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Trans adults need the NHS to have faith in us that we know what we want | UK News

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Trans adults need the NHS to have faith in us that we know what we want | UK News

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I worry how NHS England’s review of adult Gender Dysphoria Clinics is going to go down (Picture: Ugla Stefanía Kristjönudóttir Jónsdóttir)

My partner, Fox, first tried to get access to gender-affirming surgeries through the NHS in 2012, but there was delay after delay.

In fact, after one particular hurdle due to contractual issues, the NHS sent them a letter notifying of a temporary stop, alongside a phone number to a suicide prevention helpline. 

It is no wonder these are known as the waiting lists that shorten themselves.

But finally, earlier this year – around 12 years in the making – they finally got the green light for a long-awaited major gender-affirming surgery.

Being there to support them afterwards on their journey was incredibly meaningful to me. They’ve taken another step to truly be themselves, and as someone who has undergone gender affirming surgery, I know the importance of it.

But why did it have to take 12 years for this to come to fruition? Unfortunately, this is the true reality of trans healthcare in the UK – not some rushed and careless process that certain prominent anti-trans voices would lead you to believe.

It’s why I worry how NHS England’s recently announced review of adult Gender Dysphoria Clinics (GDC) is going to go down and whether it could continue to feed into the moral panic on trans lives that appears to dominate the UK at the moment.

This announcement comes off the back of the Cass Review that was published last week, which took a snapshot at the care for young trans people in the UK.

While I believe the review had many inconsistencies, problematic language and biases, I was glad to see that one conclusion was that young people need better quality care and that waiting lists are far too long.

It is clear to me that the NHS has failed trans people – some who are more than a decade in the system

Responding to the Cass Review findings, NHS England called for a further ‘broader, systemic review of the operation and delivery of the GDCs’ and to deploy ‘external quality improvement experts into the services’.

While I agree that these services need a serious intervention, I am also worried about how this review will be conducted and whether the findings will further exacerbate trans health inequalities.

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Waiting lists for trans-related healthcare in the UK are atrocious, with people in England waiting an average of seven years for a first appointment, despite the NHS saying their target is no more than 18 weeks to be seen. 

And that’s only the first appointment – if people want access to hormones or surgeries, they could still wait several more months or years.

It is clear to me that the NHS has failed trans people – some who are more than a decade in the system, waiting to be able to move on with their lives and get life-saving hormones and surgeries.

I know transitioning saved my life (Picture: Ugla Stefanía Kristjönudóttir Jónsdóttir)

Just like my partner, Fox, I have also heard many stories of people facing prejudice, sexism and even feeling like they have to perform gender stereotypes in order to be taken seriously.

They say they have to tell an ‘acceptable’ story to the medical professionals as a result – things like they prefer certain types of clothing, have traditional hobbies and interests and fit into the mould of your ‘typical woman’ or ‘typical man’.

This has made it difficult for many, especially non-binary people, as many trans people don’t fit into narrow gender stereotypes.

So it is obvious to me that there are many things that can be improved, and it’s clear that the NHS doesn’t have enough resources and staff to deal with the need for transition-related services.

The best case scenario from NHS England’s review of adult GDC services would be more local support without the need for specialists. This could give people what they require based on an informed consent model and without the incessant need to ‘diagnose’ trans people – where adults are given all the information about what the care entails, what they can expect, risks and results, and the person makes an informed decision about what care they wish to receive.

Despite research showing the benefit of transition-related care, the focus always becomes about people that might regret their decisions

This is the case for most surgeries cisgender people have related to their bodies – why shouldn’t the same go for trans people?

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The worst case scenario is that anti-trans groups will weaponise this potential review against trans healthcare and advocate for it to be removed altogether. If those calls were to be listened to, it would be catastrophic for the trans community. 

Research tells us that transition-related healthcare high satisfaction rates, with a recent study published in the Journal of the American Society of Plastic Surgeons showing only 0.3% of the 1,989 people in the study who had undergone gender-affirming surgery ‘experienced regret and either requested reversal surgery or transitioned back to their gender assigned at birth’.

On top of that, a study in the US that surveyed over 90,000 people showed that 94% of respondents were more satisfied after transitioning, with up to 98% stating that hormone therapy made them more satisfied.

But despite research showing the benefit of transition-related care, the focus always becomes about people that might regret their decisions – despite research showing that in the UK those are less than 0.5%, which comes to a total of only 16 people expressing some level of regret.

This is to say, I hope this future review recognises this and also recognises the autonomy of trans adults. We want to be trusted to know what we want and need.

And if services had more funding and gave more all-rounded care for people, they could also support those who regret their care for one reason or another, to everyone’s benefit.

If this review on adult services is to go ahead, I believe it has to be clear that those who need healthcare in the meantime will still be able to access it without pause.

NHS England has already said: ‘Our letter instructs the adult gender clinics to implement a pause on offering first appointments to young people below their 18th birthday’.

People have already waited long enough, and a review pausing it even further will only make the problem worse.

It also needs to steer away from language that can easily be taken out of context, and where trans lives and our care will become a political football in the same way as the Cass Review has. 

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But first and foremost, it needs to be conducted by people who genuinely care about making things better for trans people.

If the review leads to restriction or banning of care, we risk causing irreparable harm to people who need it – who will be forced to access expensive private support, move abroad or live an unhappy life where they suppress who they are, if they can even bear it at all. 

I know transitioning saved my life, and that is the case for all trans people I know who undergo transition-related care – including Fox, especially after their recent surgery.

Transitioning has allowed us to thrive, have a beautiful relationship, a home, a family. Without it, I know for a fact we wouldn’t be here.

At the end of the day it’s about survival, and about finding ways to feel happy, content and fulfilled.

So I hope this review will consider the impact it can have – and how it can be a force of good. If it doesn’t, it will be yet another example of how the UK has failed the trans community.

Do you have a story you’d like to share? Get in touch by emailing jess.austin@metro.co.uk

Share your views in the comments below.


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