5 Things You Didn’t Know Being Trans in the UK ~ Max Slack

In the words of Trans activist and writer Shon Faye;

"By and large, the transgender issue is seen as a 'toxic debate', a 'difficult topic' chewed over (usually by people who are not trans themselves) on television shows, in newspaper opinion pieces and in university philosophy departments. Actual trans people are rarely to be seen.” - Shon Faye, The Transgender Issue, Penguin Press 2022. 

In short; it is incredibly important for the real experience of Trans people in the UK to be made clear, by those experiencing it directly. So, with this in mind, I’m here to delve into the top 5 things that most people don’t know about being Trans in the UK. 

It takes four to six years to start hormones or have surgery via the NHS.

Yes, you read that correctly. As of March 2022, of the 8 Gender Identity Clinics run by NHS England, the shortest waiting time was in Leeds, currently seeing patients referred in June 2018, and the longest in Exeter who are offering initial appointments to patients referred from July 2016. The London service, who update and share their waiting times monthly on their website, are currently offering first appointments to people who were referred in December 2017. 

Image ID: Current waiting list figures for the London Gender Identity Clinic, from their website, March 2022. 

So what does this actually mean for Trans people? The reality is that in order to medically transition (which helps people feel more comfortable in themselves, and present to the world in a way that reflects their identity) they will be waiting on average 59 months to begin the process. That’s nearly 5 years from when a Trans person makes the decision to medically transition, which can involve personal emotional distress, and often the loss of family support or employment, until they can access what is often life saving treatment. It’s also important to acknlowedge here that not all Trans people do have surgery or take hormones, and that medical transition is not a requirement of people who identify as Transgender.

If you aren’t able to wait, private care can cost you around £20,000.

With wait times increasing, it’s unsurprising that growing numbers of Trans people in the UK are turning to private medical services to help them.  On average, the process to start hormone replacement therapy (HRT) in the UK starts at £1500. Although once being treated the patient can make a request to their GP surgery to take over their care, this will usually still involve regular private costs.  It’s also worth noting that there is no legal expectation for NHS doctor surgeries to treat or support trans patients with their hormones or surgeries. 

 ID: Stonewall “Some people are Trans, get over it” protest sign”. Creator: Andy Tyler Photography. Copyright: Andy Tyler Photography 2014 - http://AndyTylerPhotography.co.uk

Gender affirming surgeries are even more expensive. With costs for upper body surgeries starting at £5000, rising to £27,000 for lower body surgeries. With most Transgender people requiring more than one procedure, the cost of being comfortable in your body can quickly add up. This is especially concerning when taking into account that in a 2018 Government LGBTQ+ survey, 60% of Trans people reported earning less than £20,000 per year. For many, these sorts of costs are simply not an option. One increasingly popular option is crowdfunding, with GoFundMe reporting a 26% increase in gender affirming surgery fundraisers between 2019 and 2020. There are also growing numbers of Transgender people self treating with greymarket hormones, which carries its own significant health risks. 

You will need to be “diagnosed” as Transgender before you can medically transition. 

The NHS England’s current commissioning protocol  (which has not been updated since 2013, and uses the outdated term “Transexualism”) states that: 

“After a period of assessment, typically two to four consultations shared between two clinicians, one of which must be medically qualified, a provisional diagnosis should be agreed”

In the reality of private care for Transgender people, this means that prior to hormone therapy or surgery they will need at least two hours of psychological assessment (usually at the cost of £200-£500 per hour). This is put into perspective by the fact that comparatively, there are currently no regulations that require a psychological assessment (or GP referral) to receive any form of cosmetic surgery or HRT in the UK.  

ID: A GenderCare instructive graphic on who to contact for gender dysphoria
 If you want the government to recognise your gender, you will need a certificate. 

A Gender Recognition Certificate (or GRC) is a government issued document that allows a trans person to correct their gender on legal documents. According to the gov.uk website “in order to obtain a gender recognition certificate, you need to be living as your chosen gender for two years”. On submission, a panel of “legal and medical” people will decide whether the GRC can be granted. Further to this, the government does not currently recognise non-binary gender identites, or include them under GRC applications. 

ID: A graphic from Shon Faye’s article on Gender Recognition Act reform

GRCs are only issued when a trans person can prove they have had medical treatment to transition, and are living explicitly as their “acquired gender” in all aspects of their life. This means that if a Trans person is not able to be out as Trans to their parents, or in their workplace (both of which are common for safety reasons), their request could be denied. Without a GRC, a Trans person can be denied a passport, pensions, inheritance, social security or government benefits. It can also affect their rights to privacy about their gender, and legal protections against discrimination. 

If you’re married, your spouse can stop you from legally transitioning. 

Under the Marriage (Same Sex Couples) Act 2013, if a spouse refuses to consent to their partners gender being legally recognised, the Trans partner can only receive an interim GRC, which is designed only to allow the marriage to be ended, and therefore blocks their access to correct other legal documents like passports and birth certificates. 

Although a vague improvement on previous legislation where there was no option other than divorce or annulment for a married Trans person, this law still allows for a spouse to block their partner from gaining a GRC for as long as a legal dispute may take.

On understanding the above experiences, it’s hardly surprising that a Council of Europe report released in January 2022 singles out the UK, alongside Hungary, Poland, Russia and Turkey for threatening LGBT rights, specifically highlighting “highly prejudicial anti-gender, gender-critical and anti-trans narratives”. 

This Trans Day of Visibility, we challenge you to take the time to read and watch resources created by Trans people who are attempting to live in this environment, and understand how you can help.