NAVIGATING THE TRANS HEALTHCARE CRISIS

By Rachel Badham

Sharing their experiences with Rachel Badham, three selfidentifying trans men explain how inadequate healthcare and a lack of access to gender-affirming treatments and surgery has affected their daily lives and mental wellbeing, and why the government needs to prioritise the needs of the trans community now

As of October 2020, the UK has had no surgical facility able to perform phalloplasty and metoidioplasty operations, leaving many trans men and non-binary unable to access this form of gender-affirming care. Those who were on the waiting list for surgery, or have already had the first stage of the surgery, have been left suffering both mentally and physically, with many seeking alternative options overseas.

Chay Brown, director of TransActual, confirmed that the contract for St Peter’s Andrology Centre – the only UK location able to provide phalloplasty and metoidioplasty – was discontinued at an unknown point between October 2020 and April 2021, with patients only being made aware of this in May. Although the NHS has now confirmed that it is in the process of securing alternative providers of this lifesaving surgery, thousands of trans people across the UK are still struggling to access any form of gender-affirming healthcare.

According to Stonewall, more than 50% of trans people reported they have been told by their GP that they don’t know enough about trans-related care to provide it, while a report from GenderGP found that some trans people have been waiting for around three years for an initial appointment with a specialist gender clinic.

The insufficient number of professionals who have been provided with adequate training on trans healthcare, coupled with overstretched clinics and the lack of surgeons able to perform gender-affirming operations, means trans men and non-binary people are having to grapple with gender dysphoria without access to testosterone and transitional surgery.

Endeavour (he/him, YouTube: Endeavour Dowsett), began medically transitioning four years ago at 35, after grappling with dysphoria since childhood: “I knew at six I wanted to be a boy but didn’t have the vocabulary for it or understand why I felt that way. I didn’t realise until I was 34 that the feeling and dysphoria I’ve had all my life was because I was transgender. That was a scary realisation but also a relief. I’d referred myself to the NHS Gender Identity Clinic (GIC) at the same time as contacting Gendercare in 2018. It’s now been three years since I’ve been on testosterone and I still have yet to have a first appointment with the London NHS GIC.”

Because of the long waiting times, Endeavour decided to get top surgery privately and was able to do so with the help of GoFundMe. However, he is now struggling to get a hysterectomy, which he is in need of due to extreme cramping pains from testosterone: “My GP has been fantastic in referring me to gynaecologists for a hysterectomy but the gynaecologists are refusing without referrals from the NHS GIC and I’ve yet to see them! Essentially I’m at a dead end and the pain I’m in is not taken seriously enough.

"Both gynaecologists I’ve seen have not been good experiences either. Either knowledge is poor or they think I’m making it up. I contacted the NHS GIC for advice for them to refuse to engage with me as I’m under private care and yet to be seen by them. I cannot go further privately and the NHS is ignoring what is a problem for many trans men/non-binary people on testosterone who have sought medical care elsewhere to get on hormones.”

He believes the government urgently needs to address the “unacceptable” trans healthcare crisis, adding: “There should be better support in private/NHS shared care. It’s often frowned upon if you seek private healthcare if you’re trans but in other areas of medicine, it’s better accepted.” After many years of struggling, he attributed gender-affirming healthcare to preventing his mental health from reaching “rock bottom”, and described it as life-saving.

“As someone who works as an NHS student nurse, I know that NHS funding is limited. But the way trans people like me are treated has been quite a shock”

Ethan (he/him), a 20-year-old trans man, began hormone treatment just over a year ago, which has helped to alleviate his gender dysphoria, but has been unable to afford top surgery:

“As someone who works as an NHS student nurse, I know that NHS funding is limited. But the way trans people like me are treated has been quite a shock. I’ve still been waiting for one single appointment after years, so I’ve lost any hope of being able to access surgery via the NHS. I have had to rely on friends/family/ strangers who have supported me financially via GoFundMe to continue education and get the medical care I need and pay for my prescriptions.”

As a result of being “let down massively” by the current healthcare system, Ethan is planning to go abroad to access surgery: “I am currently funding my top surgery, which I will be forced to go abroad for. Even private waiting lists are going up or just far too expensive for anyone to afford. No young person should be worried about if they’ll be able to continue their education or living costs because of healthcare and prescription costs. Additionally, wearing my binder every day has caused immense back pain and my blood levels aren’t being checked as often as they should due to my GP feeling he has inadequate knowledge of trans healthcare.

Healthcare professionals need to receive sufficient education on trans-related care.”

Soph (he/they/she), a trans non-binary person, is hoping to begin medically transitioning, but has been on the GIC waiting list for nearly two years: “I’ve known for years that I didn’t fit as a woman, but wasn’t able to put a name on how I was feeling until a good friend of mine came out as trans about three years ago. I came out about a year after them and haven’t been able to start medically transitioning yet. I was referred to the GIC back in January 2020 so I’ve been waiting nearly two years (about 21 months).”

Soph has found that their depression has worsened due to healthcare barriers, and finds it “shocking” that there is only one GIC in the South East and London:

“I was diagnosed with depression about five years ago, which I realise now is due to being trans and how I’ve been feeling about my body. The waiting list time hasn’t helped and it doesn’t give me much hope for the future. I was referred at 25 and probably won’t be able to start transitioning until after I’m 30, which is very depressing indeed.”

Sources: The Waiting List for NHS Gender Identity Clinics: Patients’ Experiences, GenderGP, February 18, 2020