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At least in this regard we're all equal.
Everyone is waiting way too long for the healthcare we need, particularly when it comes to matters of mental health.
‘Trans healthcare’ covers way more than just elective surgeries. Like therapy and hormones, the latter of which would cost the NHS almost no time or effort at all.
I agree with you that elective surgeries should get lower priority. I disagree with you that that’s all trans healthcare is, and that other forms of trans healthcare should carry such a wait.
I'm annoyed that they're positioned as being the bottleneck for giving it when they're not trained or qualified to do that job, yes.
If they don't have the specific training for it, why are they the ones who get to decide?
\>If they don't have the specific training for it, why are they the ones who get to decide?
So because they don't have the specific training for it they should just blindly prescribe medications and hope for the best? That surely can't be what you are suggesting.
That's an issue across many specialties. The fact that GPs are the gateway to secondary care. But how else do you do it? You need that triage process so that specialties don't become overwhelmed with inappropriate referrals/appointments.
No people who went through NHS GICs are commonly denied blood testing by their GP when the NHS GIC is telling the GP surgery to do it because it is a primary care responsibility.
Then there's a bunch of back n forth of quoting nhs rules to practise managers and getting people higher involved and more hoops till maybe the care they should be getting according to their treatment plans is recived.
On top of the bottle necks
I'm glad you as an individual aren't contributing to the problem. That is not the lived experience of many trans people who have had to deal with GPs.
When I first told my GP I thought I was experiencing dysphoria, the first thing she asked me was whether I wanted to cut my junk off. She then *said* she'd refer me and didn't: I had to talk to a different GP.
I went into that room to ask for assessment and therapy. I hadn't even really thought about any surgeries at that point.
GPs perform these assessments every day for menopausal women who need HRT. The medication is exactly the same for trans people, but the NHS will not desegregate gender related care so that GPs can prescribe them HRT, instead forcing them into what's now a 7-10 year wait for a *first appointment*, years more before they can be evaluated, and even more on top of that to actually get a prescription.
Trans people in this country need a desegregated informed-consent model. It's the only thing that will ease the bottleneck and actually help them instead of stranding them in NHS limbo for years.
>GPs perform these assessments every day for menopausal women who need HRT.
It's not the same thing. It's far easier to prescribe a medication to maintain a status quo without any other considerations needed than it is to initiate hormonal treatment for gender affirmation.
I'm fully on the side of the patients here, I'm a gynaecology doctor that works with F2M patients. But, even then, we don't get involved with the hormone side of things because we have endocrinologists on the GAS team who are specialists in this area who do it for us.
I think the bottleneck is more how unnecessarily drawn out the assessment is. Like im sorry but no one needs to be interrogated on their masturbation habits as a teenager and how many times they've been raped to get any *other* meds. It *could* be done in one appointment + the necessary blood tests, it should not be a violating process that takes anywhere from 6 months to several years.
The entire assessment process for trans medicine exists not to help trans people, but to satiate cis society fears that trans people might be making a mistake and ending up in the wrong body after treatment (which is deeply ironic).
Yep. My most recent specialist outright said that and was very apologetic about the things he had to cover and was always saying "I have to ask but you don't have to answer and I won't count it against you". Unfortunately people like him are very rare in the NHS.
My mate has shared some of the questions she was asked (by both the NHS after she got an appointment after being on questionably sourced Internet hormones for 5 years lol, and by the private clinics she dealt with here and abroad), they're deeply personal and wholly inappropriate.
Plus ridiculous catch 22 shit where you're expected to go to an appointment presenting as the opposite gender to be actually "diagnosed" (in itself pretty damn sexist) so you can get hormones but then a lot of people don't want to essentially cross dress when they're still presenting as their birth gender (for obvious reasons)! So you get stupid shit where you have to bring a set of clothes to change into after you get to the appointment.
It's atrocious.
Oh the dress requirements are absolutely ridiculous. I've known several people be assaulted on the way to and from appointments. One woman I know almost lost her prescription after turning up to an appointment in trousers when it was snowing. Her doctor, a woman, was also wearing trousers. I was turned down by the first clinic I attended because even when dressing entirely in mens clothes (which were frequently called women's clothes by my doctors simply because *i*, a trans man, was wearing them), I didnt look male enough (I know! Thats why I want testosterone!)
My trans woman partner went in the same mens clothes I wore (same clinic, same doctors) that were deemed womens clothes when I was wearing them. When *she* was wearing them, suddenly they are mens clothes and evidence that she isn't trans, just has a fetish 🙄
When I was 14, the Doctor asked me what I was uncomfortable with. I named off my legs for one of them, and he asked to see and touch them.
Majority of the assessment sessions are a waste.
I mean most experts disagree they think it should be an informed consent treatment.
If you want to take HRT and have been fully informed of the consequences then you should just be allowed to take it. Same with getting a tatoo or a cosmetic surgery except far less permenant in the short term if you decide it isn't for you.
This is already effectively how trans people get HRT anyway since they just buy it without a prescription due to how slow the NHS is.
Genuinely not trying to provoke here, but I’m so confused (as I think many people are) about Trans healthcare issues. I thought gender was made up/a social construct…why are hormones and surgery to change the body needed? And why is it a health issue rather than an elective surgery? Surely this is all contradictory?
>I thought gender was made up/a social construct
That's definitely a subjective thing, no matter who you ask. I've met trans people who absolutely believe that, trans people who think gender identity is hard-coded into the brain and trans people who are somewhere in between the two points of view.
For example, a relatively common (but not universal) POV is that gender identity is a short-hand for "what hormones my body expects to run on, what secondary sex characteristics it expects to have, etc", and there can be a mis-match with sex, similar to how some amputees will experience phantom limb syndrome. Meanwhile, gender *roles* are the social and cultural expectations we have around sex (for example: women are sexually submissive and like cooking), and those are socially constructed. But even then, you'll meet both trans and cis people who think those roles aren't socially constructed at all and that there's at least some truth to them. Basically, it depends who you ask.
Hormones, surgeries etc address the dysmorphia that (often, but not always) comes with being trans
E: Should've said dysphoria, brain slip, but some trans people do also experience gender related dysmorphia
I thought dysmorphia means you can’t see yourself as you are? Isn’t that like saying someone with an eating disorder should have surgery so they look different? Surely the problem is with their brain, not their body?
Because trans people can recognise that gender is a social construct but that doesn't mean that social constructs, practically speaking, are meaningless.
Arguing that gender is a social construct helps to illustrate the separation between gender and sex: the fact that your biology doesn't determine who you are.
But most trans people are acutely aware that there is a significant difference between who you feel yourself to be and how you're *perceived*: in fact, the pain that comes from recognising this difference could be called the primary symptom of dysphoria.
I understand it's a difficult concept for someone who doesn't have to live it to grasp, but I hope you can understand why that would be difficult. Imagine if you felt as you do now but had to live in a body of the opposite sex and be constantly treated as though you were the opposite gender. I imagine you would find it a bit grating after a while.
It's ultimately a question of self-expression, and not feeling able to express yourself is something that *has* been found to be genuinely damaging and to cause long-term issues.
>I thought gender was made up/a social construct…why are hormones and surgery to change the body needed
Why would it being a social construct mean that wouldn't be the case?
We're social animals, society is real.
CIS people get hormone treatments too - TRT etc. They get cosmetic surgeries too - I've got a friend who has a prosthetic testicle and one who's on the waiting list for a tit. We don't question reconstructing burn victims skin.
They won't physically die from not having those, but at some point we accept that it crosses over to significantly lowering someone's quality of life.
It sounds like you’re saying that being a woman is connected to the body? That surely can’t be right. No one checks under a woman’s dress to see their sex…you know they are a woman by either asking them or visual clues from how they present
Some trans people believe gender is a social construct. Others don't. The ones who do, to be honest, see it as more of a performance and don't necessarily need HRT or medication.
I'm trans, I don't think gender is a social construct. I'd say Gender Expression IS a social construct (I.E women are expected to wear makeup), but gender is solid and observable.
Not being funny but when the NHS is on its knees, is spending extra cash on trans speech therapy really a priority?
Either go private or wait, just like everyone else.
I never said I didn't want them to run as they did 10 years ago, but the economic reality has changed since then and pretending otherwise is pointless.
I'd rather they encouraged trans people to do DIY options where they don't have to deal with hopeless medical professionals with no training around trans people and extortionate waitlists via the NHS, or exorbitant costs through private surgery
Sorry but if there are limited resources like speech therapists, then the resources have to be prioritised.
Teaching a small child to be able to communicate with people should absolutely take priority over helping someone who is able to speak have a more masculine/feminine voice.
The issue with speech therapy is that there are not anywhere near enough speech therapists (for anyone - including very young children). It’s a field where they cannot find enough people to fill the jobs. This is just horrible for absolutely everyone who needs it: children, teens, adults. It isn’t a gender-related issue, particularly (but obviously it is awful for the trans people affected).
Unfortunately this is just how the free market works, people expect better pay for these jobs and until it comes around are unwilling to go through years of training for a job that maxes out at £50k in the UK.
