Content warning: some sections on this page discuss poor mental health, body weight, self-harm, and suicide.
One of the hardest things about accessing medical transition is the amount of waiting you’re expected to do. The longest waiting time is usually for your first appointment with an NHS gender clinic, but once you’re seen by a gender clinic, you usually have to wait again before getting hormones or surgery. The additional wait can be a lot longer and harder than you expect. After the excitement of having an appointment at the gender clinic, and feeling like things are happening, suddenly having to wait again can be very difficult.
It’s really important that you don’t feel ‘stuck’. There’s lots of things you can do that don’t need you to have started hormones or had surgery. The rest of this page has some suggestions of practical things you can do while you are waiting.
Lots of people make a plan or schedule of all the things they want to do as part of their transition. Ticking things off of a plan can help you feel like things are still moving forwards.
How long will I be waiting?
You can read about waiting times for initial appointments at NHS gender clinics on our Gender Clinics page.
There are particularly long waiting times for masculinising genital surgery. If you’re waiting for these surgeries, we’ve got information for you on our What’s happening with NHS phallo and meta? page.
If you’re struggling with waiting to be seen by an NHS gender clinic or to get hormones or surgery, there is support to help you.
- Online support: Waiting List Warriors is an online support group for those waiting for the Nottingham Centre for Transgender Health, the West of England (Laurels) NHS gender clinic, or the East of England NHS Gender Identity Clinic.
- Peer support services: You can find links to these on our Sources of support page under ‘Peer support services’. These services offer support for trans people provided by other trans people. Some services offer individual support, and some may offer group support.
- Helplines: The Gendered Intelligence Support Line is available to trans people, their friends and family, and professionals directly impacted by gender healthcare waiting lists. You can call 0800 640 8046, WhatsApp on 07592 650 496, or email supportline@genderedintelligence.co.uk to get support.
- Support groups: You can find details of local trans support groups on our Sources of support page under ‘Social and support groups’.
- Apps and websites: VODA has an app with interactive exercises specifically designed for helping LGBTQ+ people with their mental health and confidence.
- Mental health support: You can find ideas for support from other people with your mental health on our Sources of support page under ‘Mental health support’ and ‘Mental health helplines’.
Many trans people experience gender dysphoria. Gender dysphoria is distress caused by “gendered” features of your body, or how other people treat you in a “gendered” way. Gender transition is the most effective way to reduce your gender dysphoria, but the changes you might want to make to reduce dysphoria – like changes to your body, style, or social interactions – often involve long waits for medical treatment or for effects of treatment to become visible. This means that even once you’ve decided to transition you may still have to cope with gender dysphoria for a long time.
You’re not alone in facing this – many trans people have had the same problems in the past, and invented their own strategies to avoid, manage, or reduce gender dysphoria.
Take a look at tips that other trans people have found helpful in these pages from other organisations:
- Allsorts Youth Project: Managing Gender Dysphoria
- Chai MI: Gender Dysphoria
- TENI: TENI’s 19 ways to help gender dysphoria
- TransgenderSG: Managing gender dysphoria
- Umbrella Cymru: How can I avoid things that cause me to feel dysphoria?
- Umbrella Cymru: How do I handle negative thoughts related to dysphoria?
If you’d like to spend more time thinking about tackling your gender dysphoria, take a look at Empowerment Lab’s Coping With Gender Dysphoria worksheets, which can help you devise your own strategies for handling gender dysphoria.
If you can afford to use them, there are private gender clinics outside of the NHS. These gender clinics have much shorter waiting lists, but you have to pay for the service yourself.
You can use a private gender clinic while you’re still on the NHS waiting list. The NHS gender clinics are very used to people on their waiting list using private gender clinics, and this shouldn’t affect your later NHS treatment. You can’t use a private diagnosis to skip diagnosis by the NHS – the NHS gender clinics want to do their own diagnosis of you.
Our Private care page has information about private gender clinics and the costs of using these services.
