‘I’d never wish this upon anyone’: Trans surgery waiting times increase over the pandemic

In 2020, support group LGBT Hero reported that visits to their suicide prevention pages had increased by 44% between January and March. Of the LGBT community, trans people make up around 20% and over two thirds have reportedly considered suicide. Gender dysphoria, anxiety and depression are the silent killers of the trans community and while not the cure, gender affirming healthcare such as hormones or surgery can massively improve a trans person’s quality of life.

Not all trans people will go down the route of gender reassignment surgery but those that do are offered the removal of breasts, construction of a vagina or penis, and face and voice altering hormones. These procedures can be done privately, but the expense prevents most from accessing the surgeries, costing between £10,000 to £100,000.

A pride flag hanging from a tower block balcony.
Celebrations commence around the world for Pride Month

The NHS offers everything from gender identity consultations to reassignment surgery but with the huge pressures healthcare faced during the pandemic, ‘non-essential’ surgeries and treatments were postponed. While this postponement was crucial for the NHS’s survival, trans people have directly suffered. Gender reassignment surgery on the NHS already has a waiting list of at least five years and while deemed ‘non-essential’, these waiting times can actually be life threatening.

On May 20, trans activist Sophie Williams took her own life after waiting over five and a half years for her first appointment at the Gender Identity Clinic. Just last year, Williams co-founded We Exist, a UK organisation committed to raising funds for trans private healthcare.

June is globally recognised as Pride Month but in what should be a time of identity celebration, tragedies and injustices are still rife in the trans community.

Children coming out as trans

Sam* came out as a trans man when he was 16. Despite being assigned female at birth (AFAB), he felt different to others but couldn’t pinpoint why. He’d often say to his friends “don’t you just wish you were a boy?” and get opposing responses, making him realise this wasn’t what most young girls think. Not having a definition for what he felt was what delayed Sam in coming out, but when he had the understanding, it was a sudden acknowledgment that he would now identify as a man.

A man stood in a field looking over a town. He's wearing a black top and facing away from the camera.
In 2017, 50 children a week were referred to GIDS

When a minor comes out as trans, they are referred to the Gender Identity Development Services (GIDS) for emotional support up until their 18th birthday. Before treatment of any kind is given, a person has to be diagnosed with gender dysphoria, which is the mismatch between biological sex and gender identity. For a person who feels their identity matches with their biological sex, this can be a hard thing to understand. For Sam, it felt like everyone was telling him what he was, when he knew he was something else.

“Imagine being told you look a certain way but in the mirror you see something entirely different, or everyone calls you Steve but you know your name is John- it’s so frustrating.”

The process of being diagnosed with gender dysphoria can be invasive. When a minor is referred to GIDS, their whole family is involved in the process of diagnosis, having meetings to discuss the possible family impacts or reasons why their child feels this way. Puberty blockers and hormones are then offered after a consultation period to prevent the development of female/male features. Sam’s parents were supportive, but for many trans children, even this first step is daunting.  

While Sam felt he had a relatively positive experience with the children’s gender services, by the time of his referral he was told he’d been through female puberty so was denied puberty blockers. This was the start of his issues with the system.

“It felt like nothing was being done, I hadn’t emotionally gone through puberty yet despite the physical changes and that wasn’t considered. I was positive when I first came out but the longer I waited and still nothing was being done for me, I started to get more negative and my mental health declined.”

Gender reassignment surgery

Currently in the UK, to be referred for gender reassignment surgery, you have to be over 18 and have been on cross-sex hormones for at least a year. From GIDS, an 18 year old moves to the Gender Identity Clinic (GIC). Sam was 20 when he received his double mastectomy; this was still after a multi-disciplinary team meeting and 4 years after he began his transition.

For top surgery, only one medical opinion is required. For lower surgery, two opinions are needed which increases the wait time even further. ‘Opinions’ are the clinical assessment of a person’s mental health and physical health to ensure they are prepared for the transition.

A man sat on a bench in front of a stately home. He has a white mask and a black box covering his eyes to remain anonymous.
Sam* was denied hormone blockers despite wanting to see physical change

“For lower surgery, you have to be on hormones for at least a year and then you have to wait for this first opinion. After the first opinion, you have to wait another 18 months at least for a second. The logic in this is fundamentally flawed, the wait between the opinions is too long, never mind the referral time and Covid has just extended it further.”

For a child entering the adult services, wait times are lower having already been in the system. For an adult entering the system, waiting times are upwards of five years.

Annabell Roodi Newbould, 33, came out as non-binary at 26 but didn’t get a gender dysphoria diagnosis until she was 28. The wait for cross-sex hormones was so long that she began self-medicating.

“Self-medicating Oestrogen can be so dangerous, it can cause blood clots, liver failure, not to mention the toll on your mind. GPs aren’t trained experts in trans people’s health concerns and it took me seeing three GPs until one would test my blood for these potential problems.”

A close up of a woman with glasses and a lip ring and 2 nose piercings.
Many trans people resort to buying hormones online from unregulated sources

Not only do the waiting times encourage self-medication, but they can lead lying to your clinician. Sam experienced this when waiting for lower surgery.