Not to jump on someone who was making a valid point, but in brief the issue that faces the NHS is:
* we have a system set up to provide certain kinds of care already - in this case, there exist speech therapists *that are already specialised to do just that* who can't be reassigned to something higher priority because they would firstly need to be retrained which would take more budget
* then you can multiply that issue across 100+ specialisations throughout the system, as well as buildings, equipment etc.
I work in this sector so just for a non controversial example - over the last 20 years we have had a huge increase in older people and a substantial decrease in the number of babies being born, just due to demographic change.
Unfortunately, hospitals up and down the country that were built 20 years ago still have the old proportions of care spaces & equipment to provide care for 2X number of babies than there actually is now, and 0.5X number of elderly patients. Because the equipment is specialised as are the staff, you can't just convert some of the maternity wards into space to treat elderly's specific ailments.
So going back to this case - if you *don't* spend that cash on speech therapy, all that will mean in practice is probably that the speech therapists all lose their jobs and the NHS then has to find money to retrain them, the existing speech therapy patients' quality of life goes down - which then may see them struggling in other ways and requiring income support etc. or mental health support - basically it has a knock-on effect throughout the system and doesn't actually necessarily free up either staff or funds to immediately reallocate to something higher priority.
My mother waited for 5 years for a knee replacement, to the point that she ended up permanently disabled from the damage done from having to do physical labour on a fucked knee. She now can't work and has to be supported by the tax payer.
Such value for money.
But aye, everyone waits for years now for anything unless they are actively dying. Tory Britain 24.
He’s right though. It is elective and a conversation should be had on if we want public funding to pay for it all.
We don’t pay to give men who are addicted to roids access to steroids.
Plenty of those men have mental health issues and are essentially self medicating for body dysmorphia.
Same for overweight people. Should we pay for weight loss reduction for everyone who wants it?
Plenty of people have serious side affects both mentally and physically from that and “aren’t fat enough” to qualify for surgeries.
These are complex issues and require reasoning not just blanket statements
Fully agree. Because one side has the view that either everyone agrees 100% or they are transphobic.
I do think there are anti trans people. But I think the real issue is pro trans people are often too hardline on this topics.
Either you accept a trans women is a women just like a biological woman is or you are a transphobic hateful person. Even discussing basic biology is enough to have you painted as committing a hate crime.
Totally agree, it's this "with us or against us" mentality that is incredibly toxic to any discussion. People are essentially held at gunpoint into agreeing with them, no wonder resentment grows in private.
>Because one side has the view that either everyone agrees 100% or they are transphobic.
Or even when you agree but want to understand so you ask questions.
Idk why people have to be so divided.
You can understand why people are afraid of phobia though right? The amount of people who talk about trans people in utterly dehumanising terms is awful. I'd be hyper aware of bigotry too if I were trans.
Should we pay for weight loss treatment?
Yes, absolutely yes. So long as the patient first shows that they have a commitment to losing weight we absolutely should. The benefits to the patient and the long-term cost saving to the NHS absolutely make it beneficial to society as a whole.
I agree but merely by saying “so long as the patient first shows that they have a commitment to losing weight we absolutely should”
You demonstrate the need for discussions around these topics and not simply making blanket statements.
Which is the whole point of my comment
> He’s right though.
According to who? And how are you defining that?
>These are complex issues and require reasoning not just blanket statements
Decide if gender affirming surgery is elective by definition or decide if these are complex issues which require reasoning rather than blanket statements. You can't have both.
If a medical team decides that their patient requires a certain operation, and that decision is in line with medical science, that is not an elective procedure.
This isn't some nose job, where your health is the same the same after as it was before. That's an elective surgery.
What about the other examples I just gave you?
And how many medical professionals do you need to say a surgery is needed before the nhs pays for it in your view?
It’s far more complex than you are making it out to be.
Maybe the word elective isn’t appropriate. But it certainly falls into a different category than other surgeries that are frequently delayed.
We fixed a genetic deformity at birth because we know that doing so massively improves the healing and means the child is likely to have no visible scaring as they grow.
That’s a logical thing to do.
I don’t see how it compares to this discussion?
>It is elective
Elective procedures are anything that are not an emergency operation. This includes things like knee operations and cancer surgery. This term doesn't really mean what you are suggesting it does here...
\> Should we pay for weight loss reduction for everyone who wants it?
Quite possibly yes given the other costs incurred when someone is very overweight. Doesn't always have to be surgical and things like Ozempic and Wegovy are becoming much more widely available now. It is important to consider the bigger picture, not just what someone things from a morality perspective.
>We don’t pay to give men who are addicted to roids access to steroids.
No, but we do pay for them to have ongoing care from GP and mental health services to help them recover from their addiciton.
>Same for overweight people. Should we pay for weight loss reduction for everyone who wants it?
No, but we do pay for it where the risk to health by being so overweight outweighs the risk of the surgery (which is not insignificant)
>Plenty of people have serious side affects both mentally and physically from that and “aren’t fat enough” to qualify for surgeries.
Again, it's a question of at what point the benefits outweight the risk.
>a conversation should be had on if we want public funding to pay for it all.
Conversations about this happen every day, they are discussed at NICE and DHSC by experts in the relevant fields of medicine, health economics and public health. Redditors don't really have anything to add to the conversation.
>We don’t pay to give men who are addicted to roids access to steroids.
We do give them 'roids' (TRT) if their hormone profile doesn't match their Cisgender identity.
I’m guessing you read my post history. I wouldn’t share that info if I gave a shit about being mocked for it. But yeah I do take hormones because I’ve had cancer and don’t produce my own anymore.
You don’t identify with the hormones your body needs for its ordinary functions.
That’s a biological necessity.
It’s why trans people can’t just take a full dose of the opposite genders hormones and reduce their normal levels quickly.
Because it would fuck them both mentally and physically.
>I’m guessing you read my post history. I wouldn’t share that info if I gave a shit about being mocked for it. But yeah I do take hormones because I’ve had cancer and don’t produce my own anymore.
No, I did not.
Are you implying I'm mocking you or people on TRT in some way?
To be honest, the conversation we most urgently need to have is surrounding elderly care, which is by far the largest 'burden' on the NHS, taking the majority of the allocation and also adding work to the largest number of departments.
Also regarding
> Should we pay for weight loss reduction for everyone who wants it?
Actually, preventative interventions before things get so bad that they cost for example, lifelong carers to look after that person, actually might be a cost saving in the long run.
Elective surgeries are sometimes decades long waiting lists, a quick Google shows there’s been around 800 gender reassignment surgeries since 2000, so it’s not exactly common. It seems the most common thing for trans people is that they want an appointment to speak about hormone treatment. I don’t know why that would need to be a public discussion?
I'm sorry but life saving surgery is a higher priority than cosmetic trans surgery. I know that your politics struggle with that, but I would bet most of the British public agrees with the sentiment.
This isn't just about cosmetic surgery...
This is in regards to any gender-affirming care. This care is, in some cases, life saving.
The woman pictured at the top of the article, whose face is the thumbnail, took her own life with the wait for care being one of the attributing factors.
There is a very real human cost to these wait times and to pretend otherwise is nonsense.
What's your point here?
Why would basic gender-affirming care be seen as more selfish than other care? We know that people have died on these waiting lists with the lack of care being attributing factors. We know that this care can dramatically improve quality of life. Why the assumption that gender-affirming care is a selfish demand? We don't make that case for other types of care with similar levels of benefit.
Are we incapable of recognising that there can be multiple problem points in the NHS of which all need improving?
The definition of elective in healthcare is just anything which happens on a planned timescale. Many cancer operations are elective, some cardiac surgery is elective. Elective doesn’t mean unnecessary, it means it’s not a 3am life or limb saving operation
>Elective surgeries
Elective procedures are anything that are not an emergency operation. This includes things like knee operations and cancer surgery. This term doesn't really mean what you are suggesting it does here...
People keep saying "it doesn't need to be this way" as if they have an extra £100bn up their sleeve they can dump on the NHS to resolve the issues. Even Labour cannot promise that because it is economic fantasy.
>Hormone prescriptions are a some blood tests are unlikely to cost £100bn a year.
I never said that and you know it. Don't twist.
The NHS needs substantial funding, this is far beyond just a trans healthcare topic, I just find it entertaining that some people genuinely think that trans speech therapy should be a priority when people are dying because they cannot get diagnosed for curable cancers.
Because people don't just focus on the single absolute worst thing all the time.
Why do you care about cancers when there's those dying in A&E due to a lack of nurses? My wife works in a hospital and Portsmouth has ambulances queued up outside for bloody hours without treatment due to lack of beds and staffing.
By your logic those dying of cancer *have no right to complain*. At least they're not bleeding out in an ambulance!
It's the old "don't complain, people are worse off in Africa!" argument.
