“I’ll put ‘gender crisis’ down as the reason you’re here, for now,” said the very nice woman, as I tried hard to stop sobbing, “and you can figure out the rest later.” We were in a small room at 56 Dean Street, the sexual-health centre in Soho, London, earlier this year. It was Valentine’s Day.
The form she was filling in was pretty basic – name, date of birth, address – but when she asked me what my pronouns were, I broke. And then she asked what had brought me there and I didn’t know how to explain; I was crying too loudly by that point to make much sense, anyway. She understood, though, and put me on the waiting list for gender-identity counselling. It will be about eight weeks, she said, and I replied that that was amazing – I’d expected to wait much longer.
I was at CliniQ’s weekly clinic: a transgender-led community organisation that provides sexual health and wellbeing services to trans people who feel uncomfortable accessing mainstream healthcare. Many queer people have had experiences with a GP that might make them reluctant to go to a regular doctor’s surgery for help. Rowan Ellis, my colleague at The Pool, told me about a time when she was 17 or 18 and she told her GP she was gay. “She suggested my vaginismus ‘caused’ me to be gay, so I wouldn’t be worried about ‘letting down’ a boyfriend,” Rowan said. “There are so many problems with that I can’t even… I was just shock-laughing in her face.”
While Rowan was comfortable enough in her sexuality to laugh this off, others aren’t. I haven’t felt like I could talk to a GP about anything queer-related since university, when I went to the doctor to ask about getting a sexual-health check-up. He asked about the gender of my sexual partners and I said women. Looking at my records on his screen, he turned to me and said, quite sternly, how could I possibly be a lesbian when I was on the contraceptive pill.
I was 21, very recently out and I’d been nervous about going to the GP. I felt so confused and embarrassed afterwards – like I’d done something wrong. Seven years later, when I needed LGBTQ+ help in a health setting, going to my GP (even though I have a different GP now and she’s lovely) was never an option I considered.
The Times recently reported that an increasing number of trans teenagers are buying hormones online, because of their frustration at the waiting time for NHS treatment. Self-medicating with hormones, without GP supervision, risks serious health problems – like liver damage and fatal blood clots – and is a problem that was being warned about as far back as 2004.
The form she was filling in was pretty basic – name, date of birth, address – but when she asked me what my pronouns were, I broke
Why buy hormones online, when you can get a prescription for them? Arguably, a major factor contributing to this is how long it takes to get help from the NHS. NHS waiting lists are the longest they’ve been in a decade and the wait for a first appointment at a Gender Identity Clinic (GIC) can be up to two and a half years. In this light, Theresa May’s statement last October that she would “use all [her] power to transform mental-health services” looks like lip service, at best.
Government cuts mean mental-health services had £105m less funding last year than in 2012, while experts warn that mentally ill patients are “bearing the brunt” of NHS cuts. This is despite health secretary Jeremy Hunt saying, last October, that the NHS spent a “record” amount on mental health. And following recommendations made by the Women and Equalities select committee in 2016, NHS England set an 18-week waiting time “standard” for GICs and pledged it would have the waiting time down to 18 weeks by 2018.
But it hasn’t happened. People are still being left in limbo, on waiting lists, for more than two years – largely because of the tiny pool of resources. There are only eight NHS GICs in England and only 14 across the whole of the UK. Referrals to all of them are increasing. And consider this: the most definitive figure I could find to estimate the size of the UK trans population is from a Gender Identity Research and Education Society study in 2009, which estimated the UK had between 300,000 and 500,000 “gender variant” people. So that’s 14 clinics for (potentially) half a million people. Furthermore, the Tavistock and Portman – the only GIC that sees under-18s – received 226 referrals in April this year alone; an increase of 17.7 per cent on the same month in 2017. Appointments are only now being given to people who were referred in June last year.
We all know that cuts to mental-health services are damaging to the whole country, regardless of gender or sexuality – it’s commonly reported that at least one in four people have a mental illness each year. And it’s important to note that being trans does not inherently mean a person will have mental-health problems. But being LGBTQ+, and subject to the discrimination, stigma and prejudice that still persists, means you are disproportionately likely to experience problems like depression, anxiety or suicidal feelings. Bullied, stigmatised and on the receiving end of death threats, almost half of trans pupils in Britain have attempted suicide.
Medical chiefs have warned before that the NHS is “failing” trans people, because gender-identity issues are rarely covered in detail during medical training, and insufficient training in LGBTQ+ issues for healthcare staff creates additional barriers to healthcare for the queer community. Cuts to the NHS undoubtedly have an impact on this.