Many people can’t afford to pay the fees for private gender clinics, or don’t want to, and buy medications directly from the internet to take without the supervision of a medical professional. In our Transition Access Survey in 2022, 25% of the people that we surveyed indicated they had done this. Self-medicating comes with serious risks but many people decide that the benefits of being on hormone therapy outweigh these risks. If you’re in this situation, you can read our Hormone Therapy page to learn more about the risks and how to mitigate them.
If you’d like to have children who are genetically related to you (and don’t have them already), you might want to access fertility preservation (sperm, egg, or embryo freezing). Hormone treatment can have effects on your fertility. You may be able to start the fertility preservation process before you are seen by an NHS gender clinic. This is particularly important to learn about if you’re planning on starting hormones soon.
Getting your personal details changed and getting them updated across all the different organisations that hold information about you can take months to do. It could feel a bit overwhelming, so take it a bit at a time if you’d like – prioritise the organisations you interact with most.
To find out how to inform organisations and get your ID documents updated, read our pages on:
There can be a lot of different people you want (or need) to come out to.
It can take a long time to tell everyone, especially if you are waiting for the ‘right moment’ to do it. There’s no ‘best’ time to come out. It’s up to you and will depend on your particular situation, but you might find that having already come out leaves you free to try other things on this list.
There’s a list of resources about how to come out to people on the Gender Construction Kit ‘Coming Out’ page.
Making connections with other trans people can be really valuable while you’re waiting. It can build your confidence, allow you to get practical support and information, or just help you feel less isolated. Taking part in groups and activities with other trans people is a really important part of most people’s transitions. Some things you could consider are social and discussion groups, sports, crafts, choirs, exercise, games, or other hobby groups.
Being in groups of other trans people is important to building your confidence. Seeing other people in similar situations really helps – it’s much easier to get past your fears if you’ve seen other people doing something.
Support and social groups can be a great place to experiment with how you express your gender and try new things out. If you’re practicing your makeup or voice, or trying out new clothes or hair, it can be much less scary if you’re around other trans people who seem confident to be themselves. This can be a good stepping stone before doing these things in more public settings.
Groups of trans people can also be really important for getting information about transition. It can give you an important opportunity to ask questions, find out if other people have had similar experiences, and ask about local services you might want to use.
Social groups can be great for making friends, and making friends can make you feel less lonely and isolated.
People who are at the same stage of transition as you can be easier to make friends with. Many people meet long term friends at trans groups. This can be really important to help you as you make changes in your life. If you want to move away from where you’re currently living, the friends you make at a social group might end up sharing a flat or house with you. The people you make friends with at the start of your transition could later be the people who might drive you across the country for your hospital appointments, or fetch your shopping when you’re recovering from surgery.
Some people find it easier to make friends by doing an activity together with other people, like a sport or hobby. If this if you, you could look into whether there is a local:
- LGBTQ+ gaming night
- LGBTQ+ tabletop roleplaying group
- LGBTQ+ book club
- LGBTQ+ gardening club
- LGBTQ+ craft group
- LGBTQ+ sports and fitness groups
- LGBTQ+ walking, hiking, and swimming events
In some areas, there are sites that list all of the LGBTQ+ activities going on in the area. You might be able to find a list for your area on our Sources of support page under ‘Social and support groups’ or ‘Sports, fitness, and exercise’.
If you’re not used to socialising with other people, or you find it difficult, going to a social or support group can also give you an opportunity to get more experience in being part of a social group and build your social skills. If you’re neurodivergent, you might want to look into whether there are any local groups for neurodivergent people. In some areas, there are specific groups or events for neurodivergent LGBTQ+ people.
If you get very anxious about attending social events, have a think about what might help you attend. It’s not unusual to be anxious for your first time going to a group. Would it help you to contact a group organiser to ask about what kind of things happen at the group, or to ask them to introduce you to other people at the event?