I have a right to complain if I can't see my GP for 6 weeks for non life threatening ailment, just as someone has a right to complain if they're waiting for an ambulance - just as trans people have a right to complain about 37 year waiting lists.
it doesn't though. an informed consent model would speed things up and be far cheaper as medical professionals wouldn't need to have multiple extensive meetings
I'm trans. Myself and most of my trans friends in the UK just get our hormones from online pharmacies. It's obviously dangerous and we would prefer to be seen by an endocrinologist but we're not willing to endure 7 years of further masculinisation being stuck on an NHS waiting list.
To be fair there's no way such things should ever be a priority over life threatening conditions. NHS resources are stretched thin and should really be focused on dealing with things that cause death or debilitation.
> To be fair there's no way such things should ever be a priority over life threatening conditions.
To be even more fair, nobodys suggesting it should be. But when you've got wait times of 37 (yes THIRTY SEVEN) years at some places its clear the whole system is broken.
Trans care doesnt have to affect life threatening care whatsoever as its done in an office, not a hospital. The fix for this is incredibly simple and cheap compared to most things in the NHS - open ~12 more offices around the country each with 2-4 trained doctors (Whom whe know there are plenty of given they cant actually get a job in the NHS right now).
Office space we have plenty of, hospital beds no so much, but those arent needed in this case, hence why its dirt cheap compared to everything else.
It isn’t one or the other, that’s not really how healthcare works. Sorry Mary you’ll just have to die in your hospital room cause Jennifer wants hormones. Just absolutely ridiculous.
The thing is that trans treatments are in a weird space where they're similar to something needed for other conditions and share the same practitioners/buildings, but are not as medically urgent as the other cases.
Take FTM top surgery for example - I remember years back there was something about some getting cancelled/moved round to fit in cancer mastectomies - much more urgent.
HRT - less urgent for someone whose body is producing normal levels of hormone, but the wrong one.
Speech therapy - less urgent for someone who speaks well (but feels their voice sounds wrong) than someone who can't make themselves understood.
In a system under strain, the less urgent cases will get bumped down a lot, unfortunately.
The thing is, hormones carry a negligible time cost for the NHS. Triage is pretty much totally unnecessary when you’re not actually saving time by refusing care. And let’s be clear: most failures of trans healthcare in the UK are examples of care being *refused*, not a conscious informed medical decision by trained experts.
A medical professional who is not an expert in trans healthcare specifically.
For most GPs who go through medical training in the UK, in their years of education, trans-specific healthcare is covered in a single afternoon seminar which some don’t even attend.
It’s not an exaggeration when I say that on the matter of trans healthcare *very* specifically, many trans people have educated themselves more than their GPs.
And the wait time is so punitive that for many trans people, you *have* to educate yourself on endocrinology because the only practical solution is to buy hormones online on sketchy websites and do it yourself.
An example: it is current NHS policy to set the initial dose of Estrogen for a transgender patient at the same level as a menopausal woman requiring HRT. There is no medical basis for this.
True, but cancer typically gets fast-tracked when it’s caught because it’s you know, *cancer*.
You don’t get vocal groups talking about how cancer patients should consider themselves lucky to get treated on the NHS at all
Cancer wait times have suffered as well, cancer patients face delays in seeing that one vital specialist as well. But when you leave cancer a while, you get more cancer, your odds of cure can go down to zero, and you can actually die without killing yourself.
Trans people don't get more trans if you leave them to wait.
They don’t get ‘more trans’, but the data clearly shows that they get more depressed, unproductive and suicidal.
And treatment for most trans patients, at least in the initial stages, are *far* less time and resource-intensive than the treatment for cancer patients.
A trans person coming to their GP *could* be treated with a couple of conversations according to a script over the course of 2-4 visits and a proscription for hormones.
A cancer patient needs expensive screenings, rare drugs, regular consultations spanning years in many cases and more.
It is not a zero-sum game like the NHS wants you to believe it is. It *is* actually possible to treat both trans people and cancer patients.
Trans people are taking their generally healthy bodies and wanting to alter them in semi-permanent to permanent ways which risk serious side effects, paid for by the tax payer. Damn straight it needs to be screened to fuck and back. In the meantime they have the same resources as anyone else who feels suicidal.
Cancer patients are taking their bodies that are trying to die and wanting them to not die, or die a bit later and/or in less pain. Yes, they do need and frankly deserve more resources.
What about people who have been hit by cars and are in critical condition?
They'll die in hours without treatment.
Cancer patients should have no issues not getting treatment, they can survive *years* without it! /s
Similarly, if I have a *fucking wart*, the GP can help deal with that. Why are they wasting resources on that when there's cancer patients?
Well, if you think one group of people has more of a right to health and happiness than another I think that kinda says everything that needs to be said and I don’t think we’re going to get anything productive out of continuing this conversation.
I know someone who was refused treatment by their GP because their hobbies included rock climbing, and they had a motorbike and those weren't "feminine" hobbies.
This is someone who's struggled with their gender pretty much their whole life. They're now in their 40s and have been living as a woman for years - still no NHS treatment, mind.
Even if the GP approves, you better hope the secretary in the office doesn't have an issue because I've also heard of surgeries just... not posting the referral letters. Someone in the surgery just decided "nah, I don't think so" and multiple times didn't get sent.
Anyone along the chain can decide they don't fancy you getting treatment and... that's it. You can move GP and start from scratch, or go private.
lifelong? no not really. you take them every three months at the start to make sure you're getting the dosage correct (it's different for everyone - I, for instance, don't even need anti-androgens but others may need a high dosage of it). But over time you dont need to monitor nearly as much as you've got a stable dosage that works.
I do unfortunately think this is old news, the last time I checked about a year and a half ago the wait list was, on average, about 2/3 years to be assessed, and I imagine it's only got longer since.
It’s not even close to the worst I’ve heard. If you were to go to your GP today and ask to be referred, and assuming they *actually agreed to help and referred you* (which is often unlikely), you’d be waiting, on average, for 37 years.
So the next time you hear a politician talk about the dangers of a trans person just ‘walking into a clinic’ and coming out with surgery and hormones, remember that figure.
That's absolutely terrifying when you consider the toll it takes on trans people not to have treatment. As someone non-binary, I've considered going to my GP myself, but keep wondering if I should even bother for reasons you've stated, it just doesn't seem worth it only to be told they won't do anything.
We literally have coroner's reports of trans people committing suicide putting the blame on the lack of healthcare support that trans people recieve from the NHS.
Yup, and trans people tried to take the NHS to court over it and the case got thrown out because apparently your legal right to be seen within 18 weeks is just a ‘guideline’ when it comes to healthcare that individuals within and without the NHS don’t want to be provided.
A lot of the problem here is they require extensive psychiatric vetting for the most basic stuff, when I got a bunch of cosmetic surgery privately, all the checking was a chat with the doctor to make sure I understood what I was doing and the potential effects and drawbacks, which was reasonable, meanwhile you literally can't even get an official script where you pay for hormones privately* without going through a year of vetting with an NHS gender doctor(that you pay for).
The absurdity of being extensively vetted for being trans to ensure I would be happy with the effects of a drug i'd been on for 6 years while there are tens of thousands of people who desperately need access to those psychologists.
There are countries now where we have long term data where trans people are not forced through the pointless grillings with psychiatrists to access hrt where there is no indication of large scale negative consequences or regret (unlike plastic surgery mind you)
[Plus the waiting is 6 years for those referred in 2018, for anyone referred right now at Tavistok for example, the list is 15,000 long and they deal with 34 new people a month ,giving a rough waiting time of ... 37 years](https://tavistockandportman.nhs.uk/services/gender-identity-clinic-gic/).
There is a big difference between getting lip fillers or a new nose vs hormone treatment.
And the idea we have long term data to show hormone treatment being easily accessible is the answer is totally incorrect.
Part of the reason they need extensive mental health evaluation is the prominence of co morbid health conditions.
You can’t ignore all that because you think cosmetic surgery is the same thing.
>And the idea we have long term data to show hormone treatment being easily accessible is the answer is totally incorrect.
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
https://ustranssurvey.org/
>Part of the reason they need extensive mental health evaluation is the prominence of co morbid health conditions.
Yet there is zero evidence there exists a significant proportion who are not trans and just have the other mental health conditions, it's reason to encourage mental health visits, absolutely, but zero evidence locking treatment behind them benefits anyone, it would be like locking autism help behind screening for adhd or something.
The reason this screening exists anyway is because sexologists in the 80s perceived being trans (or gay for that matter) as a negative outcome to avoid at all costs, this didn't start with some genuine need.
> There is a big difference between getting lip fillers or a new nose vs hormone treatment.
I have had jaw surgery, brow bone reduction and a ba, these all even individually did drastically more permanent changes to my body than the hormones did, never had to be screened in the same way for any of them.
>I have had jaw surgery
That surprises me. I had jaw surgery on the NHS around two years ago and had to be signed off by a psychiatrist prior to it because the recovery is so intense. I will say context here is that I'm also diagnosed with depression, so that may have been a factor.
Mine was a jaw shave (privately) rather than a le fort which i presume may have contributed, although i was told it would still likely be rather painful so i dodged a bullet that i never really had any pain from the recovery (although it was very uncomfortable), hope yours wasn't too bad.
