December 15th 2024.
This year has brought about some concerning changes in the healthcare options available for transgender children and teenagers. According to a recent Freedom of Information request, thousands of young individuals in the trans community are facing incredibly long wait times for essential healthcare services. In fact, the waiting list for gender-affirming care through the NHS has reached a staggering 308 weeks for a first appointment. This means that more than 6,000 trans youth are currently "languishing" on the waiting list as of July.
To make matters worse, the number of referrals by GPs has been steadily increasing, with about 10 young people being referred each month. However, between April and July, only eight of these individuals were actually seen by the Children and Young People's Gender Service (CYPGS). Anne, a trans healthcare provider who analyzed the FOI findings, described the situation as "catastrophically overwhelmed". This is especially concerning because once a trans individual reaches 17 years and nine months old, they are no longer eligible for treatments through the CYPGS.
One major change in trans healthcare has been the restriction of certain medications. Instead of being able to continue their treatment through the CYPGS, individuals must now start the referral process all over again at the adult gender identity clinic, where the waiting list can be as long as 93 months. The CYPGS has acknowledged that these lengthy wait times can have a "catastrophic" impact on patients.
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The NHS has stated that they are continuously working to improve and expand services in order to reduce wait times. In April, the CYPGS took over the country's only gender clinic for young people, Tavistock and Portman NHS Trust, following a report by pediatrician Hillary Cass which resulted in restrictions on youth gender care. About 250 open cases were transferred to the new system, with those on the waiting list to follow. However, the FOI revealed that the new gender healthcare service was only at 75% staffing capacity between April and July. In an effort to address this issue, a third regional CYPGS opened in Bristol last month.
As Susie Green, co-founder of Anne, points out, the more the medical system for trans youth struggles, the more harm is caused to these individuals. The Cass Review's recommendations have been widely criticized by trans rights campaigners. Green stated, "The findings revealed in this FOI are devastating but, sadly, not surprising. At Anne Health, we see the real-world impact of these waiting lists every day as young people denied gender-affirming healthcare descend into poor mental health and self-destructive behaviors."
Mary, a parent of a trans teenager who preferred to remain anonymous, shares this sentiment. She describes the current state of trans healthcare for young people as a "crisis". Mary's daughter had already been seen by the NHS under the old Tavistock system at Leeds, but they were one of the first in line for the new and improved service recommended by the Hilary Cass review. However, their main issue has not been the long wait times, but rather the change in policies and practices which fail to provide timely and appropriate care for her daughter's needs.
According to the NHS, gender-affirming healthcare for trans youth includes counseling and, under strict criteria, hormone therapy. However, puberty blockers, which act as a pause button for puberty, are no longer offered on the NHS for trans youth due to the Cass Report's recommendation citing a lack of evidence. Just this week, the government announced an indefinite ban on blockers for those under 18 with gender dysphoria. However, for Mary, this is not good enough. She strongly believes that "trans youth deserve better" and that her daughter has been living as her authentic self since the age of nine.
Mary's daughter has experienced significant improvement in her mental health and overall well-being since her gender identity has been affirmed. Mary emphasizes that as a parent, she will do anything to support and protect her child, including accessing necessary medical interventions. She states, "She trusts that I will keep her happy and safe."
The longer trans youth are forced to wait for gender-affirming care, the more at risk they are of developing depression and anxiety, according to researchers. Mary has seen this firsthand in her own daughter. She explains, "Faced with a trans 15-year-old who has been happily living in their own skin, supported by us socially and medically, the service had nothing to offer. In fact, ultimately, the only offer was to be discharged from the service."
An NHS spokesperson responded to these concerns by stating that the new children and young people's gender services are first prioritizing assessments and treatments for patients transferred from the now-closed GIDS service before seeing new patients. They also added that the new services, including the recent opening of a third center, are now seeing patients from the waiting list and are offering a more comprehensive and holistic model of care in line with the recommendations from the Cass Review.
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