Trans people waiting years for gender healthcare as demand surges

When British tattoo artist Eva Echo found the courage to come out as transgender, she quickly sought specialist medical care to help her transition. More than four years later, she is still waiting for her first appointment.

Echo, who is part of a potential legal challenge to England’s National Health Service (NHS) over waiting times, said the delay left her “drowning” in gender dysphoria – the distress caused by someone’s gender identity not matching their body.

“There’s no way to tell where I am on the list or when I’m likely to be seen,” said Echo, 41, who lives in Britain’s second-largest city, Birmingham.

“I basically feel like I’m in limbo – my life is on hold.”

As greater awareness and acceptance leads more people to come out as trans worldwide, waiting times for gender care are soaring – even in wealthy countries with relatively generous state-funded healthcare provisions.

Britain has free public healthcare and gender clinics, specialist centres that assess people for cross-sex hormones and refer for procedures such as hair removal and gender-affirming surgeries, but long waits drive many trans people to go private.

Some trans patients and rights campaigners say the delays smack of discrimination and neglect.

Echo estimated that she had spent about 30,000 pounds ($40,000) on private doctors since she first went to her local doctor in August 2017.

She is one of four people, two under 18, supported by legal advocacy group the Good Law Project (GLP) considering legal action over waits for a first consultation that can stretch to four or five years for adults.

“We’re now preparing to issue judicial review proceedings against NHS England,” a GLP spokesperson said.

“We don’t think they’ve done enough. Trans people have heard this story repeatedly and the situation continues to deteriorate.”

The NHS said it was doing its best to respond to a steep growth in patient numbers.

“We have seen a significant increase in demand for gender identity services as more people feel able to come forward for support,” a spokesperson said by email.

‘PEOPLE ARE DESPERATE’

Trans people have to “jump major hurdles” to get transition-related healthcare in many countries, said Masen Davis, executive director of advocacy group Transgender Europe (TGEU).

“Long waits for state-funded or subsidised healthcare, challenges finding a doctor, and providers and insurance providers forcing trans people to justify why they need care are common globally,” he said.

Defenders of systems that require trans people to wait for certain care or to get psychiatric diagnoses of gender dysphoria claim it reduces later regrets, but many trans advocates criticise what they term “gatekeeping”.

A research summary by Cornell University found between 0.3% and 3.8% of people regret going through medical transition, with most data showing it improved well-being.

Sam, who uses the pronouns they and them, has been trying to access gender reassignment surgery in New Zealand since 2012 and has been on the waiting list since 2014.

“I still don’t have any indication of when I might get surgery,” they said, asking not to give their real name for privacy reasons.

Just over 300 people are waiting for the procedure, the health ministry said on Oct. 31 on its website. Five surgeries were performed in 2020 by the country’s only surgeon, after COVID-19 delays, and nine so far in 2021.

In 2019, the government pledged 3 million New Zealand dollars ($2.1 million) over five years to address the backlog.

“The Ministry is currently working on improving capacity,” a spokesperson said by email.

Sam was first required to be on testosterone and have had a double mastectomy, known as top surgery, though doctors said waiting times made that a long shot.

Eventually travelling to Thailand to undergo the procedure privately in 2014, Sam noted that the COVID-19 pandemic had prevented other trans New Zealanders from going overseas for care, making waiting lists at home even longer.

“People are desperate,” Sam said.

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