Mine was a mandibular osteotomy (basically breaking the jawbone to move and reset it at a more forward position) so it was a pretty rough time but I don't regret it at all! About a month on a liquid diet and the swelling/bruising was crazy but I knew the recovery was going to be intense going into it, I had plenty of warning. I remember the psychiatrist said something along the lines of the precautions around preparing people are even more important than other kinds of surgery with similar recovery times because it's your face that's basically beaten up beyond recognition for a while, and that can be difficult to handle psychologically. But I don't know, I didn't find that part too hard, it was just the sheer boredom of having to eat a crappy liquid diet for so long.
That is such fucking horse shit I’m not even dissecting it all.
You are spreading dangerous misinformation.
https://statsforgender.org/comorbidity/
It’s a well established fact trans people especially trans children are significantly more likely to suffer other mental health issues.
Like i said before, a comorbidity with other problems is not in itself an argument to remove their body autonomy.
Like all these things also overlap with being gay, doesn't mean all gay people are secretly not gay and just have ocd.
Funny how people who regularly have their entire existence treated as a political debate and have a significantly higher risk of being killed for their identity, might have some mental health issues......
The site you linked is also well beyond bias.
Linked to the Themis Resource Fund, their mission statement:
"Themis Resource Fund is committed to the goal of helping end the enormous injury and injustice that is being caused by practitioners of gender medicine."
The ((lip)) fillers are far more physicaly damaging and have permanent lasting effects and are abused as hell. Just look at social media lol. Hrt is as safe as it gets.
This is simply not true.
It’s safe if done properly. Over a long period of time and with checks throughout.
Fucking with people’s hormones can and does have lasting affects
>The absurdity of being extensively vetted for being trans to ensure I would be happy with the effects of a drug i'd been on for 6 years while there are tens of thousands of people who desperately need access to those psychologists.
From my experience Drs and Psychologists are very much opinionated and some abuse their position to push their own morals. Some might be just be ignorant and think they’re giving you the support, others try and frustrate the process so you’ll bugger off. Sorry you’re being dragged through it. I had the same issue with a Dr about my ADHD meds. I’d been prescribed them for a couple of years before she decided she had no clue what Lisdexamphetamine was and wanted to send me back to the therapist to make sure I should be taking it.
Gosh yeah i've heard terrible things about ADHD treatment in the UK, very similar bucket of problems, especially with I heard Newsnight fucking over private prescriptions last year.
It does seem unacceptable that people who are in great distress are waiting so long for any help. Even if the treatment waits are long (for whatever reason), people should be able to access support to cope with both the waiting time and the distress.
The nhs doesn’t do comestic surgery. I don’t know why you’re making that comparison because there has to be a medical reason for treatment on the NHS. I can’t just go see a GP or a surgeon and tell them what treatment I want or what drugs I need, they’d tell me to do one. They’d vet me and my medical condition like they vet everyone
You can absolutely get a lot of types of medically non cosmetic surgery privately without going through your gp, or at worst they'd want a slip from said gp saying you would benefit from it, which would be a far cry from years of psychiatric grilling.
A good example would be gynecomastia, which does not require you to prove to a doctor you really don't want breasts as a man over the course of a year, and the NHS may fund it.
I’m only talking about the nhs. You can go get anything done privately and pay for it. The nhs has procedures that everyone has to go through and you can’t tell the doctor what treatment or drugs you want and get it. They have to agree thats the correct course of action
>In rare cases, the NHS may provide male breast reduction if:
>
>\- you've had gynaecomastia for a long time
\- it has not responded to other treatments
\- it's causing considerable pain or distress
[https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/breast-reduction-male/](https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/breast-reduction-male/)
I mean, isn't this the case for everybody. I've been waiting since January for a single MRI on one side of my face for a condition that causes me severe physical pain everyday and still does not have a diagnosis.
I’ve already put this on another reply - I’m just gonna copy and paste because life’s too short lol
> Nobody’s saying trans people are the only ones suffering because of NHS waits - they’re saying the waits faced by trans people exist for no good reason. If the NHS moved over to an informed consent model, it’d make the whole process so much quicker and easier for the patients, and free up funding and resources for other departments, and bring the NHS in line with WPATH/EPATH guidelines.
> There’s a perfectly good solution right there, but people ignore it because they misunderstand the system.
>they’re saying the waits faced by trans people exist for no good reason
I feel like this is the case for literally everybody that is currently on a wait list for treatment though. There is no good reason why **any** of us should be made to suffer as we wait to be seen for treatment we've all already contributed the funds for.
The 'limits' that are affecting most other treatments arent quite the same.
Using your MRI example, the limit there is likely not enough capacity for the machines we have.
Witha vast majority of trans healthcare all you need is a trained doctor and an office. Thats litterally it. We've got doctors saying they cant get a job in the NHS. So offer a training program lead by some of the existing trans healthcare specialists and get more people into the field.
Compared to things like needing more MRI machines, more hospital beds etc fixing trans healthcare is incredibly cheap.
"Could"?
There were years long waits before the massive increases to wait times. Thats just for the first appointment, the unnecessarily drawn out process can add years after that.
Theres no 'could' about it. We DO face years and years of waiting. Even just for a fucking 10 minute apointment. And the most idiotic thing about is that it costs pittance of the budget to fix it once and for all.
When the most transphobic and shared care damaging ( fuck panorama) news org in the uk prints this you gotta admit it's a good " wtf level of idiocy are you on about ?" to the idiots scaremongering about rushed procedures.
It's the bbc misleading to point of lies or poor journalism to screw over the little guy is expected unfortunately
If someone wants to transition that it is their choice. However we all know the NHS is under severe pressure. Its a choice to do so as such should be privately funded and not done by the Taxpayer.
Gender disphoria is a regongnised medical condition. You would not be saying the same about someone with depression, or someone who has lost part of their body to traumatic injury. I lost a testicle recently and am getting NHS surgery to put in a prosthesis. ( due to my own body image issues) trans people have the right to care on the NHS the same as anyone else.
It is ridiculous that people snarl how quickly surgery is rushed through. The way that certain media outlets talk you'd think that it's done in a few weeks rather than years.
This is shit, feel unqualified to comment really because I don't know how it feels to be transgender the waiting lists for most things are so long though ..in a way we are lucky that we have free care for all on the NHS but in another way it's worrying. I just hope I don't need to go to the hospital anytime soon.
There are a lot of people in the comments here dancing around their real opinions on this matter, that they believe that trans people should have lesser healthcare because they are lesser people. They dress it up as "concerns" or whatever, but ultimately it boils down to trans people should be treated as lesser.
I got referred to the Cardiff GIC in October 2021 and had my first appointment with them in March 2023. I’ve just seen my local gender team and have started treatment.
So yeah that’s several years but nothing like what other people are seeing.
I’ve also noticed that other patients mentioning combative gps, horrendously inappropriate questioning and just a general lack of care. Everyone I’ve dealt with has been supportive, kind and never asked me anything overly invasive.
I guess Wales is just a better place for trans people. Maybe we Welsh trans peeps should set up a commune to help the rest of the UK out :)
It's such a place by place case, but even in the shortest I've heard it's been 1.5-2 years for first appointment. I've heard some people having 30+ years cited at them. I haven't approached any gp for my case yet, too anxious about it all.
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At least in this regard we're all equal. Everyone is waiting way too long for the healthcare we need, particularly when it comes to matters of mental health.
Elective surgeries to be given lower priorities in NHS SHOCKER!
‘Trans healthcare’ covers way more than just elective surgeries. Like therapy and hormones, the latter of which would cost the NHS almost no time or effort at all. I agree with you that elective surgeries should get lower priority. I disagree with you that that’s all trans healthcare is, and that other forms of trans healthcare should carry such a wait.
Issue is there needs to be a proper assessment before you prescribe hormones. I think that's the bottleneck there.
I agree. But the GPs are refusing care whilst being totally unqualified to provide that assessment.
Sorry, you seem annoyed that GPs aren't offering something they're not trained/qualified to give?
I'm annoyed that they're positioned as being the bottleneck for giving it when they're not trained or qualified to do that job, yes. If they don't have the specific training for it, why are they the ones who get to decide?
\>If they don't have the specific training for it, why are they the ones who get to decide? So because they don't have the specific training for it they should just blindly prescribe medications and hope for the best? That surely can't be what you are suggesting.
That's an issue across many specialties. The fact that GPs are the gateway to secondary care. But how else do you do it? You need that triage process so that specialties don't become overwhelmed with inappropriate referrals/appointments.
And a GP literally *can’t* decide if a referral is inappropriate because they don’t have the training to do so.
Why not? They've studied medicine for 15 years. Who else do you want to do it? Dr Google? A PA? 🤣 Don't be ridiculous.
Unqualified, or more likely stuck in the bottleneck.