Increasingly, these cuts are felt by trans teens. Erik Pascarelli, 19, came out as trans when he was 11, and told me: “The first thing I did was go to my GP and say, ‘I’m trans.’ They obviously didn’t know what to do, because it wasn’t a very big town, so they referred me to the child mental-health services (CAMHS). I was at CAMHS for years, on and off – my parents were hoping they’d convince me out of it – and had private therapy. When I was 15 or 16, they referred me to the Tavistock and I was discharged from CAMHS.”
What followed was a catalogue of errors: the crucial referral to the adult service Erik needed was forgotten, several times; a botched blood test delayed his hormone treatment for months on end. His depression only started to ease once he began testosterone.
The Tavistock has a 14-month wait for under-18s. The emotional cost of being trans is excruciatingly high. For most people, the first conversation is with yourself. Acknowledging, accepting and then celebrating your transness is a process rather than a moment. Then you might tell friends, or family, tentatively, when you feel comfortable. For many, worries around safety add even more anguish, especially for teenagers who still live at home and risk being thrown out.
Being gay, no action is required from others – but being trans requires other people to change the language they use to address you, their behaviour towards you, to question their own biases
Coming out as trans is different to coming out as gay. Being gay, no action is required from others – but being trans requires other people to change the language they use to address you, their behaviour towards you, to question their own biases. Some trans people also want medical intervention – hormones, surgery – and have to come to terms with that, too.
After all of that, getting up the courage to get to a doctor and finding out that it will be a year, at least, before you can have an appointment at a GIC… and all the while, your body is changing, against your will, in ways you don’t want and can’t prevent.
While being trans is hard in itself, the difficulties of getting help through the NHS compounds everything. The process is opaque, slow and difficult to navigate. “I think the worst thing about it is that everyone just tries to par you off,” Erik said. “The Tavistock blames your GP, Charing Cross blames the Tavistock, your GP blames everyone else. Not one single person has taken responsibility for all the fuck-ups with my transition.”
Erik was referred for chest surgery, but, after two months on the waiting list, his referral was cancelled due to an administrative error. Now, his case is up for “triage”, which means that it will be assessed and could be fast-tracked if it’s deemed urgent enough. “If they feel bad enough for me, I’ll get an appointment sooner than 12 months. But that means it could still be 10 months. And if they don’t feel bad enough, then I have to wait a year,” he says.
“It’s been eight years of me being out and I still haven’t had chest surgery because no one can say, ‘Oh, we’ve fucked up – let’s help you.’”
Erik told me his depression is “low-key” and “manageable” now, because he knows how to deal with it. “I was on 100mg a day of sertraline [an SSRI antidepressant] at 13 years old, because I kept trying to off myself,” he says. For the uninitiated, that’s double the common dosage of sertraline when it is prescribed to treat depression. “I tried overdosing on antidepressants a load of times.”
“Having the NHS fuck me around was so difficult growing up, because I had absolutely no power. In the long run, it’s made me a really strong person. But no child should have to go through that when they already hate themselves for being trans.”
One in 10 people who identify as trans and/or non binary (a person who does not identify as only male or only female, or who may identify as both, or neither) have been so frustrated with NHS waiting times that they’ve bought hormones over the internet or gone abroad for medical treatment, interviews with 800 trans and non binary people, conducted last year by Stonewall and YouGov, found. Almost half wanted some form of medical intervention, but hadn’t had it yet because of the wait. A quarter didn’t know how to access treatment through the NHS.
I fall into the last category; I’m non binary and I have no idea how to navigate the medical system to get what I want. That’s why I went to CliniQ to get gender-identity counselling. I’m hoping they can help – and I’m hoping that I don’t need to go through my GP and a GIC.
Avalon, 19, hasn’t gone to their GP, either. “Right now, to get hormones or surgery on the NHS, you have to have lived ‘as your gender’ for two-plus years. What does that mean for non binary people?” they say. “It’s a very binary way of looking at gender and it’s really harmful. Non binary people exist and some of us need hormones/therapy/surgery.”
Avalon tells me that part of the reason they haven’t gone to their GP is because of what their friends have experienced: “Not being taken seriously, having to pretend to be binary to access services, being told they’re not ‘trans enough’, having files lost. I’ve heard of friends being referred to by their birth names and prescriptions being made under birth names – even when they’ve had their names legally changed. It’s so horrible, and disheartening.”
As for me, an eight-week wait for gender-identity counselling did turn out to be too good to be true, after all – it’s been three months now and there are still 10 people ahead of me on the list. I have supportive family, monumentally caring friends and a 100mg-per-day antidepressant habit in the meantime. I know that I can wait for that appointment. But what if I was a teenager, young and alone and afraid? The government needs to wake up to this crisis and properly fund mental-health services for young trans people – and for the whole queer community. Before it’s too late.