The state of trans healthcare in Britain

Rose Raistrick argues why more needs to be done to improve NHS access to trans healthcare
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There seems to be a prevailing myth peddled by various reactionaries that trans access to healthcare is a simple matter, where one can simply walk in to a doctor’s office and –– after a small chat –– leave with as many oestrogen pills as one can carry. As such, a great deal of attention is put in the media to so-called ‘detransitioners’, people who once considered themselves trans, but have since taken steps to reverse the changes made from transitioning. The content of each story varies, but the conclusion is always the same –– either through agenda or simple misunderstanding, too many people are transitioning. The conclusion? It needs to be more difficult.

The reality, however, couldn’t be further from the alarmist myths. Cases of detransitioning are exceedingly rare. For the rest of us going through the trans healthcare system, access to medical treatment remains a significant challenge, one which we have to struggle with our whole lives. Let’s go over the facts:

The most common and most immediate step towards medically transitioning is gaining access to hormone supplements. In order to receive a prescription for hormone treatment, a trans person has to get a letter of recommendation sent to their GP by a gender clinic, of which there are only 8 in the entirety of England (seven adult clinics and just one for under 18s). These clinics are incredibly small, sitting at around 20 full-time equivalent employees each.

Waiting times to get a first appointment at these clinics are notoriously long, currently sitting at around 3 years (bear in mind that, according to NHS guidelines, a patient should wait no longer than 18 weeks for an appointment). Even once in contact with a gender clinic, patients will be made to wait months or even years to get further appointments. Since getting a letter of recommendation takes multiple meetings to do, it becomes an incredibly laborious process.

Even once a letter of recommendation is given, the prescribed dosage of medicine is often tiny. The increased demand for Hormone Replacement Therapy over the past few years has resulted in a nationwide shortage. Low dosages can put people at genuine health risks, drastically increasing the chances of developing osteoporosis for instance.

On top of that, it was revealed in 2021 that 1 in 7 trans people have been refused access to their GP service.

As a result of the lack of funding, some individuals have chosen to sidestep the NHS by seeking private alternatives. On the surface, private healthcare appeals to some, as wait times are significantly cut, existing on the scale of months instead of years.

However, as is to be expected, private trans healthcare has a whole host of other problems. The most obvious of these being the cost. Depending on the provider, a person may have to spend thousands on medical treatment, which once started, becomes both permanent and necessary. For many working-class people, this is simply not an option.

Private hormone providers are financially incentivised to cut corners wherever possible in order to maximise profits. Taking advantage of trans people, pharmaceutical companies are pumping billions of pounds out of the ever-growing population of people on hormones.

Due to the lack of funding, the NHS is only capable of the bare minimum. But on the other hand, private options do nothing but prey on trans people’s desperation. What’s the cause then? And more importantly for us, what’s the solution?

The most obvious thing to blame is bigotry, be that healthcare professionals or the government. However, bigotry alone cannot explain the horrible situation trans healthcare finds itself in. The conclusion we must reach is that the poor state of trans healthcare in Britain is a product of austerity –– and the symptom of an increasingly starved health system.

The stated goal of austerity is to make public services more efficient. When costs are cut –– the Tories say –– public services will drop unnecessary clutter, and keep only what’s efficient. They’re terrible liars, of course. The real goal is to strain these services as much as possible, to gut them and leave them ripe for privatisation.

In gender clinics, this is especially obvious. Despite an increase in both employees and patients, funding barely changed. Leading to –– in one clinic –– a 35% decrease in average wages over the course of just three years, with no increase in efficiency to show for it. Apparently, the unnecessary clutter is working-class people’s needs and comfort.

Trans people face discrimination in the healthcare system. But NHS gender clinic staff are not to blame. Tory austerity is affecting both trans people and NHS workers whose jobs are underpaid and often at threat.

However, no solution can be found individually. While some within the trans community push for self-medication, this is highly unsafe, and will never substitute for real care from real doctors. What we need is a state which truly cares for its people, with a free and functioning healthcare system where the needs of trans people, disabled people, and people with mental illnesses can properly be met –– a society led by the working class.

Rose Raistrick, is a member of the YCL’s Manchester branch

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