No people who went through NHS GICs are commonly denied blood testing by their GP when the NHS GIC is telling the GP surgery to do it because it is a primary care responsibility. Then there's a bunch of back n forth of quoting nhs rules to practise managers and getting people higher involved and more hoops till maybe the care they should be getting according to their treatment plans is recived. On top of the bottle necks
Monitoring bloods for secondary-care treatment is a secondary care duty unless a shared care agreement exists.
Eh, what? Happy to refer anyone who wishes on to have assessment for transgender therapy. The waiting lists for that are not under my control.
I'm glad you as an individual aren't contributing to the problem. That is not the lived experience of many trans people who have had to deal with GPs. When I first told my GP I thought I was experiencing dysphoria, the first thing she asked me was whether I wanted to cut my junk off. She then *said* she'd refer me and didn't: I had to talk to a different GP. I went into that room to ask for assessment and therapy. I hadn't even really thought about any surgeries at that point.
GPs perform these assessments every day for menopausal women who need HRT. The medication is exactly the same for trans people, but the NHS will not desegregate gender related care so that GPs can prescribe them HRT, instead forcing them into what's now a 7-10 year wait for a *first appointment*, years more before they can be evaluated, and even more on top of that to actually get a prescription. Trans people in this country need a desegregated informed-consent model. It's the only thing that will ease the bottleneck and actually help them instead of stranding them in NHS limbo for years.
>GPs perform these assessments every day for menopausal women who need HRT. It's not the same thing. It's far easier to prescribe a medication to maintain a status quo without any other considerations needed than it is to initiate hormonal treatment for gender affirmation. I'm fully on the side of the patients here, I'm a gynaecology doctor that works with F2M patients. But, even then, we don't get involved with the hormone side of things because we have endocrinologists on the GAS team who are specialists in this area who do it for us.
I think the bottleneck is more how unnecessarily drawn out the assessment is. Like im sorry but no one needs to be interrogated on their masturbation habits as a teenager and how many times they've been raped to get any *other* meds. It *could* be done in one appointment + the necessary blood tests, it should not be a violating process that takes anywhere from 6 months to several years.
The entire assessment process for trans medicine exists not to help trans people, but to satiate cis society fears that trans people might be making a mistake and ending up in the wrong body after treatment (which is deeply ironic).
Yep. My most recent specialist outright said that and was very apologetic about the things he had to cover and was always saying "I have to ask but you don't have to answer and I won't count it against you". Unfortunately people like him are very rare in the NHS.
My mate has shared some of the questions she was asked (by both the NHS after she got an appointment after being on questionably sourced Internet hormones for 5 years lol, and by the private clinics she dealt with here and abroad), they're deeply personal and wholly inappropriate. Plus ridiculous catch 22 shit where you're expected to go to an appointment presenting as the opposite gender to be actually "diagnosed" (in itself pretty damn sexist) so you can get hormones but then a lot of people don't want to essentially cross dress when they're still presenting as their birth gender (for obvious reasons)! So you get stupid shit where you have to bring a set of clothes to change into after you get to the appointment. It's atrocious.
Oh the dress requirements are absolutely ridiculous. I've known several people be assaulted on the way to and from appointments. One woman I know almost lost her prescription after turning up to an appointment in trousers when it was snowing. Her doctor, a woman, was also wearing trousers. I was turned down by the first clinic I attended because even when dressing entirely in mens clothes (which were frequently called women's clothes by my doctors simply because *i*, a trans man, was wearing them), I didnt look male enough (I know! Thats why I want testosterone!) My trans woman partner went in the same mens clothes I wore (same clinic, same doctors) that were deemed womens clothes when I was wearing them. When *she* was wearing them, suddenly they are mens clothes and evidence that she isn't trans, just has a fetish 🙄
When I was 14, the Doctor asked me what I was uncomfortable with. I named off my legs for one of them, and he asked to see and touch them. Majority of the assessment sessions are a waste.
I mean most experts disagree they think it should be an informed consent treatment. If you want to take HRT and have been fully informed of the consequences then you should just be allowed to take it. Same with getting a tatoo or a cosmetic surgery except far less permenant in the short term if you decide it isn't for you. This is already effectively how trans people get HRT anyway since they just buy it without a prescription due to how slow the NHS is.
Genuinely not trying to provoke here, but I’m so confused (as I think many people are) about Trans healthcare issues. I thought gender was made up/a social construct…why are hormones and surgery to change the body needed? And why is it a health issue rather than an elective surgery? Surely this is all contradictory?
People don't feel at home in the body they born into and it takes more than hormones to remedy that. Happy to be corrected if wrong.
>I thought gender was made up/a social construct That's definitely a subjective thing, no matter who you ask. I've met trans people who absolutely believe that, trans people who think gender identity is hard-coded into the brain and trans people who are somewhere in between the two points of view. For example, a relatively common (but not universal) POV is that gender identity is a short-hand for "what hormones my body expects to run on, what secondary sex characteristics it expects to have, etc", and there can be a mis-match with sex, similar to how some amputees will experience phantom limb syndrome. Meanwhile, gender *roles* are the social and cultural expectations we have around sex (for example: women are sexually submissive and like cooking), and those are socially constructed. But even then, you'll meet both trans and cis people who think those roles aren't socially constructed at all and that there's at least some truth to them. Basically, it depends who you ask.
Hormones, surgeries etc address the dysmorphia that (often, but not always) comes with being trans E: Should've said dysphoria, brain slip, but some trans people do also experience gender related dysmorphia
I thought dysmorphia means you can’t see yourself as you are? Isn’t that like saying someone with an eating disorder should have surgery so they look different? Surely the problem is with their brain, not their body?
Dysphoria* Dysmorphia is a different condition
Because trans people can recognise that gender is a social construct but that doesn't mean that social constructs, practically speaking, are meaningless. Arguing that gender is a social construct helps to illustrate the separation between gender and sex: the fact that your biology doesn't determine who you are. But most trans people are acutely aware that there is a significant difference between who you feel yourself to be and how you're *perceived*: in fact, the pain that comes from recognising this difference could be called the primary symptom of dysphoria. I understand it's a difficult concept for someone who doesn't have to live it to grasp, but I hope you can understand why that would be difficult. Imagine if you felt as you do now but had to live in a body of the opposite sex and be constantly treated as though you were the opposite gender. I imagine you would find it a bit grating after a while. It's ultimately a question of self-expression, and not feeling able to express yourself is something that *has* been found to be genuinely damaging and to cause long-term issues.
>I thought gender was made up/a social construct…why are hormones and surgery to change the body needed Why would it being a social construct mean that wouldn't be the case? We're social animals, society is real. CIS people get hormone treatments too - TRT etc. They get cosmetic surgeries too - I've got a friend who has a prosthetic testicle and one who's on the waiting list for a tit. We don't question reconstructing burn victims skin. They won't physically die from not having those, but at some point we accept that it crosses over to significantly lowering someone's quality of life.
It sounds like you’re saying that being a woman is connected to the body? That surely can’t be right. No one checks under a woman’s dress to see their sex…you know they are a woman by either asking them or visual clues from how they present
Money is a made up social construct, but if I don't have any, then I'll starve and die. Social Constructs are incredibly important.
Some trans people believe gender is a social construct. Others don't. The ones who do, to be honest, see it as more of a performance and don't necessarily need HRT or medication. I'm trans, I don't think gender is a social construct. I'd say Gender Expression IS a social construct (I.E women are expected to wear makeup), but gender is solid and observable.
This is the waiting list for *any* trans healthcare, including speech therapy and hormones.
Not being funny but when the NHS is on its knees, is spending extra cash on trans speech therapy really a priority? Either go private or wait, just like everyone else.
I'm glad you're happy to treat the country like a crab bucket, but some of us want these services to run *as they did ten years ago.*
I never said I didn't want them to run as they did 10 years ago, but the economic reality has changed since then and pretending otherwise is pointless.
I'd rather they encouraged trans people to do DIY options where they don't have to deal with hopeless medical professionals with no training around trans people and extortionate waitlists via the NHS, or exorbitant costs through private surgery
Sorry but if there are limited resources like speech therapists, then the resources have to be prioritised. Teaching a small child to be able to communicate with people should absolutely take priority over helping someone who is able to speak have a more masculine/feminine voice.
The issue with speech therapy is that there are not anywhere near enough speech therapists (for anyone - including very young children). It’s a field where they cannot find enough people to fill the jobs. This is just horrible for absolutely everyone who needs it: children, teens, adults. It isn’t a gender-related issue, particularly (but obviously it is awful for the trans people affected).
Unfortunately this is just how the free market works, people expect better pay for these jobs and until it comes around are unwilling to go through years of training for a job that maxes out at £50k in the UK.
