One cheer for the press; one cheer for the media reporting this weekend on the parlous state of trans healthcare in the UK today.
One cheer – no more. For the story is already old, dangerously old. And in its telling the press has fallen, line and sinker, for the official misdirection that seems now de rigueur for any story that touches on trans issues.
In reports that patients are now having to wait as long as three years for an appointment at a gender identity clinic, it has been suggested that this is specifically because of the portrayal of trans characters in popular culture.
It’s true that this year has seen an explosion in public awareness of the trans-related; We are du jour. But the idea that trans is trendy and people are therefore rushing to transition is as daft, as laughable, as the idea that people once did it for the cheaper car insurance.
The seeds of the present crisis were sown a decade ago when respected trans support organisations such as the Gender Identity Research and Education Society (GIRES) warned of a steady upward trend in the numbers transitioning. The simple, obvious reasons were threefold. Firstly, a large, as yet unidentified cohort of individuals who would transition if they could: not massive numbers – but more than once was believed. Secondly, greater awareness, a side-effect of the internet. And last, but by no means least, not so much social encouragement as a diminishing of social discouragement.
Those in touch with the trans community raised the issue of these spiralling numbers, and the increasingly inadequate provision, in parliament long before 2015. The civil service and officialdom were alerted. Still, little happened. If anything, resources, particularly in the surgical sphere, seem to have fallen even further.
Meanwhile, the NHS has not helped itself. A service that should be mostly prophylactic, checking that candidates for transition were of sound mind and understood the consequences of their decisions, has expanded into gatekeeping and micro-management. Until recently, you needed to undergo a psychiatric assessment, be in full-time employment, and wear a skirt at all times if you were a trans woman, or not wear a skirt at all times if you were a trans man, to be considered. Thankfully, the last requirement is now mostly consigned to the history books. But it has always rankled, with trans folk and feminists alike, this idea that there is a “correct” way to perform gender – and this way is most appropriately policed by mostly male, mostly middle-aged “experts”.
The first requirement, for psych assessment, is variable: not needed in Scotland, recently abolished in England (though that news has still to filter down through the NHS), and is still demanded in Wales.
Imagine if the NHS set such hoops before they would treat a sprained wrist, or a cancer patient. Imagine the outcry. Imagine, too, the bureaucratic overhead, the delay. Yet such infantilisation of the average trans patient is apparently needed, because of potential regrets – despite much evidence to the effect that gender reassignment has one of the lowest regret counts of any NHS procedure (including cancer treatment).
Treatment comes. Eventually. Yet there is a major cost to delay, which is rarely factored into anyone’s equations. For what every trans person knows, whether they came out full-time and joyously at age 16, or crept out many years later after a lifetime in hiding, is the grinding awfulness of that wait: the knowledge that you are ready to move on, juxtaposed with the seeming glacial pace of the NHS process.
That is when depression sets in. And the self-harming, and risk of suicide, and everything else bad that the trans community has also been telling the media about for years.
Last week I sat through the saddest of occasions: an inquest. The tale that emerged to grace the weekend papers was that of a young trans woman, Synestra De Courcy, aged 23, who partied too hard, and one time too many, and who died of a drug overdose one night in July of this year.
What they did not hear – because such things are not spoken of at inquests – was her backstory: a mix of NHS incompetence and delay and rejection, as her parents have told me, that left a young vulnerable woman, then aged just 19, convinced that her only option was to find some way to pay for her own treatment.
This Synestra did – as do many trans folk failed by the NHS – through sex work. With the money she earned from this she was able to self-medicate, buying hormones over the internet.
Self-medication is always a risky business, because you can never quite be sure of the purity of hormones bought this way, nor whether the dose is as it says on the packet. Nor will anyone be checking the impact of this medication on your system: again, important if there are side-effects, if you are allergic or if you have any undiagnosed condition. Expensive, too. According to her parents, Synestra could be spending up to £500 a month on medication that would have cost the NHS a fraction of that amount.
And she was saving up for her op, which she hoped would take place in Thailand next year.
The lifestyle took its toll. She took other drugs – illegal ones – to cope with the emotional pain. She became addicted, received treatment and was in recovery at the time of her death. She survived assault and abuse.
In the end, her parents believe she made choices that were less safe, more likely to lead to the tragic outcome that came to pass, in part because of delay and difficulty in accessing NHS treatment.
This is the reality of NHS failure. Not just the raw waiting list statistics, but flesh and blood and pain. For Synestra, the story ended earlier this year.
For others, it goes on.
The gender surgery service provides male-to-female gender reassignment surgery.
Commissioned by NHS England, our service draws expertise from specialist nurses, surgeons and our partners at gender identity clinics, and provides the majority of male to female reassignment surgery in England.
Published: December 2017
Current statistics on gender reassignment surgery at Imperial College Healthcare NHS Trust:
As of 13 December 2017, there are 244 patients on the list for surgery. There are 81 patients actively attending outpatient clinics or awaiting surgery, and 163 are under the Trust's care but not ready for surgery immediately.
- 25 patients are waiting for their first outpatient appointment
- 7 patients are attending outpatient clinics in advance of surgery being arranged
- 32 patients have been given a date for surgery
- 163 patients are not ready for surgery immediately. This includes patients who are currently unfit, or who need associated treatment first
These numbers include 79 patients who are being cared for by a private provider under subcontract to the Trust.
During November 2017:
- we received 30 referrals
- 16 patients had primary surgery, including 6 operations performed at a private provider subcontracted by the Trust
"Changing your body to reflect your real gender isn't quick or easy, but it is a longer, lonelier road trying to deal with it on your own."
Chloe Oliver, a former patient of our gender surgery service, shared her story in the Autumn 2016 issue of Pulse, the Trust's magazine. Read her story.