I realised I was transgender at 21.
It was after I’d had a dream where I was a woman, and I felt completely right in myself.
As soon as I woke up, I knew exactly who I was, and set about the task of making my life reflect this.
However, even though I was convinced, it turns out a dream is unconvincing evidence to a medical professional.
I initially went to my GP who, it seemed to me, did not believe it is possible for anyone to be trans. This was only the beginning of my difficulties engaging with this country’s healthcare system.
In order to live meaningfully as a member of the opposite sex, most trans people feel the need to take cross-sex hormones.
These do all sorts of amazing things: testosterone increases your muscle mass, deepens your voice and promotes the growth of body hair. Oestrogen – which I am now taking – redistributes fat, accenting hips and breasts; it changes the texture of your skin; it even changes your emotional responses to stimuli.
For trans people, it is all pretty wondrous stuff – it feels like magic.
In order to get access to them, individuals must first navigate what I describe as a healthcare gauntlet. It’s hard to put into words how tough it is to get healthcare as a trans person.
Whether in public or private care, on this waitlist or that, being kicked from pillar to post, or sent to fill out one form only to find out months later it was the wrong form (or was incorrectly filed by some clerk somewhere) it is not something I would wish on anyone – and it sometimes feels as though this is all by design.
This disorganisation, for many people – including me – means a long, long wait.
From months waiting for a referral to years waiting for a single appointment with a gender specialist, this is an interminable period in which many trans people find being forced to live an empty half-life too much to bear.
GPs are the backbone of the NHS, but my goodness can they make your life difficult if they so choose. For trans people navigating the NHS, a GP – depending on who they are – has the potential to completely derail any attempt to get the care you need.
In my case, I signed up to an online GP and was able to get a referral to the Gender Identity Development Service (GIDS), operated through the Tavistock gender identity clinic in London, which at the time was the only one of its kind in the capital and the southeast.
At the time of my referral – which was in mid-2021 – over 30,000 people were on the waitlist, and at the rate they were seeing new patients, the Tavistock could expect to get through that backlog in about 35 years – not counting anyone who might join the waiting list within that time, of course.
After about six months of hoping for some kind of cataclysm to befall exactly 30,000 other people, I gave in to the crushing reality that I would not be getting the care I needed, which left the private sector as the only game in town.
For many this is out of reach financially, so I am very fortunate to even have had it as an option. I was having to pay a monthly £50 fee just for the privilege of being registered with a provider – but at least I could expect swift, white-glove service.
The service also had immediate availability with a psychiatrist, who after 30 minutes diagnosed me with gender dysphoria (a requirement for getting any surgery in the UK) for the low, low cost of only £850.
For hormone treatment, you need to be seen by an endocrinologist, who performs a blood test and can then green light you for hormones. All that I needed was this private clinic to sort me out with an endocrinologist. For literally 15 minutes.
Oh dear. Another waitlist. The first clinic to which I applied was facing incredibly high demand, apparently. They estimated a four-month wait.
Four months came and went with the private clinic (costing £200). Then another two months went by (another £100), and I got an email to say they really were incredibly sorry – hard to put into words how sorry they were – but they were unfortunately temporarily pausing new appointments and recommended circling back in a year, perhaps, if you’re still interested. They couldn’t even take my money successfully.
So a full calendar year had gone by, and neither the public nor the private sector was able to get me a solitary appointment.
Now, I have moved onto my second private clinic, which costs me about £70 a month, after paying a one-time £200 startup fee.
Through this second clinic I’ve been taking hormones for the last two years – which have cost me £1,880 in fees and prescriptions (not forgetting the £1,200 I pissed away at the first private clinic). For many trans people this is too much to bear, pushing them towards either to use unsafe self-medication, or an even more unsafe option: no medication at all.
This should all make terrifying reading, not just for trans people, but for everyone.
The way we treat those who need gender-affirming care is an excellent case study for what happens when state healthcare disappears. And it is disappearing. Remember GIDS? It was shut down in March of this year, and is yet to be replaced.
There is no secret, private version of the NHS sitting there waiting for us. If we do not cling to it, fund it, drastically improve it, then we all will be left with nothing but a long, long wait.
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Do you have a story you’d like to share? Get in touch by emailing James.Besanvalle@metro.co.uk.
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