After you’ve been to a group or social event, have a think about how it made you feel. There’s often several groups in an area with different types of people, different feels, and different kinds of activity. You might want to try several and see which ones work for you – you don’t have to stick with the first group you try.
Don’t worry if you don’t immediately make friends at the first event you go to – people are more likely to try and make friends with you if they’ve seen you turn up several times. When you first go to a new group, you can be really nervous, and this can make it difficult to relax or talk to people. However, if you’re finding the group still isn’t right for you after you’ve been along several times, it might be time to look at other options in the local area.
While you’re waiting, you can read about your options for gender treatment.
You might want to read about your medical options on this website. We have pages on topics like hormones, surgery, speech and language therapy, hair removal, and fertility preservation. Have a think about what’s right for you. Which things might you like? Which would you not like?
If you’re not sure what you want from medical transition, it might be helpful to keep a diary about what you’ve been learning about and how you felt about it. You may find that your feelings change from day to day.
Some people find it helpful to learn about what other people’s transitions have been like. You could try reading books other people have written, or following people on platforms like YouTube or Instagram, to learn about other people’s experiences of medical transition. If you’re doing this, be careful to keep an eye on whether this is helpful to you and how it makes you feel – are you learning useful things, or is it just making you feel afraid, angry, alone, or jealous?
If you already know someone who is trans, they might be happy to answer some questions for you about how they found particular parts of medical transition. Make sure you’re asking questions appropriately and politely – ask whether they would be happy to answer questions or not first, and which subjects they’d be happy to talk about. Be careful to do this privately – they might not be out to everyone, and they might not be comfortable talking about these topics around other people.
If you don’t know someone trans already who is willing to talk to you, you could talk to other trans people about their experiences and ask questions at a support group. Remember not everyone at a support group will be planning to medically transition, and there may be some things that people don’t want to discuss. You could also try joining online groups (like Facebook, Reddit, or Discord groups) that let trans people ask these questions. If you do this, make sure you follow the rules of the group, which may say that certain types of questions aren’t allowed.
Transitions are unique
Remember that different people have different experiences, and you might find your experience of medical transition might be very different to other people’s.
The people you meet will have different changes to what you might experience if you started hormones. For example, many trans feminine people will find they get different effects from hormones, like different amounts of breast growth or body fat distribution, and many trans masculine people find they get different amounts of beard growth or voice changes.
When you meet someone at a support group, you don’t know if they’ve been on hormones or for how long, they have different genetics to you, and they may be wearing padding that you’re not aware of.
It’s really easy to fall into a trap of comparing yourself to other people. Just because a YouTuber has a six pack, and you don’t, that doesn’t mean you’re ‘not man enough’. If you find yourself worrying about how other people perceive you, it can really help to ask trusted friends, family, or a partner how they see you, and what they love about you or how you look.
In our Transition Access Survey in 2022, nearly everyone we spoke to (86.9%) told us that waiting for hormones had a negative effect on their mental health. It’s really important to make sure you’re taking care of your mental health in this situation.
While you’re waiting, you might want to:
- Remove things from your daily routines if they aren’t helping you – does social media have a negative effect on your mental health? Is keeping up to date with the latest news headlines affecting you?
- Take part in hobbies, interests, and sports – or consider starting new ones. Look at our Sources of support page for information about social, sports, activity, and fitness groups you can join.
- Keeping in touch with friends and family – or make new friends if you need to.
- Use mental health self-help resources – check out our Wellbeing hub for suggestions.
If you feel it would be helpful, you can find information about accessing counselling on our Sources of support page under ‘Mental health support’.
You might already be happy with your style and not want to change anything! Many of us here at TransActual were already rocking looks that made us comfortable years before we started our medical transitions.
However – if you’ve been avoiding doing things for years to keep other people happy, you might want to use the waiting time to try new things.
Here’s some ideas for things you might want to try:
- Do you want to grow or cut your hair?
- Do you want to change your hair style?