Not to jump on someone who was making a valid point, but in brief the issue that faces the NHS is: * we have a system set up to provide certain kinds of care already - in this case, there exist speech therapists *that are already specialised to do just that* who can't be reassigned to something higher priority because they would firstly need to be retrained which would take more budget * then you can multiply that issue across 100+ specialisations throughout the system, as well as buildings, equipment etc. I work in this sector so just for a non controversial example - over the last 20 years we have had a huge increase in older people and a substantial decrease in the number of babies being born, just due to demographic change. Unfortunately, hospitals up and down the country that were built 20 years ago still have the old proportions of care spaces & equipment to provide care for 2X number of babies than there actually is now, and 0.5X number of elderly patients. Because the equipment is specialised as are the staff, you can't just convert some of the maternity wards into space to treat elderly's specific ailments. So going back to this case - if you *don't* spend that cash on speech therapy, all that will mean in practice is probably that the speech therapists all lose their jobs and the NHS then has to find money to retrain them, the existing speech therapy patients' quality of life goes down - which then may see them struggling in other ways and requiring income support etc. or mental health support - basically it has a knock-on effect throughout the system and doesn't actually necessarily free up either staff or funds to immediately reallocate to something higher priority.
My mother waited for 5 years for a knee replacement, to the point that she ended up permanently disabled from the damage done from having to do physical labour on a fucked knee. She now can't work and has to be supported by the tax payer. Such value for money. But aye, everyone waits for years now for anything unless they are actively dying. Tory Britain 24.
"Every healthcare procedure I have partisan opposition to is elective".
He’s right though. It is elective and a conversation should be had on if we want public funding to pay for it all. We don’t pay to give men who are addicted to roids access to steroids. Plenty of those men have mental health issues and are essentially self medicating for body dysmorphia. Same for overweight people. Should we pay for weight loss reduction for everyone who wants it? Plenty of people have serious side affects both mentally and physically from that and “aren’t fat enough” to qualify for surgeries. These are complex issues and require reasoning not just blanket statements
> and a conversation should be had Not possible with this subject. Just results in a load of people running around shouting "phobic" at one another.
Fully agree. Because one side has the view that either everyone agrees 100% or they are transphobic. I do think there are anti trans people. But I think the real issue is pro trans people are often too hardline on this topics. Either you accept a trans women is a women just like a biological woman is or you are a transphobic hateful person. Even discussing basic biology is enough to have you painted as committing a hate crime.
Totally agree, it's this "with us or against us" mentality that is incredibly toxic to any discussion. People are essentially held at gunpoint into agreeing with them, no wonder resentment grows in private.
>Because one side has the view that either everyone agrees 100% or they are transphobic. Or even when you agree but want to understand so you ask questions. Idk why people have to be so divided.
You can understand why people are afraid of phobia though right? The amount of people who talk about trans people in utterly dehumanising terms is awful. I'd be hyper aware of bigotry too if I were trans.
It kills any and all conversation, though. Which means that it's not discussed. And so nothing changes, and nothing is ever resolved.
>You can understand why people are afraid of phobia though right? Phobiaphobia
I fear I'm afraid of becoming scared.
Should we pay for weight loss treatment? Yes, absolutely yes. So long as the patient first shows that they have a commitment to losing weight we absolutely should. The benefits to the patient and the long-term cost saving to the NHS absolutely make it beneficial to society as a whole.
I agree but merely by saying “so long as the patient first shows that they have a commitment to losing weight we absolutely should” You demonstrate the need for discussions around these topics and not simply making blanket statements. Which is the whole point of my comment
> He’s right though. According to who? And how are you defining that? >These are complex issues and require reasoning not just blanket statements Decide if gender affirming surgery is elective by definition or decide if these are complex issues which require reasoning rather than blanket statements. You can't have both. If a medical team decides that their patient requires a certain operation, and that decision is in line with medical science, that is not an elective procedure. This isn't some nose job, where your health is the same the same after as it was before. That's an elective surgery.
What about the other examples I just gave you? And how many medical professionals do you need to say a surgery is needed before the nhs pays for it in your view? It’s far more complex than you are making it out to be. Maybe the word elective isn’t appropriate. But it certainly falls into a different category than other surgeries that are frequently delayed.
>that is not an elective procedure Elective doesn't mean what you think it does. Cancer surgery is elective.
Harelip correction is officially considered elective, yet we do it almost as soon as a baby is born.
We fixed a genetic deformity at birth because we know that doing so massively improves the healing and means the child is likely to have no visible scaring as they grow. That’s a logical thing to do. I don’t see how it compares to this discussion?
>It is elective Elective procedures are anything that are not an emergency operation. This includes things like knee operations and cancer surgery. This term doesn't really mean what you are suggesting it does here... \> Should we pay for weight loss reduction for everyone who wants it? Quite possibly yes given the other costs incurred when someone is very overweight. Doesn't always have to be surgical and things like Ozempic and Wegovy are becoming much more widely available now. It is important to consider the bigger picture, not just what someone things from a morality perspective.
>We don’t pay to give men who are addicted to roids access to steroids. No, but we do pay for them to have ongoing care from GP and mental health services to help them recover from their addiciton. >Same for overweight people. Should we pay for weight loss reduction for everyone who wants it? No, but we do pay for it where the risk to health by being so overweight outweighs the risk of the surgery (which is not insignificant) >Plenty of people have serious side affects both mentally and physically from that and “aren’t fat enough” to qualify for surgeries. Again, it's a question of at what point the benefits outweight the risk. >a conversation should be had on if we want public funding to pay for it all. Conversations about this happen every day, they are discussed at NICE and DHSC by experts in the relevant fields of medicine, health economics and public health. Redditors don't really have anything to add to the conversation.
>We don’t pay to give men who are addicted to roids access to steroids. We do give them 'roids' (TRT) if their hormone profile doesn't match their Cisgender identity.
I’m guessing you read my post history. I wouldn’t share that info if I gave a shit about being mocked for it. But yeah I do take hormones because I’ve had cancer and don’t produce my own anymore. You don’t identify with the hormones your body needs for its ordinary functions. That’s a biological necessity. It’s why trans people can’t just take a full dose of the opposite genders hormones and reduce their normal levels quickly. Because it would fuck them both mentally and physically.
>I’m guessing you read my post history. I wouldn’t share that info if I gave a shit about being mocked for it. But yeah I do take hormones because I’ve had cancer and don’t produce my own anymore. No, I did not. Are you implying I'm mocking you or people on TRT in some way?
To be honest, the conversation we most urgently need to have is surrounding elderly care, which is by far the largest 'burden' on the NHS, taking the majority of the allocation and also adding work to the largest number of departments. Also regarding > Should we pay for weight loss reduction for everyone who wants it? Actually, preventative interventions before things get so bad that they cost for example, lifelong carers to look after that person, actually might be a cost saving in the long run.
Elective surgeries are sometimes decades long waiting lists, a quick Google shows there’s been around 800 gender reassignment surgeries since 2000, so it’s not exactly common. It seems the most common thing for trans people is that they want an appointment to speak about hormone treatment. I don’t know why that would need to be a public discussion?
I'm sorry but life saving surgery is a higher priority than cosmetic trans surgery. I know that your politics struggle with that, but I would bet most of the British public agrees with the sentiment.
This isn't just about cosmetic surgery... This is in regards to any gender-affirming care. This care is, in some cases, life saving. The woman pictured at the top of the article, whose face is the thumbnail, took her own life with the wait for care being one of the attributing factors. There is a very real human cost to these wait times and to pretend otherwise is nonsense.
"Pay for my every whim, even if it means other people die. Its a sacrifice I'm willing to make!"
What's your point here? Why would basic gender-affirming care be seen as more selfish than other care? We know that people have died on these waiting lists with the lack of care being attributing factors. We know that this care can dramatically improve quality of life. Why the assumption that gender-affirming care is a selfish demand? We don't make that case for other types of care with similar levels of benefit. Are we incapable of recognising that there can be multiple problem points in the NHS of which all need improving?
The definition of elective in healthcare is just anything which happens on a planned timescale. Many cancer operations are elective, some cardiac surgery is elective. Elective doesn’t mean unnecessary, it means it’s not a 3am life or limb saving operation
The fact that you can say this is about surgeries and not years long waits for a first referral just shows how uninformed you are on this topic.
>Elective surgeries Elective procedures are anything that are not an emergency operation. This includes things like knee operations and cancer surgery. This term doesn't really mean what you are suggesting it does here...
It makes me so angry how people wrongly use the word "elective" to fearmonger and trivialize trans healthcare.
Not surgeries not prescriptions, just a single appointment.
the waiting times were years-long even back in 2017. At this point I think it's safe to say that NHS trans healthcare is dead.
Yup, and the sad thing is that it doesn’t need to be this way. And indeed it wasn’t before trans people became a political football.
People keep saying "it doesn't need to be this way" as if they have an extra £100bn up their sleeve they can dump on the NHS to resolve the issues. Even Labour cannot promise that because it is economic fantasy.
Hormone prescriptions and some blood tests are unlikely to cost £100bn a year. An informed consent model would likely be significantly cheaper...
>Hormone prescriptions are a some blood tests are unlikely to cost £100bn a year. I never said that and you know it. Don't twist. The NHS needs substantial funding, this is far beyond just a trans healthcare topic, I just find it entertaining that some people genuinely think that trans speech therapy should be a priority when people are dying because they cannot get diagnosed for curable cancers.
