Gender Identity Clinics (GIC) provide specialist services in England and Wales for adults* who are seeking support with their gender identity. Staff are part of a multi-disciplinary administrative and clinical team, including psychologists, psychiatrists, endocrinologists, speech and language therapists, and nurses. They aim to provide holistic gender care, focusing on the biological/medical, psychological and social aspects of gender*2.
There are a number of services across England and Wales including London, Sheffield, Leeds, Daventry, Nottingham, Exeter and Cardiff. You can find more information about locating an NHS gender identity clinic here [add to resources page]. New services are currently being piloted in Greater Manchester, London, Wales and Merseyside, as well as being planned elsewhere (see website for up-to-date details). The waiting time for the first appointment varies across the services, but with high demand this can take a long time (measured in years). It is best to check each individual service for specific waiting times. For young people, see ‘Experiences of Gender Identity Development Service (GIDS)‘ as well as the experiences of crossing over between GIDS and GIC.
Young people we spoke to talked about their experiences with gender identity services across the UK. They talked about:
- Waiting and the impact of COVID-19
- Experience of assessment and NHS process
- Communication and correspondence with NHS services
- Concerns about power and gatekeeping
Waiting and the impact of COVID-19
The waiting times to be seen by an adult NHS gender identity service varied. People who took part in our study shared how long they waited to be seen before their first appointment or how long they were currently waiting. Freya described how she had been waiting a year and four months on the waiting list so far, and thought this was not even half way there: ‘[if] I think of everything I’ve done in that time [so far], I can do it all again and still probably not get there.’ Jack talked about making his referral to an NHS service in mid-2017 when he was told the wait would likely be 22 months. However over 2 ¬Ω years later he still hadn’t heard anything. Cassie had been waiting nearly a year with no contact from the service. Reuben said, ‘It’s just sort of an ongoing joke in the trans community about how long the waiting times actually are.’
Bay talks about being on the waiting list and the lack of contact causing them to panic.
Many found the experience of waiting for their first appointment frustrating, confusing and distressing. PJ described it as ‘very soul crushing, just overall lonely and you just feel like you’re not going to get anywhere.’ Noelle, who waited two years for her first appointment described the wait as ‘miserable, absolutely miserable.’ She said ‘in that entire time, I had to do everything on my own, transition related because I didn’t have the support of my GP’. This meant she was driven to self-medication.
Erion describes his super frustrating’ experience of being on the waiting list a long radio silence.
Many felt it would have helped to have some contact while waiting, as Bay says, ‘even if it’s just a letter to say that halfway through or something, to say you are still on the list, don’t worry.’ Declan said, ‘I feel they should improve the communication when you’re on a waiting list; they should send you like a letter periodically saying that you’re still there because I feel that it’s easier to get lost in the waiting list.’
Finding sources of support was important while on the waiting list. Declan said, ‘They should offer like resources to help you cope’. He also suggested to ‘advertise youth groups and support networks and online communities and stuff because that can really get you through a waiting list and help a lot.’
The young people spoke about how they tried to support themselves during the waiting time to be seen by an NHS service. PJ said, ‘You’ve just got to think of other things, like for me going to uni helped a lot, cos that made me think of looking forward to something else’. He also said ‘surrounding myself with a good support network’. He said ‘my friends at the minute are like my family, and really, really helpful, and keeping me grounded when I’m really stressed out or really depressed that I’m not being seen yet.’ (See Experiences of mental health).
Anderson feels there should be support and contact offered to people while on the long waiting list for GIC.
Those we interviewed also brought up how the Coronavirus pandemic had impacted the NHS gender identity services and the waiting time. Young people tried to come to terms with the realisation that the waiting times were very likely to increase further. Tyra talks about how she was given an appointment ‘for 19th March 2020, which obviously because of all this Covid shit didn’t end up happening.’ Pj said, ‘I got a call from [NHS service] in February , saying okay your appointment is on the 7th April. He said ‘I screamed the house down, being like I’m finally getting seen’. However, ‘then the Coronavirus happened, and it got pushed back. He said ‘I don’t think I’m going to be seen till next year’.
Jack talks about the impact of COVID-19 on his wait for the NHS service coronavirus has put everything on hold.
