UK law on transgender healthcare has been hard to follow, especially for young trans and non-binary people and their parents. A combination of anti-trans legal action and misinformation have led to the withdrawal of and subsequent reinstatement of rights; a situation that is worsened by a lack of general understanding among healthcare professionals.
That isn’t to say it’s all doom and gloom. There have been some big wins. But what’s the state of play now, and is the NHS taking action to support trans people as it should?
Access to Puberty Blockers
One major struggle has been for access to puberty blockers. In December 2020, a High Court ruling pronounced that under-16s were unlikely to be able to give informed consent to puberty blocking treatment. This left thousands of young people stranded, without care, and also threatened the foundations of Gillick competence – the legal provision that allows people under 16 to consent to medical treatment, like contraceptive pills.
The ruling did not ban puberty blocker treatment, and explicitly stated that it did not in any way alter Gillick. Despite this, GIDS – the only service that provides comprehensive gender-affirming care to young people in England – put a complete hold on referrals.
The Good Law Project launched its own case (ABCD v Tavistock) in March 2021, and won a partial victory for the parents and carers of young trans people. The court instructed that parental consent was sufficient to allow for puberty blocking treatment to commence, but the NHS still didn’t budge. With the support of other trans-positive organisations and the Trans Legal Defence Fund the Good Law Project continued its work and eventually the judgement was overturned in September 2021, less than a year from its inception. The Court of Appeal concluded the judgement should never have happened in the first place: ‘the original claim should have been dismissed,’ and it ‘was inappropriate for the Divisional Court to provide the guidance.’
We celebrated a victory for trans rights. So what progress has since been made? GIDS have recognised the appeal on their website, but guidance for those left in limbo since December 2020 is scarce. GIDS claim that referrals were ‘temporarily paused’ after the initial judgment and have since been resumed, but the online community tells a different story. Wait times remain so high that many who were waiting to be seen before December 2020 have still heard nothing. Meanwhile, any decision-making in relation to the prescribing of hormone blockers continues to be referred to a panel – a Multi-Professional Review Group – about which we know very little.
It seems that the green light has been given for GIDS to continue treating young people, but that no meaningful progress is being made. We hope that appointments resume and that the speed of referrals picks up to meet the increasing demand for gender-affirming care. Until then, GenderGP is here to help support young people and families in any way they need.
Transmasculine Surgery Provision
In June 2021, Pink News revealed that NHS transmasculine surgeries had almost completely ceased. The tender – the contract by which the NHS contracts private surgeons and facilities for public services – had expired for phalloplasty and metoidioplasty, and no suitable replacement had been found. The result was that thousands, if not tens of thousands of trans people were suddenly left without medical support.
Phalloplasty and metoidioplasty are ‘bottom surgeries’ that some transmasculine people choose to undergo. Metoidioplasty is the creation of a small phallus (typically about 5-7cm) using existing genital tissue, while phalloplasty is the creation of a larger phallus using skin grafts from elsewhere in the body. Both surgeries are complex, with phalloplasty in particular requiring multiple interventions and recoveries over a long period of time. They aren’t right for everyone, and no trans person of any gender is more or less trans because they do or do not have surgery.
For some people, however, these surgeries are a necessary component of their transition, and represent a life-changing release from gender dysphoria. And without warning, after enduring years of waiting lists and pandemic disruption, those surgeries were taken away. Worse, some patients were midway through the phalloplasty process, or needed surgical maintenance, or were suffering complications – and none of them could get the care they needed.
For a long time there was little to no communication from the NHS, however, reports from Trans Actual suggest that gradual progress might be being made. In September 2021 the NHS confirmed that the tender had been awarded to New Victoria Hospital, with Mr Nim Christopher, Professor David Ralph, and Mr Philip Rubin performing the procedures. By late October, the NHS gender dysphoria referral service had confirmed that patient records and waiting lists were being reviewed and that surgeries should resume from December 2021.
The break in services has contributed further to the already lengthy waiting lists, with the current backlog taking an estimated three years and eight months to clear. We urge the NHS to expand all gender-affirming surgery provision to meet the needs of the trans and non-binary community. In the meantime, however, we hope that those who are waiting for their surgery, or who require care for complications or maintenance, can feel some relief.
If you’re on the waiting list for phalloplasty or metoidioplasty, or are waiting for repairs, maintenance, or similar care, you should have received a letter from the NHS regarding the situation. If you haven’t received a letter, you should contact the Gender Dysphoria National Referrals Support Service (GDNRSS) on 01522 857799 or firstname.lastname@example.org.
The successful appeal of Bell v Tavistock and the return of phalloplasty and metoidioplasty provision should be celebrated, but there’s still a long way to go until we have good quality trans healthcare in the UK. If you’d like to share a healthcare experience or personal story, positive or negative, you can get in touch with us via our website. We are always looking for guest writers for our blog to share their first hand experiences so get in touch. Alternatively, you can find us @GenderGP on Twitter, Facebook, or Instagram.