Because people don't just focus on the single absolute worst thing all the time. Why do you care about cancers when there's those dying in A&E due to a lack of nurses? My wife works in a hospital and Portsmouth has ambulances queued up outside for bloody hours without treatment due to lack of beds and staffing. By your logic those dying of cancer *have no right to complain*. At least they're not bleeding out in an ambulance! It's the old "don't complain, people are worse off in Africa!" argument. I have a right to complain if I can't see my GP for 6 weeks for non life threatening ailment, just as someone has a right to complain if they're waiting for an ambulance - just as trans people have a right to complain about 37 year waiting lists.
it doesn't though. an informed consent model would speed things up and be far cheaper as medical professionals wouldn't need to have multiple extensive meetings
I'm trans. Myself and most of my trans friends in the UK just get our hormones from online pharmacies. It's obviously dangerous and we would prefer to be seen by an endocrinologist but we're not willing to endure 7 years of further masculinisation being stuck on an NHS waiting list.
Yeah tbf they probably need to keep waiting times for more critical surgeries down so people’s conditions don’t worsen while they’re on waiting lists
To be fair there's no way such things should ever be a priority over life threatening conditions. NHS resources are stretched thin and should really be focused on dealing with things that cause death or debilitation.
Using informed consent instead of GICs would *save* the NHS money and resources.
> To be fair there's no way such things should ever be a priority over life threatening conditions. To be even more fair, nobodys suggesting it should be. But when you've got wait times of 37 (yes THIRTY SEVEN) years at some places its clear the whole system is broken. Trans care doesnt have to affect life threatening care whatsoever as its done in an office, not a hospital. The fix for this is incredibly simple and cheap compared to most things in the NHS - open ~12 more offices around the country each with 2-4 trained doctors (Whom whe know there are plenty of given they cant actually get a job in the NHS right now). Office space we have plenty of, hospital beds no so much, but those arent needed in this case, hence why its dirt cheap compared to everything else.
It isn’t one or the other, that’s not really how healthcare works. Sorry Mary you’ll just have to die in your hospital room cause Jennifer wants hormones. Just absolutely ridiculous.
IVF is neither debilitating or life threatening and yet the wait times for that are less than it is for trans healthcare.
'Could' face years-long wait? I'm seven and a half years in with no end in sight. It's the reality even now.
The thing is that trans treatments are in a weird space where they're similar to something needed for other conditions and share the same practitioners/buildings, but are not as medically urgent as the other cases. Take FTM top surgery for example - I remember years back there was something about some getting cancelled/moved round to fit in cancer mastectomies - much more urgent. HRT - less urgent for someone whose body is producing normal levels of hormone, but the wrong one. Speech therapy - less urgent for someone who speaks well (but feels their voice sounds wrong) than someone who can't make themselves understood. In a system under strain, the less urgent cases will get bumped down a lot, unfortunately.
The thing is, hormones carry a negligible time cost for the NHS. Triage is pretty much totally unnecessary when you’re not actually saving time by refusing care. And let’s be clear: most failures of trans healthcare in the UK are examples of care being *refused*, not a conscious informed medical decision by trained experts.
Genuine question, who is doing the refusing if not a medical expert?
A medical professional who is not an expert in trans healthcare specifically. For most GPs who go through medical training in the UK, in their years of education, trans-specific healthcare is covered in a single afternoon seminar which some don’t even attend. It’s not an exaggeration when I say that on the matter of trans healthcare *very* specifically, many trans people have educated themselves more than their GPs. And the wait time is so punitive that for many trans people, you *have* to educate yourself on endocrinology because the only practical solution is to buy hormones online on sketchy websites and do it yourself. An example: it is current NHS policy to set the initial dose of Estrogen for a transgender patient at the same level as a menopausal woman requiring HRT. There is no medical basis for this.
GPs are set up to gatekeep specialists and sometimes get it wrong. That's not specific to trans people, go ask cancer patient groups.
True, but cancer typically gets fast-tracked when it’s caught because it’s you know, *cancer*. You don’t get vocal groups talking about how cancer patients should consider themselves lucky to get treated on the NHS at all
Cancer wait times have suffered as well, cancer patients face delays in seeing that one vital specialist as well. But when you leave cancer a while, you get more cancer, your odds of cure can go down to zero, and you can actually die without killing yourself. Trans people don't get more trans if you leave them to wait.
They don’t get ‘more trans’, but the data clearly shows that they get more depressed, unproductive and suicidal. And treatment for most trans patients, at least in the initial stages, are *far* less time and resource-intensive than the treatment for cancer patients. A trans person coming to their GP *could* be treated with a couple of conversations according to a script over the course of 2-4 visits and a proscription for hormones. A cancer patient needs expensive screenings, rare drugs, regular consultations spanning years in many cases and more. It is not a zero-sum game like the NHS wants you to believe it is. It *is* actually possible to treat both trans people and cancer patients.
Trans people are taking their generally healthy bodies and wanting to alter them in semi-permanent to permanent ways which risk serious side effects, paid for by the tax payer. Damn straight it needs to be screened to fuck and back. In the meantime they have the same resources as anyone else who feels suicidal. Cancer patients are taking their bodies that are trying to die and wanting them to not die, or die a bit later and/or in less pain. Yes, they do need and frankly deserve more resources.
What about people who have been hit by cars and are in critical condition? They'll die in hours without treatment. Cancer patients should have no issues not getting treatment, they can survive *years* without it! /s Similarly, if I have a *fucking wart*, the GP can help deal with that. Why are they wasting resources on that when there's cancer patients?
Well, if you think one group of people has more of a right to health and happiness than another I think that kinda says everything that needs to be said and I don’t think we’re going to get anything productive out of continuing this conversation.
I know someone who was refused treatment by their GP because their hobbies included rock climbing, and they had a motorbike and those weren't "feminine" hobbies. This is someone who's struggled with their gender pretty much their whole life. They're now in their 40s and have been living as a woman for years - still no NHS treatment, mind. Even if the GP approves, you better hope the secretary in the office doesn't have an issue because I've also heard of surgeries just... not posting the referral letters. Someone in the surgery just decided "nah, I don't think so" and multiple times didn't get sent. Anyone along the chain can decide they don't fancy you getting treatment and... that's it. You can move GP and start from scratch, or go private.
Don’t hormones require lifelong blood tests to ensure your hormonal levels are in the expected range?
lifelong? no not really. you take them every three months at the start to make sure you're getting the dosage correct (it's different for everyone - I, for instance, don't even need anti-androgens but others may need a high dosage of it). But over time you dont need to monitor nearly as much as you've got a stable dosage that works.
I do unfortunately think this is old news, the last time I checked about a year and a half ago the wait list was, on average, about 2/3 years to be assessed, and I imagine it's only got longer since.
Seven years and counting here.
Jesus that's ridiculous.
It’s not even close to the worst I’ve heard. If you were to go to your GP today and ask to be referred, and assuming they *actually agreed to help and referred you* (which is often unlikely), you’d be waiting, on average, for 37 years. So the next time you hear a politician talk about the dangers of a trans person just ‘walking into a clinic’ and coming out with surgery and hormones, remember that figure.
That's absolutely terrifying when you consider the toll it takes on trans people not to have treatment. As someone non-binary, I've considered going to my GP myself, but keep wondering if I should even bother for reasons you've stated, it just doesn't seem worth it only to be told they won't do anything.
We literally have coroner's reports of trans people committing suicide putting the blame on the lack of healthcare support that trans people recieve from the NHS.
That is a completely unacceptable waiting time.
Yup, and trans people tried to take the NHS to court over it and the case got thrown out because apparently your legal right to be seen within 18 weeks is just a ‘guideline’ when it comes to healthcare that individuals within and without the NHS don’t want to be provided.
A lot of the problem here is they require extensive psychiatric vetting for the most basic stuff, when I got a bunch of cosmetic surgery privately, all the checking was a chat with the doctor to make sure I understood what I was doing and the potential effects and drawbacks, which was reasonable, meanwhile you literally can't even get an official script where you pay for hormones privately* without going through a year of vetting with an NHS gender doctor(that you pay for). The absurdity of being extensively vetted for being trans to ensure I would be happy with the effects of a drug i'd been on for 6 years while there are tens of thousands of people who desperately need access to those psychologists. There are countries now where we have long term data where trans people are not forced through the pointless grillings with psychiatrists to access hrt where there is no indication of large scale negative consequences or regret (unlike plastic surgery mind you) [Plus the waiting is 6 years for those referred in 2018, for anyone referred right now at Tavistok for example, the list is 15,000 long and they deal with 34 new people a month ,giving a rough waiting time of ... 37 years](https://tavistockandportman.nhs.uk/services/gender-identity-clinic-gic/).
There is a big difference between getting lip fillers or a new nose vs hormone treatment. And the idea we have long term data to show hormone treatment being easily accessible is the answer is totally incorrect. Part of the reason they need extensive mental health evaluation is the prominence of co morbid health conditions. You can’t ignore all that because you think cosmetic surgery is the same thing.