- Do you want to change your clothes style?
- Do you want to wear a different style of underwear?
- Do you want to get piercings?
- Do you want to buy different jewellery to wear in your piercings?
- Do you want to get different bags?
- Do you want a different purse, wallet, watch, or phone case?
- What about glasses and sunglasses?
- Do you cover your head with a hat, hijab, or turban? Do you want to try different styles?
- Do you want to wear makeup?
You might find creating a mood board helps you think about what sort of things you could do.
If you’re doing things that are brand new to you, it can be overwhelming to do them without help and advice. You can read about how to do many of these things on genderkit.org.uk – see their pages on growing hair, cutting your hair, buying new clothes, and buying a bra for practical advice. You can also find practical resources on the genderswap.org website, including a detailed index of retailers and services for UK trans people including free options for getting clothes.
If you’re someone who worries about what other people think about you and how you look, you might want to do these things in small steps gradually over time. Do you have a friend who can go with you for support while you try new things? Do you have somewhere you could go that’s a long way from home where no-one knows you?
Don’t pressure yourself to figure everything out at once. It’s not unusual to spend months or years gradually building a new wardrobe during your transition. If you’re changing your look to something that’s quite different to before, it might take you a particularly long time to work out what’s right for you – you might need to try lots of different options before finding ones you are happy with.
Some trans people want to remove their facial hair or body hair permanently.
If you’re willing to pay for it yourself, you can get started on the process before you are seen by a gender clinic.
Permanent hair removal takes time. Sessions of treatment on a part of your body or face are usually spaced out by at least a month in between each appointment.
Some people find that having finished permanent facial hair removal makes them feel safer to make further changes.
Read our Permanent hair removal page to learn more about your options.
Many trans people would like their voice to have a different pitch, resonance, intonation, rhythm, or volume. If you want to make changes to your voice, you can get started on this before you’re seen by a gender clinic.
You can make changes to your voice quickly – but working out exactly what you want your voice to sound like and perfecting your skills can take much longer!
Read our Speech therapy page for more information about your options.
If you’re able to do it, building up money in your savings accounts can be helpful to:
- pay to use a private gender clinic to access hormones or surgery more quickly than you could via the NHS
- pay for things that the NHS does not fund, like facial surgeries
- buy new clothes, makeup, bags, watches, or jewellery
- have money to cover the costs of moving to a new home
We recognise that many trans people aren’t able to build up savings – because they don’t have an income, because they can’t afford to, or for other important reasons. In particular, if you’re receiving DWP benefits, remember that these may be affected by the amount of savings you have – for example, Universal Credit can be affected by your savings. If you’re not sure how putting money into savings accounts could affect the benefits your receive, you could ask for advice from your local Citizens’ Advice Bureau.
Some people find it can be helpful to work on their career while they are waiting to access treatment. However, this can be much harder for some people to do than others. Many trans people find it difficult to access employment or move forward with their career due to transphobia, ageism, racism, ableism, or a lack of suitable jobs in their area, or struggle to work due to their mental health or dysphoria.
Most surgeons have rules that say they will only operate on people that are below a certain BMI. We know that BMI is not an accurate measure of how healthy someone is, and that having a higher BMI doesn’t mean you’re at a higher risk than someone with a lower BMI when having surgery. We work with clinicians who are trying to change the rules on BMI to help them make progress.
However, with the current rules on eligibility for surgery, losing weight while you are waiting can help reduce your risk of waiting later on in the care pathway.
Weight loss isn’t practical for everyone. You may have a diagnosis of an eating disorder, or have a lived experience of disordered eating, in which case reaching a BMI threshold might be particularly difficult for you.
If you do try and lose weight, it’s important to do it safely and make sure you’ve got a medically appropriate target weight. Your GP should be able to offer you help around losing weight, including referring you to weight loss services. You can read about your options on the NHS website if you want to know what the NHS can offer you.