“You don’t get surgery until they know you’re mentally ‘well’ and I’ve heard of trans people saying they’re not suicidal when they are, just to speed up the process. They’re suicidal because their body doesn’t match with their mind and if the process of changing that was faster, maybe their mind would be better.”

Annabell experienced something similar in her initial consultations.

“They delve into your childhood and it’s actually extremely outdated. If you’re transitioning into a woman, they ask you if you had a strong maternal instinct as a child or if you spent time in the kitchen. If you’re transitioning into a man, they ask if you were into sports or cars. The process is that baffling that you end up saying yes to things that aren’t necessarily true.”

Tattoos of theatrical faces, the sad and the happy.
‘Homophobia, transphobia and sexism are intrinsically linked, and not
acknowledging this has perpetuated society’s apathy and misunderstanding of
trans people.’

While these long waiting times deny a person of the true self for longer, the toll of self-medicating or lying about mental health only add to a person’s possible depression or anxiety. The system continues to hinder the trans community.

This is of course not the NHS’s fault, but instead the lack of understanding and the constant cuts in funding. Since 2015, the government cut funding to health services by £850m and this has a direct effect on funding for gender reassignment surgery.

Having been on the waiting list for lower surgery for nearly seven years, Annabell is desperate for something to change.

“Some people risk their lives and go abroad with little research, some get stuck in another country with complications because they’re not insured and in some cases the NHS will not treat people who have gone abroad. As it stands, this country is not equipped to see everyone on waiting lists. Every year there are more and more trans people, but less and less funding.”

However, funding isn’t the only setback in the journey to transitioning, especially for children.

The 0.5%

In 2020, 23 year old Kiera Bell sued the Tavistock and Portman NHS Foundation Trust for prescribing her cross-sex hormones at 16. Bell was referred to the gender clinic and began her transition into a man but she has since started the process of de-transitioning and believes as a 16 year old, she shouldn’t have been allowed to give consent.

The High Court ruled that a child is unlikely to give informed consent on using puberty blockers and cross-sex hormones, meaning that new referrals to these treatments for under 16s were halted entirely.

Kiera Bell regretted her decision to transition to a man, acknowledging that gender dysphoria didn’t necessarily mean she was trans. According to the BBC, Bell said she should have been ‘challenged more’ and being only a teenager, shouldn’t have been able to make this life changing decision. However, cases like Kiera Bell’s are extremely rare, research showing only 0.5% of trans people de-transition.

A woman looking at herself in the mirror.
The term gender dysphoria is more often being described as gender incongruence

For children who are going through these identity difficulties, it is crucial that they are given this time and information before making this life altering change. The waiting times can cause numerous problems but for a child, they can help solidify their decision.

While the effects of hormone blockers and cross sex hormones are reversible, medical intervention is often not and is a costly and long procedure. Despite limited funding, the NHS works to make sure medical intervention is the right path for the child and won’t cause complications, such as de-transitioning, when they’re an adult.

However, for the children and adults like Sam and Annabell, who are sure about changing their gender, the waiting times and invasive questioning can be traumatic and makes what should be an exciting transition, instead a very damaging one.

Annabell commented: “I’m proud to be trans, but I would never ever wish this upon anyone. Why would anyone choose to make their lives difficult and painful.”

Local Support

Annabell has been the director of TransLeeds for a year now. TransLeeds is an support group for trans people in West Yorkshire and hosts weekly meetings which involve friends and family.

“My aim with TransLeeds is to register us as a charity and provide more support for the community, as currently the NHS has no support in between appointments. I think raising awareness also helps. Trans exclusionists spread vile false facts about how “easy” it is for trans people to transition. This is not the case. People need to understand the entire process.”

A woman sat at her desk making a sculpture.
Trans support groups are becoming paramount for those waiting for gender reassignment surgery

For people new to the trans community, TransLeeds can be an immense help for understanding yourself. As many GPs are not trained for it, trans people have to know what to ask for and TransLeeds can accompany members to appointments.

A woman practicing ventriloquy with a green furry puppet.
During the pandemic, medical care for trans people was put on hold

Annabell described the support between waiting times as life saving:

“Only fairly recently I got my two surgery opinions, but I was told that surgeons are not taking any referrals at the moment, and this has been the case for nearing two years! So when they finally take referrals again there will be a massive backlog. If it wasn’t for TransLeeds, I would have been completely isolated.”

A woman stood in front of the tower block she lives in.
Annabell hopes she can help trans people through the waiting times and give the support she wished she had

She added:

“It brings me a lot of joy knowing that I can have a positive impact on the trans community and potentially give people chances in life that I never had.”

The waiting times for gender affirming healthcare are only getting longer due to the pandemic.  While pressures on the NHS have been high over the past year, trans people have endured the extensive limbo phase for years. Private healthcare is not an option for most and even with fundraisers, loans are still required to cover the costly process.

For the majority of trans people, these waiting times are unnecessary, unfair and exacerbate mental struggles. It is also no easier for the few who go through the long, arduous process and then change their mind. Regardless, it is clear that more support is needed for people struggling with their gender identity.

*This name has been changed for anonymity