Shash describes the impact of COVID-19 on gender services they had to put a pause on things’ but were still trying to do video call appointments.
Experience of assessment and NHS process
People talked about their experience at the Gender Identity Clinic (GIC). This included the assessment sessions, and the process. They described their sequence of sessions with the NHS services, often there were many months between appointments. Summer said, ‘This first appointment was half of my assessment. I have the second appointment in a year and that’s when I get the [gender dysphoria] diagnosis and that is when the [NHS service] write my prescription [for oestrogen]. That is when they take over my hormone care. Even though,I’ve been living full time as a woman for two years now.’
Rahul talks about his experience of the sequence of sessions at GIC and what he spoke about.
CJ talks about their experience of answering questions at their first and second NHS GIC appointment.
A few of our young people described the frustration of needing multiple diagnoses of gender dysphoria from clinicians and different levels of healthcare. Ari was annoyed that the NHS services ‘had to diagnose me with gender dysphoria again which I’d already been diagnosed with’. They said ‘I’d seen four psychiatrists, diagnosed with the same thing at this point so that was really a hassle.’ This was similar for Declan who was frustrated he needed another diagnosis of gender dysphoria by new clinicians after previously being seen by the GIDS. He said, ‘they didn’t believe that I’d been to The Tavistock before or had a diagnosis yet so I had to get diagnosed again despite me bringing all my evidence ,I was like, ‘Look, I’ve been diagnosed,’ and they were like, ‘We still need to diagnose you again.”
H shares his experience of the process of NHS GIC appointments and trying to get signed off for surgery.
Many of those we spoke to talked about a clash between expectations, hopes and the reality of the service. Ari said they were expecting questions such as ‘when did you start feeling this way? How do you experience dysphoria?’ Whereas in reality the questions felt ‘very check box.’ They were asked more direct and practical questions such as ‘Have you changed your name legally? Have you changed your passport? Have you changed your driving license?’
Summer talks about her experience of answering questions at her first NHS GIC appointment you have to tick a certain number of boxes.
Henry says in light of his expectations of the NHS gender identity services, they have been pretty good.
Tyra moved to NHS care from private care and was impressed by the number of resources available, it was a lifeline.
Young people also talked about barriers they experienced at the NHS services that delayed their progress to starting hormone therapy. Jaz said she ‘turned up [to the GIC] with the expectation [thinking] if this goes well, we’re giving you a prescription’. However she said ‘because I didn’t have a life plan, [the GIC] were like, ‘Oh, you don’t know what you’re doing with your life. So, we’re going to delay your treatment.’ Jaz felt this was unfair because she was just finishing university at this time and was unsure of what to do next.
Bay talks about their experience with the NHS GIC as a non-binary person.
The young people we spoke with talked about their experiences with practitioners at the NHS services. Some felt that they established meaningful bonds with their clinicians over the course of the sessions. Tyra was grateful to have a black female practitioner at their GIC. They said, ‘it was good that I had a black woman to speak to, who had been around other trans people, like because it was a trans service’. They said, ‘she was a great woman ,I just felt like she understood the issues that I faced’.
Noelle talks about her GP not allowing a referral to the gender identity services without seeing a psychiatrist.
Communication and correspondence with NHS services
Communication and correspondence with the NHS services was a key topic of discussions for our interviewees. Some of the young people felt that the NHS services were difficult to contact and there was a lack of communication about appointments. Theo said it’s ‘impossible to contact the [GIC]’. Sally described the administration of the service ‘a mess’. She said ‘they deal with more people than they can handle, and things get lost.’ Summer said the NHS services ‘send you a letter in the post, which is not great.’ She felt that a text or an email would be better. She said as a student ‘I move house every year.’ She explained how she felt anxious at them not recording her new address and getting discharged from the service due to not responding to missed letters.
In contrast some of the young people were satisfied with the communication from their service. Sophie said ‘I have had very limited phone conversations [with people at the NHS service], but people I’ve spoken [to] on the phone have been very helpful and have explained things very well.’ Sophie thought ‘their website is fairly good, fairly easy to understand. It’s not brilliant, but it’s fairly good.’ CJ felt that his service was ‘really good with keeping on top of contacting patients’. His experience was that the GIC contacted patients and answered emails in good time.