If you’re unable to lose weight, or do not wish to lose weight, that does not mean that surgery is impossible for you. Different surgeons will have different criteria for who they will see, and surgeons may make exceptions to their rules. You can find information about choosing a surgeon on our Choosing a Surgeon page. You can find more information about BMI criteria:
- for surgeons offering NHS services, by contacting your NHS gender clinic, or by contacting GDNRSS (via email at agem.gdnrss@nhs.net, or via telephone 01522 857799 Monday to Friday, 9am-5pm).
- for surgeons offering private services, by contacting them directly and asking about BMI criteria – details of UK surgeons offering private services can be found on our Private care page
In addition to the normal risks experienced by all smokers, smoking and vaping can increase the risks of side effects of hormones or complications from gender surgeries.
We know that the majority of people who are smoking or vaping would like to stop. If you want help to stop, you can talk to your GP, or contact stop smoking services directly yourself. Read how to get help with smoking or vaping on the NHS Stop Smoking Services page.
If you’re using other substances and are worried about your use of them, you can speak to your GP to access support. If you’re not comfortable talking to your GP about this, you can find local services directly using the FRANK (England), Drugs and Alcohol Info NI (Northern Ireland), Scottish Drug Services, or DAN 24/7 (Wales) sites.
You can also find organisations specifically for LGBTQ+ people who want to reduce or stop using substances, like TransSober. You can find more suggestions of organisations that can help on our Sources of Support page.
Lots of trans people would like to stop or reduce their periods.
Many people use contraception to stop periods because you can get contraception without having to have been seen by a gender clinic. You can read about contraception options for trans people, and which ones stop or reduce periods, in this leaflet from Leeds Gender Service. Your GP should be willing to offer you any of these options. Different contraception options will be best for different people, and as none of the methods are guaranteed to stop periods, you may need to try more than one option to find the right one for you.
If you’re worried about talking to your GP about accessing contraception you can talk to a sexual health clinic instead. There are some trans-specific sexual health clinics in larger cities that you can find on our Sources of support page under ‘Sexual health’.
Once you’re receiving support with your medical transition, your GP will normally be involved in prescribing, blood testing, and supporting you during surgery recovery. It can really help to have a supportive GP who is happy to help you with these things.
Many GPs are very supportive of trans people and willing to help you. However, if you decide you want to look for another GP, you could try:
- Asking in local support groups – Other local people can tell you about their experiences with local GPs. You can find information about local organisations on our Sources of support page under ‘Social and support groups’.
- Find an accredited practice – Many GP surgeries have signed up to schemes where they have been specifically trained to work with LGBTQ+ patients. Look for surgeries that are signed up to a scheme like Pride in Practice.
- Use a community database – Members of the trans community have created maps with information about what their experiences of GP surgeries have been, such as Trans Health Intel and Trans Aid Cymu. Other sites have collected information about the policies that local GP surgeries have, like Brum Trans Health Info and Trans Aid Bristol. As GPs change jobs and policies change over time, remember that not all information on these sites will be up-to-date.
You can find more tips for waiting in the Sussex Gender Service Preparation for gender affirming pathways booklet.
Community voices
“Access support groups, build a support network with friends or family, if things get tough never be afraid to reach out and ask for help, whether that be your loved ones or professional help like a counsellor.”
“Read up about the good, bad, and ugly of any treatment you’re wanting, so you can show the clinicians you’re not making the choice lightly.”
“Be careful about comparing yourself to others, everybody’s journey is different and we’re all at different stages in the process.”
“Don’t stop living your life while waiting. It is difficult to exist on the list and feel like nothing is ever going to change, but you don’t deserve to spend your life hiding. Give yourself good experiences and good memories, it’s very important to have those good things.”
Errors or omissions
Is there something missing from this page? Have you spotted something that isn’t correct? E-mail info@transactual.org.uk to let us know.
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Parts of this page are based on information originally posted on genderkit.org.uk with permission.
A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.
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