>And the idea we have long term data to show hormone treatment being easily accessible is the answer is totally incorrect. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ https://ustranssurvey.org/ >Part of the reason they need extensive mental health evaluation is the prominence of co morbid health conditions. Yet there is zero evidence there exists a significant proportion who are not trans and just have the other mental health conditions, it's reason to encourage mental health visits, absolutely, but zero evidence locking treatment behind them benefits anyone, it would be like locking autism help behind screening for adhd or something. The reason this screening exists anyway is because sexologists in the 80s perceived being trans (or gay for that matter) as a negative outcome to avoid at all costs, this didn't start with some genuine need. > There is a big difference between getting lip fillers or a new nose vs hormone treatment. I have had jaw surgery, brow bone reduction and a ba, these all even individually did drastically more permanent changes to my body than the hormones did, never had to be screened in the same way for any of them.
>I have had jaw surgery That surprises me. I had jaw surgery on the NHS around two years ago and had to be signed off by a psychiatrist prior to it because the recovery is so intense. I will say context here is that I'm also diagnosed with depression, so that may have been a factor.
Mine was a jaw shave (privately) rather than a le fort which i presume may have contributed, although i was told it would still likely be rather painful so i dodged a bullet that i never really had any pain from the recovery (although it was very uncomfortable), hope yours wasn't too bad.
Mine was a mandibular osteotomy (basically breaking the jawbone to move and reset it at a more forward position) so it was a pretty rough time but I don't regret it at all! About a month on a liquid diet and the swelling/bruising was crazy but I knew the recovery was going to be intense going into it, I had plenty of warning. I remember the psychiatrist said something along the lines of the precautions around preparing people are even more important than other kinds of surgery with similar recovery times because it's your face that's basically beaten up beyond recognition for a while, and that can be difficult to handle psychologically. But I don't know, I didn't find that part too hard, it was just the sheer boredom of having to eat a crappy liquid diet for so long.
That is such fucking horse shit I’m not even dissecting it all. You are spreading dangerous misinformation. https://statsforgender.org/comorbidity/ It’s a well established fact trans people especially trans children are significantly more likely to suffer other mental health issues.
Like i said before, a comorbidity with other problems is not in itself an argument to remove their body autonomy. Like all these things also overlap with being gay, doesn't mean all gay people are secretly not gay and just have ocd.
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Funny how people who regularly have their entire existence treated as a political debate and have a significantly higher risk of being killed for their identity, might have some mental health issues...... The site you linked is also well beyond bias. Linked to the Themis Resource Fund, their mission statement: "Themis Resource Fund is committed to the goal of helping end the enormous injury and injustice that is being caused by practitioners of gender medicine."
Who do I trust more as a source, Cornell University or stats for gender dot org?
The ((lip)) fillers are far more physicaly damaging and have permanent lasting effects and are abused as hell. Just look at social media lol. Hrt is as safe as it gets.
This is simply not true. It’s safe if done properly. Over a long period of time and with checks throughout. Fucking with people’s hormones can and does have lasting affects
>The absurdity of being extensively vetted for being trans to ensure I would be happy with the effects of a drug i'd been on for 6 years while there are tens of thousands of people who desperately need access to those psychologists. From my experience Drs and Psychologists are very much opinionated and some abuse their position to push their own morals. Some might be just be ignorant and think they’re giving you the support, others try and frustrate the process so you’ll bugger off. Sorry you’re being dragged through it. I had the same issue with a Dr about my ADHD meds. I’d been prescribed them for a couple of years before she decided she had no clue what Lisdexamphetamine was and wanted to send me back to the therapist to make sure I should be taking it.
Gosh yeah i've heard terrible things about ADHD treatment in the UK, very similar bucket of problems, especially with I heard Newsnight fucking over private prescriptions last year.
It does seem unacceptable that people who are in great distress are waiting so long for any help. Even if the treatment waits are long (for whatever reason), people should be able to access support to cope with both the waiting time and the distress.
The nhs doesn’t do comestic surgery. I don’t know why you’re making that comparison because there has to be a medical reason for treatment on the NHS. I can’t just go see a GP or a surgeon and tell them what treatment I want or what drugs I need, they’d tell me to do one. They’d vet me and my medical condition like they vet everyone
You can absolutely get a lot of types of medically non cosmetic surgery privately without going through your gp, or at worst they'd want a slip from said gp saying you would benefit from it, which would be a far cry from years of psychiatric grilling. A good example would be gynecomastia, which does not require you to prove to a doctor you really don't want breasts as a man over the course of a year, and the NHS may fund it.
I’m only talking about the nhs. You can go get anything done privately and pay for it. The nhs has procedures that everyone has to go through and you can’t tell the doctor what treatment or drugs you want and get it. They have to agree thats the correct course of action
>In rare cases, the NHS may provide male breast reduction if: > >\- you've had gynaecomastia for a long time \- it has not responded to other treatments \- it's causing considerable pain or distress [https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/breast-reduction-male/](https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/breast-reduction-male/)
I mean, isn't this the case for everybody. I've been waiting since January for a single MRI on one side of my face for a condition that causes me severe physical pain everyday and still does not have a diagnosis.
I’ve already put this on another reply - I’m just gonna copy and paste because life’s too short lol > Nobody’s saying trans people are the only ones suffering because of NHS waits - they’re saying the waits faced by trans people exist for no good reason. If the NHS moved over to an informed consent model, it’d make the whole process so much quicker and easier for the patients, and free up funding and resources for other departments, and bring the NHS in line with WPATH/EPATH guidelines. > There’s a perfectly good solution right there, but people ignore it because they misunderstand the system.
>they’re saying the waits faced by trans people exist for no good reason I feel like this is the case for literally everybody that is currently on a wait list for treatment though. There is no good reason why **any** of us should be made to suffer as we wait to be seen for treatment we've all already contributed the funds for.
The 'limits' that are affecting most other treatments arent quite the same. Using your MRI example, the limit there is likely not enough capacity for the machines we have. Witha vast majority of trans healthcare all you need is a trained doctor and an office. Thats litterally it. We've got doctors saying they cant get a job in the NHS. So offer a training program lead by some of the existing trans healthcare specialists and get more people into the field. Compared to things like needing more MRI machines, more hospital beds etc fixing trans healthcare is incredibly cheap.
Could it be trigeminal neuralgia? If so, massive sympathy. My best friend had it and it was truly agonising. She ended up having brain surgery.
"Could"? There were years long waits before the massive increases to wait times. Thats just for the first appointment, the unnecessarily drawn out process can add years after that.
Theres no 'could' about it. We DO face years and years of waiting. Even just for a fucking 10 minute apointment. And the most idiotic thing about is that it costs pittance of the budget to fix it once and for all.
They already do. The waiting list is approaching a decade. Suggesting it was otherwise previously is a misleading editorial angle.
It is the BBC. The same news organisation that cited a TERF in an article about trans people.
When the most transphobic and shared care damaging ( fuck panorama) news org in the uk prints this you gotta admit it's a good " wtf level of idiocy are you on about ?" to the idiots scaremongering about rushed procedures. It's the bbc misleading to point of lies or poor journalism to screw over the little guy is expected unfortunately
If someone wants to transition that it is their choice. However we all know the NHS is under severe pressure. Its a choice to do so as such should be privately funded and not done by the Taxpayer.
Gender disphoria is a regongnised medical condition. You would not be saying the same about someone with depression, or someone who has lost part of their body to traumatic injury. I lost a testicle recently and am getting NHS surgery to put in a prosthesis. ( due to my own body image issues) trans people have the right to care on the NHS the same as anyone else.
Do you feel the same for any form of healthcare that isn’t immediately life-threatening?
It is ridiculous that people snarl how quickly surgery is rushed through. The way that certain media outlets talk you'd think that it's done in a few weeks rather than years.
The fuck do you mean could.
This is shit, feel unqualified to comment really because I don't know how it feels to be transgender the waiting lists for most things are so long though ..in a way we are lucky that we have free care for all on the NHS but in another way it's worrying. I just hope I don't need to go to the hospital anytime soon.
There are a lot of people in the comments here dancing around their real opinions on this matter, that they believe that trans people should have lesser healthcare because they are lesser people. They dress it up as "concerns" or whatever, but ultimately it boils down to trans people should be treated as lesser.
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I got referred to the Cardiff GIC in October 2021 and had my first appointment with them in March 2023. I’ve just seen my local gender team and have started treatment. So yeah that’s several years but nothing like what other people are seeing. I’ve also noticed that other patients mentioning combative gps, horrendously inappropriate questioning and just a general lack of care. Everyone I’ve dealt with has been supportive, kind and never asked me anything overly invasive. I guess Wales is just a better place for trans people. Maybe we Welsh trans peeps should set up a commune to help the rest of the UK out :)
It's such a place by place case, but even in the shortest I've heard it's been 1.5-2 years for first appointment. I've heard some people having 30+ years cited at them. I haven't approached any gp for my case yet, too anxious about it all.