Figures obtained from UK clinics show referral increases of several hundred percent, leading to long waits for new patients
The number of Britons taking steps to change their gender has shot up dramatically in recent years, leaving vulnerable people waiting years for treatment.
Figures obtained under the Freedom of Information Act reveal increases in the number of referrals to all of the UK’s 14 gender identity clinics (GICs) in recent years, with a number of clinics experiencing increases of several hundred percent.
At Charing Cross in London, the oldest and largest adult clinic, the number of referrals has almost quadrupled in 10 years, from 498 in 2006-07 to 1,892 in 2015-16.
“It obviously can’t continue like that forever because we’d be treating everyone in the country, but there isn’t any sign of that levelling off,” said James Barrett, consultant psychiatrist at the Charing Cross clinic.
A clinic in Nottingham reported a 28-fold increase in referrals in eight years, from 30 in 2008 to 850 in 2015. It expected this to increase to more than 1,000 referrals during 2016.
The Laurels clinic in Exeter has seen a 20-fold increase in referrals in a decade, from 31 in 2005-06 to 636 in 2015-16. Referrals to Sheffield’s clinic went up from from eight in 1998 to 301 in 2015, while a clinic in Daventry, Northamptonshire, has had a five-fold increase in the past year alone, up from 88 referrals in 2014-15 to 466 in 2015-16.
At a GIC in Leeds, referrals tripled from 131 in 2009-10 to 414 in 2015-16. The increase put such a strain on the service that last October it estimated that new patients would have to wait four years for their first appointment.
The Tavistock clinic, the only centre for children and adolescents in England, has seen referral increases of about 50% a year since 2010-11. In the past year it has had an unexpected and unprecedented increase of 100%, up from 697 to 1,398 referrals.
Referrals of children and adolescents to the Sandyford clinic in Glasgow also doubled in a year, from 90 in 2014 to 178 in 2015.
Waiting times for a first appointment at a gender identity clinic are about nine months on average for adults and half that for children. One in six adults wait more than a year.
The GIC in Leeds estimated that a patient referred to the service at the end of October last year would wait four years before their first consultation with a medical specialist. However, the clinic is hoping increased funding will see waiting times drop in 2016.
Louie Stafford, the trans programme coordinator for the LGBT Foundation, based in Manchester, was referred to the Leeds clinic in 2012 and waited two years for his first appointment.
Stafford warns such long waiting times are dangerous for trans people, who already report much higher rates of depression, and have higher rates of suicide, than the rest of the population.
“You’re referred from your GP, there is no contact with any specialists or clinicians until your first appointment at the gender identity clinic,” said Stafford. “People are completely on their own, sometimes for up to three years, dealing with issues around gender that are potentially life-threatening … It’s not surprising that people get desperate in that timeframe.”
There are just over 15,000 people who are gender identity patients in the UK – roughly 12,700 adults and 2,700 adolescents or children. Trans activists suggest this is the tip of the iceberg and that there could be tens of thousands more considering medical intervention - hormones or surgery - a demand the NHS would certainly struggle to meet.
Counting the exact number of trans people in the UK is difficult. Previous estimates were based on those who changed their passports or who were granted gender recognition certificates (5,714 as of 31 December 2015).
International research suggests the numbers are far greater. Recent studies in Belgium, New Zealand and the Netherlands, as well as a report for the EU Agency for Fundamental Rights, found at least 1% of the population reported being trans or experience some kind of gender incongruence.
The gender identity charity Gires says even the most conservative estimate in these studies - 0.2% - would suggest there are 130,000 people in the UK who feel gender incongruent enough to seek medical intervention, such as cross-sex hormones and surgery. The vast majority have yet to present for treatment.
Dr Leighton Seal, consultant endocrinologist at the Charing Cross clinic, said 130,000 trans people seeking medical treatment “sounds about right”, adding that the increase in referrals to gender identity services had come about as more people accepted transgenderism.
“I think the societal change has been really important, society is more tolerant, more accepting and people who are gender-nonconforming are a lot more visible. I think trans people have also found their voice as well,” he said.
Many of those who are waiting for treatment turn to self-medication while they wait for prescriptions for hormones. According to an audit by the Charing Cross clinic in 2014, about 20% of trans women were self-medicating with hormones purchased online when they arrived for their first appointment.
Though there have been no deaths recorded from people taking the drugs online, there are risks, warns Seal. Some of the drugs that suppress testosterone can lead to low mood and liver failure. Also, trans women who self-medicate with oestrogen often start with too high a dose, which can end up compromising the growth of their breasts.
Between 80% and 90% of patients who arrive at the Charing Cross clinic go on to have cross-sex hormones, while a smaller proportion progress to surgery. Some of this is available on the NHS, though there are currently less than a dozen surgeons in the health service who perform such procedures.
Seal said about 60% of trans women who received treatment at the Charing Cross clinic sought genital surgery, and the average waiting time for this male-to-female surgery (vaginoplasty) was 81 weeks. This compares with 10-30% of trans men who go on to have genital surgery (phalloplasty), though many trans men will have chest reconstruction surgery.
In 2015-16, the NHS in England put an additional £4.4m towards funding gender identity services and have set aside additional funding for 2016-17 of about £3m to the adult clinics and £2.2m for the Tavistock clinic.
Will Huxter, the chair of the NHS England gender task and finish group, said: “We’re keen to get waiting times down as quickly as we possibly can.”
Experts agree that the key obstacle to reducing waiting times, apart from lack of funding, is getting appropriately trained staff to fill posts in gender identity clinics. “You can throw all the money you want at a service, but unless you have people who are trained and skilled to work in those areas, you’re not going to improve capacity,” said Stafford.
Huxter agrees and says part of the problem is that there isn’t a specialised training strand that sees medical professionals emerge from training ready to work in the gender identity clinics. “We are working with Health Education England and the GMC [General Medical Council] about how we could improve that for the future,” he said.
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