What it's really like to access gender affirming healthcare as a young trans woman

Miss­ing Voic­es is a new series from Huck cen­tring and plat­form­ing the voic­es of those ignored or left out of some of the biggest debates in politics.

It is not unrea­son­able to say that trans rights are under intense polit­i­cal and soci­etal scrutiny. 

From the media fren­zy sur­round­ing the Scot­tish Government’s reform of the Gen­der Recog­ni­tion Act (GRA); to ridicu­lous­ly long wait­ing times for youth and adult gen­der ser­vices (exac­er­bat­ed by the government’s response to the Cass Report); what I see as the trans­pho­bic oppo­si­tion to Scotland’s new hate crime laws; and England’s draft school guid­ance which res­ur­rects the spec­tre of Sec­tion 28 by advis­ing teach­ers to forcible out chil­dren ques­tion­ing their gen­der iden­ti­ty to parents. 

Unsur­pris­ing­ly, many trans peo­ple and their fam­i­lies are right­ful­ly con­cerned about what the future holds. This con­cern is ampli­fied by the con­sis­tent fram­ing of trans people’s lives as a valid ​‘debate’ or ​‘dis­cus­sion’, irre­spec­tive of many of us dream­ing to be regard­ed as the ordi­nary peo­ple we are.

I’m a 26-year-old trans woman who lives in Glas­gow. I’ve been out since 2020 but remem­ber ques­tion­ing my gen­der from a very young age. Since com­ing out and begin­ning my med­ical tran­si­tion, I have begun work on a PhD in Trans­gen­der Cin­e­ma, with a par­tic­u­lar focus on films which decon­struct and sub­vert com­mon trans nar­ra­tives. These films offer a per­spec­tive on trans lives and expe­ri­ences which are dis­tinct­ly trans and do not con­form to main­stream sensibilities.

Despite com­ing out three years ago, and quick­ly refer­ring myself to a wait­ing list to be seen at a gen­der iden­ti­ty clin­ic (Glasgow’s Sandy­ford Clin­ic), I have been unable to access gen­der affirm­ing care on the NHS, as the wait­ing list has remained stuck in 2018 for the last four years. To say this has been frus­trat­ing and dis­heart­en­ing would be an under­state­ment, and my expe­ri­ence is cer­tain­ly not unique, with many friends of mine also lan­guish­ing on sta­t­ic wait­ing lists. 

The lack of any pro­vi­sion of care while on GIC wait­ing lists has been extreme­ly dis­tress­ing and it has often left me feel­ing aban­doned by the very sys­tem which should be sup­port­ing me. With no end in sight to the now six year long wait­ing list, it is hard to remain hope­ful that I’ll ever be able to access gen­der affirm­ing care through the NHS, forc­ing myself and oth­ers in the com­mu­ni­ty to turn to oth­er means.

I am in the for­tu­nate and priv­i­leged posi­tion of being able to afford pri­vate health­care and have been access­ing HRT through YourGP in Edin­burgh for almost a year now. While this has been a mas­sive­ly pos­i­tive move for me, it is sim­ply not finan­cial­ly fea­si­ble for all trans peo­ple to access health­care in this way. Trans peo­ple should not be denied vital, gen­der affirm­ing care due to finan­cial bar­ri­ers or inex­orably long wait­ing list times. Sad­ly, how­ev­er, this is the real­i­ty fac­ing many trans peo­ple in the UK.

Despite being able to access HRT pri­vate­ly, I have still come up against frus­trat­ing and exhaust­ing bar­ri­ers in my tran­si­tion, first and fore­most amongst this – the very process of being diag­nosed with gen­der dys­pho­ria in the first place. Trans peo­ple in the UK are cur­rent­ly required to receive a for­mal med­ical diag­no­sis of gen­der dyp­sho­ria in order to be pre­scribed HRT. This meant that I was required to ​“prove” my transness to oth­ers in order to con­vince them that I would ben­e­fit from hormones.

The only way to do this is through attend­ing mul­ti­ple appoint­ments at a Gen­der Iden­ti­ty Clin­ic as GPs are unable to pre­scribe hor­mones for trans peo­ple. I was first required to describe what was referred to as my ​“gen­der his­to­ry” to a doc­tor, essen­tial­ly hav­ing to explain why I am trans. This was then fol­lowed by a psy­chol­o­gist assess­ment in which I had to give over the same infor­ma­tion. After this came a three month ​“reflec­tion peri­od” before I was pre­scribed hormones.

This in par­tic­u­lar seemed laugh­able con­sid­er­ing the con­sid­er­able time and finan­cial expense involved in get­ting seen at the gen­der clin­ic in the first place. There is a nar­ra­tive in the media that trans peo­ple, espe­cial­ly trans young peo­ple, are being ​“rushed” into mak­ing deci­sions about med­ical­ly tran­si­tion­ing. This couldn’t be fur­ther from the real­i­ty: it is a long, men­tal­ly drain­ing and often expen­sive process.

Since start­ing HRT I have noticed a mas­sive change in how I’ve seen myself. I’ve felt far more set­tled and at home in my body. It was the right thing for me, and I knew this long before I came close to enter­ing a gen­der clinic’s doors.

I would like to see a stream­lin­ing of the tran­si­tion process, involv­ing a decen­tral­is­ing of Gen­der Iden­ti­ty Clin­ics and a demys­ti­fy­ing of the tran­si­tion process, enabling GPs to pre­scribe HRT under an informed con­sent mod­el. This would allow trans indi­vid­u­als to make informed deci­sions about their bod­ies with­out the need to be pathol­o­gized in a drawn out and need­less process. I would also like to see fur­ther efforts to des­tig­ma­tize tran­si­tion­ing, par­tic­u­lar­ly when con­sid­er­ing trans young peo­ple who may be ques­tion­ing their gen­der. It often feels as if tran­si­tion is treat­ed as a ​“bad result” for young peo­ple, when it can in fact be a joy­ful moment of self-actualisation.

Mer­maids is a char­i­ty doing vital work in sup­port­ing trans youth and cam­paign­ing for their rights across the UK. Their work is key in giv­ing young peo­ple and their fam­i­lies time and space to explore their gen­der iden­ti­ties, some­thing we des­per­ate­ly need to see more of. Trans peo­ple, and espe­cial­ly trans youth, need our sup­port now more than ever. Our Trans Youth Man­i­festo out­lines exact­ly what our young peo­ple need from the next gov­ern­ment (out on the 11^th June) This elec­tion, demand better.

Read more Huck Elec­tion con­tent here.

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