Healthcare for transgender people has been an ongoing issue for years as the waiting times remain mostly unchanged since 2019. Although there have been some specific changes that have happened in Manchester, funding cuts and understaffing mean that trans healthcare still has many of the same problems as before. People that do not feel content or happy in their own bodies are still told to wait or are not taken seriously.
Gender Identity Clinics (GIC) provide consultation, prescriptions and surgical referrals for people wanting to transition. The waiting times for GICs have kept going up, with the shortest wait time being for Nottingham GIC at 27 months for patients seen in June 2022. Yet, the new NHS Indigo Gender Service opened in Manchester 2020 as a pilot scheme and has removed unnecessary waiting between appointments.
Indigo is a partnership between gtd healthcare, a not-for-profit healthcare organisation in the north-west and LGBT Foundation, a national charity delivering services, advice and information for lesbian, gay, bisexual and trans communities.
Rowan, an organiser with Trans Mutual Aid Manchester (TMAM), said: “I was referred to Indigo in 2020, after being on a waiting list for Leeds Gender Identity Clinic for two years without even having had an initial ‘assessment’ appointment, which would have kicked off a process of waiting two years, having another assessment, waiting two years again to possibly talking about hormones and then waiting another two years to talk about a surgery referral.”
The Indigo Gender Service’s approach is designed to be more user-friendly than the traditional GICs. “Anyone who has dealt with GICs knows how dehumanising the experience with them can be. All of us have either been asked inappropriate, invasive and irrelevant questions by a GIC clinician about intimate details of our sex lives, or we know someone who has been denied care or shoved right to the bottom of a never-ending list,” Rowan said.
Following the announcement on 28 July that the NHS is to close Tavistock child gender identity clinic, the responses from trans people appear to be somewhat positive as it has been closed in favour of opening more regional services. This means that there will be more availability, people will have to travel less and hopefully wait times will decrease.
Vivien, an organiser with TMAM whilst working in health data science, said: “The other issue is the extensive procedure to get a diagnosis, which still requires multiple appointments before any sort of treatment is offered, meaning that even if that waiting list was kept within a reasonable time, there’s still the time it takes to jump through all of those hoops and it can then take over a year to get an HRT prescription.”
“Cisgender people don’t have to go through anything like this to be prescribed HRT for menopause or other hormonal issues, why is it not up to us what we do with our own bodies? Why are trans people not believed when we say we’re trans? And made to prove it, to be given a medical diagnosis, which works on the basis that there is something medically or psychologically wrong with us,” said Rowan.
Despite this, there has been a slow but steady change in sexual health services in Manchester lately, which suggests a positive sign as there have been increased efforts in providing trans-specific sexual health services at The Hathersage Centre.
Although the Pride in Practice scheme, run by the LGBT Foundation to make GP surgeries more aware of how they can provide good care to LGBT patients, is still ongoing, the people at TMAM still stress that GPs can be doing a lot more to provide care to trans patients as many do not know what the options are or do not feel they have the training to prescribe hormones without the GIC having approved it first.
Rowan went on to say, “I would absolutely encourage any GP practice to get in touch with Pride in Practice at the LGBT Foundation for support and advice with this.”
When answering what one of the positive changes are since 2019, Vivien said: “One of the big changes has been the number of people working on this; we started in September 2020, the Trans Safety Network also started since then and there have been more Trans Pride events and trans-supportive protests. There is also a lot of momentum on our side, and with wins like the GIDS closure, while a lot is going on, it feels worth being optimistic at this point.”
I also spoke with Cleo Madeleine, communications officer at Gendered Intelligence which is based in London. Gendered Intelligence was established in 2008 and is a registered charity that exists to increase understanding of gender diversity and improve trans people’s quality of life.
“We are not a healthcare organisation and so cannot provide medical advice or access to healthcare. We do provide groups and spaces for young trans people to share their experiences of trying to access healthcare, and discuss identity and transition in a safe, supportive environment,” said Cleo. “We also work with the NHS to help improve understanding of gender identity and the trans community more widely.”
Although there are many organisations and charities for trans people around the UK, there is still a struggle for people to get sexual health support and hormone therapies due to GICs not having the capacity to provide large-scale care. Since 2019, particularly during the pandemic, national wait lists for GICs have continued to spiral into years. Without a widespread rollout of gender identity services at a primary care level, wait times are only going to worsen.
“The GIC system was originally designed to handle relatively few patients and in the years since it was founded, demand has greatly increased as social attitudes and media representation of trans people has improved,” said Cleo. “The system cannot sustain this demand and is no longer fit for purpose.”
“Without a serious change to gender identity service provision in the UK, wait times and standards of care are only going to get worse. This isn’t the fault of the healthcare professionals who work for the GICs, but a structural problem within the system itself.”
Jordyn Leyland, LGBT youth worker in Manchester, came out as trans around the age of fourteen. After trying to get a referral from his GP and CAMHS, he eventually got one from a youth worker in 2015 and was referred to Tavistock Leeds. After waiting around 16 months, he began to feel stuck and it severely affected his mental health. Having waited all this time, he eventually found a GP that referred him directly to an endocrinologist (hormone specialist) and started on testosterone at the age of seventeen.
Once Jordyn was finally seen by Tavistock, they questioned the legality of his prescription. “I had two appointments before being discharged and referred to the adult service as by that point I was 18. If you get referred from child to adult gender services, the waiting list is shorter because you would already have had a diagnosis of dysphoria,” said Jordyn. “Tavistock never gave me one, so rather than a six month wait, I had a 4-year wait.”
Jordyn’s mental health was seriously affected during the whole process due to GPs not being aware of the process of transition and treating him as though it’s cosmetic. “Any kind of childhood trauma is scrutinised, and in one report from Tavistock, it was written that they questioned if I thought I was a trans male because my dad died and I was trying to fill a male role in the family,” he said.
He eventually had to fly abroad to Poland for top surgery in 2021 as it was the only way he could afford to go private. If he waited for the NHS, he would still be waiting now, and this month he finally got his diagnosis of gender dysphoria after living as this gender for 7 years, being on hormones for nearly 5 years, and being over a year post op. Jordyn also emphasises the level of awareness in other areas of healthcare now, and the availability of more locally-run pilot schemes for adults, like Indigo.
Recent developments in healthcare, both in the UK and around the world, have supported better access to gender identity services. “NHS England has begun developing new regional centres for youth gender identity services in response to guidance from the Independent Cass Review. The new WPATH Standards of Care Version 8 detailed recommendations that clearly support GPs and other primary care providers to care for their transgender patients with less need for oversubscribed specialist services,” said Cleo.
“Although the political atmosphere in the UK is increasingly oppressive towards the trans community, our healthcare system need not be. It is possible, in the coming years, for NHS England to make gender identity services accessible to all who need them and end healthcare inequality for trans people in the UK.”
There has been a huge amount of support within the trans community and various organisations working together to suppress the current segregation and misunderstanding the public has of transgender people. Yet there is still more to do to ensure these people are taken seriously. “By the time of getting to a gender identity clinic, a trans person will have already spent years thinking about if it’s the right decision,” said Jordyn. “When they say it is, they should be believed.”
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