The Problems with Trans Healthcare and the Case for Informed Consent — a Letter to my MP

So I seem to be writing to my MP a lot lately — I wrote this cos I was just so mad about the debate around trans healthcare being so focused on scaremongering around trans children and how I was seeing this being used to argue to take access to healthcare away from *all* trans folk, including legal adults. This scaremongering about young people being “rushed into transition” is being used to distract from the reality that trans people are currently having to wait years even to get a first appointment.

I’m not sure how much good writing to my MP about this will do, particularly as she’s supported GC groups in the past, but I just felt like I needed to do *something*! If you want to use it as a template to write to your own MP about this issue please do so, but bear in mind that I’m talking specifically about the effect on people in Bristol as well as my personal experience so you’d probably want to change that.

I’m writing to you as a constituent on the subject of UK healthcare for transgender people. There has been a lot of focus on the provisions of hormone blockers for trans people under 16 since the recent Keira Bell court case, but I feel this issue has massively overshadowed the struggles that adults have in obtaining transition-related healthcare on the NHS.

Transgender adults are waiting years for a first appointment at an NHS GIC (Gender Identity Clinic). A recent FOI request for the Laurels clinic in Exeter, the clinic that many trans people in Bristol are referred to, revealed that some people had been on the list for close to *six years*, and that since 2019 only two patients have been assessed by the service. The shortest waiting time for any adult GIC in England is listed as 30 months. This is a shocking failure of the NHS, which is only getting worse under Covid restrictions, and it is currently being hidden behind rhetoric about children being “rushed into medical transition”. Many trans people are terrified for the future of their legal rights, protections, and access to healthcare, and I know of several who have been looking into leaving the country to escape it.

There have been campaigns to close down private clinics that serve the trans community such as Gender GP, however these only exist because of the NHS’s shockingly inadequate provisions and provide a lifeline for many trans people stuck in a failing system. The mental health repercussions of this are huge. I have first-hand experience of this as a trans person who was referred to an NHS GIC two decades ago — I was on a waiting list for 2.5 years before obtaining hormones through a private clinic, then had another year’s wait before I was offered an appointment on the NHS. That time spent waiting was terrible both for my mental health and my general wellbeing. I felt like I was waiting for my life to begin and to feel I could exist in a way that made me feel comfortable, the lack of control left me really struggling. It breaks my heart that trans people today are having to endure so much worse.

At the same time those who *do* want support to explore their gender and decide whether transition is right for them are *also* being failed. It is ironic that when people are arguing that trans folk should be given therapy instead of medical transition those who *want* therapy to explore their gender can’t access it. This is part of the issues with NHS mental health provisions in general, which are in need of a massive overhaul.

Three new pilot clinics for trans people have recently opened up across the UK, but these have extremely limited capacity and a small catchment areas, and so won’t help improve things for the majority of trans folk in the UK, and definitely not those here in Bristol.

There are clinics in many other countries, including the US, which have found great success and patient satisfaction with the Informed Consent model, which puts control back into the hands of the patients. This model would massively reduce waiting times and cost if it was used by the NHS as the amount of time needed per patient would be greatly reduced. Those who *do* feel they need therapy to help them with their decision could access it through the NHS mental health facilities.

There’s no reason why a mentally competent adult who understands the implications and risks should be forced to wait years to access medical transition. Because of this I urge you to address the issue of waiting lists to access adult GICs and to advocate for the Informed Consent model as well as increased access to therapy for those who need it as a step towards improving healthcare for transgender adults.

If you would like to speak with trans people in your constituency who are currently struggling with accessing NHS gender services about how these could be improved I’d be happy to help put you in touch.