Experiences with private healthcare

Adults and children can access NHS specialist gender identity services free of charge. However, the waiting lists at these services may mean a long wait before a person is seen by a specialist. Similarly, cuts to funding and long waiting times for mental health services have made mental health support on the NHS limited. For these reasons, people sometimes opt to have private care, if they are able to afford the costs of this.
Some families found that their determination to access help earlier than was available in the NHS, due to excessively long waiting times, created a barrier to accessing NHS services later. The NHS could insist that after 12 months on puberty/hormone blockers the 12 month course must be repeated before gender affirming hormones could be given to the young person. In other cases, the NHS made it clear that they would not accept a young person into their service who had previously sought private care.

Josie says that she would have chosen to get private healthcare for her trans daughter if she were to do this journey’ again.

In our interviews, parents and carers spoke highly of the NHS as an institution, but many felt that the lack of capacity and funding meant that what their child needed was not available or was not available in a timely manner on the NHS. For example, facial feminisation surgery is not available on the NHS; Jan chose to pay for it privately for her daughter.
  • In this section, you can read about parents’ and carers’ experiences with private healthcare, including:
  • Deciding to access private care;
  • Managing the relationship between the private healthcare and NHS; and
  • Experiences and perceptions of private health care.

Deciding to access private care

When parents and carers we spoke to made the decision to pay for private trans healthcare for their young person, it was often because they felt their child had desperately needed it. Those who decided to pay for their child’s hormone blockers, hormone therapy or surgery privately spoke about doing a lot of research and weighing all the pros and cons carefully. For example, Teresa and Andrew paid for their daughter’s private counselling and hormone therapy. Andrew shared that ‘we went private. We did that, because the NHS couldn’t help us.’ He also felt that going private has been ‘a literal life saver’ for his daughter and that not being able to get the therapy she needed on time ‘would have been catastrophic for her mental health’. Similarly, Lesley who paid for her son to get hormone blockers via a private provider emphasised: ‘I don’t know what would have happened if we hadn’t been in that position to be able to do that or I actually do have a fear that he probably wouldn’t be here now if we hadn’t accessed private treatment.’
The costs of paying to see specialists can be prohibitive for many people and not everyone we spoke to felt they could afford to go private. Ali observed: ‘I had to investigate the private route, which was really very expensive, I couldnt support it.’

Adele talks about the ‘thought process’ as a parent choosing to pay privately for hormones for her son.

Parents sometimes chose to pay for some aspects of their child’s healthcare privately, whilst staying on the waiting list, or in the care of the specialist NHS gender identity services.

Lesley talks about a shared cared agreement between a private provider and her son’s GP and how she felt her son would not be alive if he had to wait to see a gender specialist in the NHS specialist services.

E and D paid for private therapy, specialist assessment and endocrinology for their adult son. They observed: ‘If we were reliant totally on the NHS, I think we’d have been able to get nothing’, ‘we’d still be struggling’.

E and D talk about getting private care and initial prescription from a private endocrinologist, with the local GP continuing the hormone care for their son on the NHS.

Managing the relationship between private healthcare and NHS care

Managing the relationship between a private healthcare provider and NHS could be difficult for parents. At times, parents and carers we spoke to emphasised that reconciling private healthcare with NHS care was very challenging. Some, like Ali, felt that exploring the private option for her daughter was perceived negatively by the NHS and caused the family a lot of anguish when they thought they would be dropped from the NHS endocrine clinic. However, Ross thought that discussing private healthcare options accelerated the process of getting hormones for his child on the NHS. He shared that he: ‘Went to the NHS appointment and the NHS said, cancel the private appointment, because we will guarantee that youll start testosterone on the NHS.’

Ali says the NHS was going to drop us like a hot brick’ when she considered paying privately for her daughter’s hormone therapy.

Ross suspects considering private care sped up the process of getting hormone therapy on the NHS for his child.

At times, private healthcare recommendations could also clash with NHS advice. Lesley shared that CAMHS, who were looking after her son as an inpatient when his mental health deteriorated, tried to stop his hormone therapy: ‘I think the inpatient unit had had a conversation with GIDS, they obviously were very disparaging about the independent provider, and they were gonna try to stop [his hormone therapy] altogether,They assumed that the assessment we’d had [from the independent provider] was not thorough enough, even though they hadn’t even asked me about the details of what they’d uncovered in the assessment. They just made that assumption.’
Trying to move parts of a young person’s care into the NHS from a private provider is not always possible. However, the alternative of seeing specialists and paying for medication privately over several years is costly. Teresa and Andrew paid for a private specialist to prescribe testosterone blockers and oestrogen for their daughter to ‘pause puberty’ and were disappointed to find out that the NHS would not take over the prescribing until she is an adult.

Lisa talks about why they chose to access hormone blockers privately at an early age and the difficulties of trying to transfer her son’s hormone blocker treatment to the NHS.

Parents and carers who got private healthcare, often did so to affirm their child’s gender identity and expression. However, this was not the case for everyone. One parent said they chose to opt for a private therapist for his daughter while on the waiting list for GIDS because, ‘that particular therapist is a non-affirming therapist, which is important for me.’ Elijah felt that this was important because they questioned their child’s gender identity and did not want affirmative care for them.It is important to note that parental support and acceptance are key to the wellbeing and mental health of young trans and gender diverse people and so is access to timely care. Denial and delaying of care cause harm.*

Experiences and perceptions of private health care

The parents and carers whose children had been looked after by private providers spoke highly of the care they received. For example, Jan said it was a good experience and that being able to access trans specific care sooner made her daughter feel ‘like something was actually being done.’
Still, some people we interviewed had a strong preference for the NHS and did not have the same confidence in private providers when it came to their children’s trans care. Leigh felt that the private route was too quick and said that with her ‘child being looked after, he hasnt got the option of going through private care, Its never been an option for my lad. Saying that, even if it had, I dont think I would have accessed it, because I think having that extra time and taking it slow has been the right thing.’ Kate stressed that she was very keen for her son to get assessed within the NHS. She emphasised that she wanted ‘that impartial assessment and, the pathway mapped out a little bit for us by that kind of professional.’ At the same time, she did not exclude the possibility of going private in the future; she shared ‘I want to start it in that way and then if we can afford to pay to hurry some things up then, then maybe we will try and do that.’
In our interviews, parents of younger children like for example Oonagh and another parent admitted that they kept their options open and kept themselves informed about what was out there in terms of private care for their trans or gender diverse child. Whilst they stressed they would prefer for their child to be looked after by the NHS, they also said they were willing to go private, or even overseas to access the care their child needed.

Oonagh says she would prefer to stay in the NHS, and that ‘keeping it slow’ was the better option, leading to a more professional’ assessment, but is also keeping her eye on private options for her daughter.

* See for example:
Puckett, J. A., Matsuno, E., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019). Mental health and resilience in transgender individuals: What type of support makes a difference? Journal of Family Psychology 33(8).
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6).
Priest, M. (2019) Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm, The American Journal of Bioethics, 19(2).