equates to approximately 39 procedures a month.

28th January 2023: TransActual have become aware that Chelsea and Westminster Hospital have now completed several metoidioplasty surgeries. The surgeon in charge of training the team is Miroslav Djordjevic, a Serbian surgeon with a great reputation internationally. We understand that the team he’s training up is a team of experienced surgeons, all six of them are already at consultant level, who are training in meta and (shortly) phallo as additional specialisms.

There’s also a whole multidisciplinary team to make that trans patients are well supported. Chelsea and Westminster Hospital have been doing lots of work to make sure they understand the needs and perspectives of trans patients and so far we’ve been hearing very good things. We’re also aware that they’ve been doing lots and lots of trans inclusion training across the hospital. We’ve been told that they plan to continue to grow the team of surgeons that can offer phallo and meta and to ensure that their work is innovative and evidence based.

26th March 2023: An updated version of the NHS Service Specification for Gender Identity Services for Adults (Surgical Interventions), lists the three NHS providers of ‘masculinising’ genital surgery as Chelsea and Westminster Hospital, New Victoria Hospital and Parkside Hospital London.

7th April 2023: Some patients have been contacted offering them Phalloplasty at Parkside Hospital. The team’s surgical mentor will be Professor Marlon Buncamper from Belgium and it’s anticipated that the first operations will take place in August.

December 2023: It has been reported that phalloplasty will not be offered at Parkside Hospital after all. NHS England have not replied to TransActual’s request for comment.

February 2024: Some Scottish patients have reported that New Victoria Hospital are not currently operating on Scottish patients due to an issue around invoicing. Other Scottish patients have recently had operations at New Victoria Hospital. What all of the Scottish patients we heard from do agree on is that they have been asked to provide New Victoria Hospital with an authorisation number – this can be obtained from your GIC. People from England, Wales and Northern Ireland are unaffected by this issue.

June 2024: Scottish patients continue to report that New Victoria Hospital are not offering them surgical dates. We have made NHS Specialised Commissioning aware of the issue.

If you’re on the waiting list for NHS phallo or meta, or are waiting for repairs, and have not received a letter from the NHS about the situation, contact the Gender Dysphoria National Referrals Support Service (GDNRSS) so that you can be sure that you’re on the list. Call 01522 857799 (Monday to Friday, 9am-5pm) or e-mail agem.gdnrss@nhs.net.

If you have been personally impacted by this situation, please reach out for support. Find a source of support in our directory or come to the peer support group which runs on Zoom at 7pm – 8:30pm on the last Sunday of each month. E-mail info@transactual.org.uk to find out more.

If you’re a journalist, you can e-mail our press office at press@transactual.org.uk.

Information correct as of 16th June 2024.

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