Max shares his experience of the slow progress with appointments at the NHS service and a lack of updates.
Communication with the service was important for a number of reasons. A few of the young people we spoke to wanted help from the service with progressing applications recognising their gender identity. Noelle talked about asking the NHS service for a letter to ‘get the F on my passport.’ She also wanted help from the GIC with getting a Gender Recognition Certificate (GRC)*3. You can find more information about applying for a GRC on the GOV.UK website. She had heard that the NHS services could ‘provide a letter saying the change is likely to be permanent’.
Communication with the service was most important for accessing hormone therapy and getting prescriptions for oestrogen or testosterone. Some of the young people we spoke to talked about their frustration with the communication between the NHS services and their GP when it came to issuing a prescription. Declan said, ‘It was a bit annoying waiting for the gender clinic to communicate with my GP and then it took me asking my GP if a letter had come through for them to give me a prescription.’ He said ‘a lot of it is just me nagging the healthcare system trying to get what I want.’
Summer talks about her experience moving from private healthcare to NHS care with the NHS services.
Concerns about power and gatekeeping
The young people we spoke to raised a number of issues they had with how the NHS services in the UK were run and what improvements could be made. A key concern was the levels of gatekeeping within NHS pathways and the power imbalance between patient and professionals (see ‘Diverse journeys and pathways‘ and `Experiences of GP surgeries‘).
Young people expressed that they were dissatisfied with the current system. Theo said, ‘The current state of trans healthcare is appalling.’ Summer said, ‘I feel frustrated.’ She describes it as ‘a game you have to play’. She said, ‘I don’t like that [the GIC clinicians] have this power over me and that they can choose to prescribe or not to prescribe and you know they can choose to give me my trans diagnosis or not.’
H talks about the imbalance of power between patient and professional in NHS gender identity care.
These concerns about gatekeeping often related to whether the person seeking care conformed to traditional performances of gender (see Changing names, gender expression and appearance). Cassie felt that there was a distrust within the trans community of cisgender professionals in positions of power in healthcare. She said ‘I constantly feel like I have to justify my existence to cis [gender] healthcare professionals in general.’
Noelle said, ‘Unfortunately, I hear from a lot of trans people that they’ve had bad experiences even within the NHS GIC speaking to doctors who don’t seem that well informed or [are] a gate keeper.’ Ezio said, ‘One of my friends went to their initial appointment and she got told that because she doesn’t come across as massively feminine that it would be a problem.’ He went on to explain that ‘the way she dresses is for her own safety because a lot of her family don’t accept her and I think she’s very afraid of being attacked.’ He said it’s like ‘telling a woman, you’re not a woman until you walk like a lady, look like a lady, act like a lady, it’s very strange’.
Max talks about the balance of power at the NHS GIC services I have no control over anything.
Some of the young people and adults had messages of support for other trans people navigating the system. Jaz said, ‘The more power you can build for yourself in terms of like your own knowledge and what you need, and the confidence you can pull that off with, it’s gonna improve your experience in terms of like what you get and what they give you and how fast, and if they delay your treatment or not.’
Other people we interviewed wanted to share their messages with healthcare professionals. Sophie said, ‘I was very nervous about the appointment, because of the fact that [the NHS practitioner] in the first appointment holds a lot of power over being able to start the transition process’. She wanted practitioners to ‘understand that it is stressful having to deal with when you are effectively being the gatekeeper about whether someone is transitioning. And, therefore holding the keys to potentially their future happiness as well and being able to have a meaningful, good, life.’
M says there is a major power imbalance’ in trans healthcare that is harmful on so many levels.
* The Gender Clinic accepts referrals for patients who are aged 17 years and older onto their waiting list. Accessed at https://gic.nhs.uk/referrals/
*2 Gender Identity Clinic [London], 2021. About us. Available at https://gic.nhs.uk/about-us/
*3 ‘A Gender Recognition Certificate is a legal document that changes the gender listed on your birth, marriage and civil partnership certificates, with effects on your pension, prison and marriage rights.’
Gender Construction Kit, 2021. Obtaining a GRC. Available at https://genderkit.org.uk/article/obtaining-a-grc/