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Initial Response to the Publication of the Levy Review of Adult Gender Services in England

For immediate release 18 December 2025

Tammy Hymas, Policy Lead at TransActual said: 

“We are concerned that this review is a missed opportunity to give all trans people timely and local access to gender affirming hormones on the basis of informed consent – the most effective way to clear 8 year long waiting lists.

“With the acknowledgement from Health Secretary Wes Streeting that trans people are being failed by the NHS, Dr Levy’s review of adult gender services should prompt this Government to turn words into action and provide long term funding to end this crisis”.

TransActual Full Response Statement

Everyone, no matter their gender or background, should have the freedom to choose how to express themselves and what they do with their body. Whether you are trans or not, you should be able to get the healthcare you need in a timely way without degrading questioning or discrimination. 

For too long, trans people have languished on dangerously long waiting lists which, in some cases, now involve more than a decade of waiting for care. Things don’t have to be this way. 

The publication of this Review is an opportunity to transform healthcare provision that, as Dr David Levy rightly acknowledges, has been failing trans communities for years.

Dr Levy’s recommendation to expand the number of clinics is an encouraging first step. The introduction of a local enhanced GP service could take the pressure off centralised gender clinics and help to address the rise in GPs refusing to prescribe gender affirming hormones. However, the NHS should make clear that trans people with existing arrangements with their GP should not lose access or be forced to transfer to a locally enhanced service. 

Recommendations for a more streamlined, patient centred care pathway are welcome and we encourage NHS England to centre trans people’s voices in putting them into practice. 

However, the requirement for assessment to be done specifically by a senior clinician risks unnecessarily hampering efforts to reduce waiting times. Additionally, removing the option of self-referral could create unnecessary barriers to care.

Whilst we recognise that some individuals might require more complex support from gender clinics, we continue to oppose any proposals during implementation that exclude those from accessing hormones and other transition related care on the basis of assumptions about their capacity to give consent. 

We will be publishing a full analysis of Dr Levy’s Review in the coming days and we will continue to engage with the Department of Health and Social Care and NHS England to ensure implementation of the Review prioritises the needs of trans people. 

Wes Streeting, the Secretary of State for Health and Social Care, has acknowledged that the waiting lists are too long. He must now turn words into action with funding to tackle the trans healthcare crisis, and ensure everyone has the freedom to express themselves with the support of timely healthcare on the basis of informed consent from our NHS.

– ENDS –

Further information

For further information, please contact jane fae via press@transactual.org.uk.

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Further commentary from TransActual


Appendix I: trans healthcare needs

This is a list of the key policy initiatives that TransActual, and the wider Trans Healthcare Coalition have been seeking from the Levy Review:

  • A national shared care policy – ensuring that GPs have to prescribe and offer blood tests when asked to by a GIC
  • Funding GP support for trans people under an enhanced services arrangement
  • Commissioning of local GP led services which are able to offer ‘bridging prescriptions’ and blood tests – such as Well-BN, The Bridge.
  • Commissioning of additional local ‘new style’ clinics – such as Indigo, TransPlus, CMAGIC.
  • Funded trans-specific and appropriate mental health support for people on the waiting lists for transition related care – this could include funding for care navigators or social prescribers
  • Fully funded training for GPs on trans inclusion, including provision of bridging prescriptions, shared care agreements and blood testing for people who are self-medicating
  • Removal of the two appointment requirement to access HRT.
  • Provision of as many facial hair removal sessions as required, instead of a ‘one size fits all’ package
  • The full reimbursement of travel and accommodation costs for anybody needing to travel more than 30 miles for an appointment with a gender clinic.
  • Services based on individual need rather than a rigid structure.
  • A commitment to ongoing service improvement, with trans people’s voices at the centre of that.
  • NHSE to include waiting times for transition related care in national waiting list reporting (and subject the lists to the same 18-week requirement)
  • Formal recognition and inclusion of non-binary people and non-binary transitions as part of NHSE transition care provisions
  • Participation in research (including use of one’s medical records) must only ever be voluntary 

Appendix II: Evidence

Case Studies

  • Alice Litman took her own life after waiting for years to access gender affirming care. Her mother has campaigned vociferously for improved access to gender affirming care. 
  • Evaluation reports of ‘new style’ gender clinics
  • WPATH Standards of Care 8: gender-affirming healthcare for adults—including hormones, surgeries, and other interventions—is medically necessary and should be accessible without unnecessary barriers. They emphasize individualized, patient-centred care delivered by trained providers, using informed consent models rather than rigid gatekeeping.
  • In many parts of the USA and Canada, clinics operate on an informed consent model for access to hormones, which is shown to be associated with better patient satisfaction, faster access to care, and reduced psychological burden.

Key Research

Core Statistics

Over half of Transition Access Survey respondents had accessed HRT privately, with more than three quarters of those telling us they went private due to the waiting times whilst a quarter of respondents had self-medicated for HRT.

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