CW: This article mentions transphobia, depression, and suicide. Names have been changed to protect anonymity.
Alice Bennett
Barriers to healthcare and gender-affirming care have a devastating effect on the mental health and well-being of transgender people. So, what do they have to say about it?
In the UK, we have the right to treatment within 18 weeks on the NHS. However, the wait for a trans person to be referred to a gender identity clinic can last over five years. Meanwhile, Dr Hilary Cass’s report for NHS England (The Cass Report) advises “extreme caution” when prescribing puberty blockers to those under 18 and even adults under 25. This contributes to further delays in gender-affirming care.
Despite facing criticism for “pseudo-science” and dismissing existing research, the report’s recommendations have already been implemented. NHS England announced they would stop prescribing under 18s hormone blockers, with Scotland already pausing the treatment.
The never-ending waiting lists, in addition to no treatment for minors, are a great cause of concern for the trans community. There is an astonishing lack of acknowledgement of the harm caused by important healthcare restrictions. Despite the harm to trans people, loud and ignorant cisgender voices dominate the media narrative.
Ignoring Trans Voices
Aidan, a 23-year-old trans-masc nonbinary student (he/they) from the University of Nottingham, thinks a huge lack of understanding about trans identities causes barriers to gender-affirming care. He says: “Very rarely are trans people’s voices listened to on what would help and instead ‘experts’ talk for us – often incorrectly.”
Isabelle, 23, is a trans woman (she/her) who works as a software developer in Manchester. She calls attention to the dismissal of trans voices and the “clear imbalance” in the Cass Report regarding the assessment of current research. Studies with a positive stance on gender-affirming care were “held to a ridiculously high standard” compared to “anti-trans” ones, she explains. Isabelle also points out Cass has previously met with Patrick Hunter, who contributed to Florida’s anti-trans bill in 2022.
She says: “It is, and always will be, a joke of a report that fails a community that desperately needs help.”
Misconceptions About Trans Healthcare
The Cass Report reinforces an existing narrative that frames gender-affirming care as “dangerous” and easily accessible. Yet, the interviewees’ experience accessing treatment could not be more different.
Aidan says: “People have a misconception that it’s a fast, rushed process that people can just decide. It’s not. You have to spend months in counselling, then if you’re lucky, you’re referred to the gender clinic, where you undergo more counselling and family therapy where all your family members are asked their opinions and feelings, then tests and then finally you might be given hormone blockers.”
“Whether this is transphobia or not isn’t really something I know or feel comfortable stating, but none of these treatments are outside of standard NHS treatments.”
Although Aidan started the process at 14, they had to be on hormone blockers for 18 months and didn’t access hormone replacement therapy until a month before their 18th birthday. They explain: “And my case was considered ‘fast’. Trans kids aren’t making these decisions on a whim. They undergo years of questioning, challenging, doubt, anxiety and fear.”
The hysteria mostly concerns those under 18. But Isabelle correctly points out that less than 100 children were on puberty blockers as of March 2024. She says: “Frankly, I don’t know why it’s such a big talking point”. She is especially critical of Cass’s stance on adults under 25, calling it “absurd”.
“Potentially life-threatening”
Isabelle similarly calls herself one of the “lucky ones” as she accessed care in a “relatively short amount of time”. She has been on hormones for three years but had to go through “shared care” and privately obtain a diagnosis. Otherwise, she would have waited an additional three years to begin treatment. As part of her care, she is supposed to have routine blood tests and hormone monitoring on the NHS.
Even “lucky ones” who could access care, like Isabelle, face barriers in the NHS: “I have had GPs that refuse to give me hormone blood tests. I’ve been told I cannot get oestradiol because I don’t have a period. This could be potentially life-threatening, and these are important hormone blood tests that I need given that I am on HRT.”
She has spent over £1000 on private blood tests, injections, and prescriptions that were all meant to be done through the NHS. However, she points out that these are not “trans-specific” treatments, as blood tests are standard practice and these injections are used to treat prostate cancer.
“Whether this is transphobia or not isn’t really something I know or feel comfortable stating, but none of these treatments are outside of standard NHS treatments.”
A “Bleak” Outlook On Trans Healthcare
Even those who can get essential and life-saving gender-affirming care experience distress. The current referral process to a gender clinic is incredibly invasive and uncomfortable.
Aidan’s experience of rigorous interviews and questioning was “pretty humiliating and depressing”. They explain that trans kids often already struggle with their mental health as they “have to go through a puberty that is wrong”. They feel ostracised by their peers and society, which causes depression and anxiety. Studies demonstrate higher levels of mental health difficulties among transgender, nonbinary, and gender-diverse populations.
“There is no doubt in my mind that wait times are killing people.”
Isabelle talks about feeling distressed due to the current state of trans healthcare, calling the situation “bleak”. She says: “I try to avoid all news to do with transgender issues as it’s downright depressing and mostly exists to undermine transgender individuals.”
However, on a more optimistic note, Aidan and Isabelle emphasise the importance and positive impact of accessing gender-affirming care. Isabelle explains: “Having access to hormones helps your body fit with how you see yourself. It helps your confidence and helps you fit in and feel like you belong. In two and a half years, I have made such significant strides in who I am because of the hormones, and without it, I don’t want to think about where I’d be mentally.”
Denying Access Is “Killing” Trans People
It is concerning that there are so many barriers to gender-affirming care. This exacerbates the mental health issues of an already marginalised group. Transgender individuals have higher rates of all psychiatric disorders. Studies show that the stress of living as a transgender person can also lead to physical health problems. Yet, trans people face incredible difficulties trying to access healthcare.
“Seeing these waiting times get worse and worse is a sick joke. Everyone knows it’s awful. It is killing us. But no one cares about us enough to do anything about it,” Isabelle confirms.
“A worryingly high amount of trans people I know have been or are suicidal. And the state of services they have access to is absolutely a huge factor in that. There is no doubt in my mind that wait times are killing people.”
“Being able to access gender-affirming care as a teenager saved my life.”
Yet, anti-trans pushback (as seen in the Cass Report) threatens to worsen the state of trans healthcare. Whilst this rhetoric focuses on the “dangers” of prescribing care, there is little acknowledgement of the devastating consequences of not doing so.
Aidan effectively summarises the urgency of the situation: “The steps that are going to be taken following the Cass Report are going to kill trans kids. I’m not being dramatic or exaggerating. Being able to access gender-affirming care as a teenager saved my life.”
If you or someone else is in immediate danger and needs urgent help or medical advice, please call 999 or the Samaritans on 116 123.
If you identify as gay, lesbian, bisexual or transgender, you can call Switchboard on 0300 330 0630 (10am–10pm every day), email chris@switchboard.lgbt or use their webchat service.
If you are looking for medical advice, contact your GP or 111.
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Featured image courtesy of Alisdare Hickson via Flickr. No changes were made to this image. Image license found here.
Alice Bennett
I'm a recent masters graduate from the University of Nottingham and aspiring writer interested in writing about everything from neurodiversity and LGBTQ+ issues to films and gaming.