Trans healthcare is in a state of emergency

With the release of the Trans Inquiry, Stephanie Farnsworth examines the health care situation which trans people must battle every day.


The Trans Inquiry has been long, arduous and unbelievably frustrating for the many desperately awaiting  improvements to the way in which the UK treats trans people. It’s finally here and while thorough in parts, there’s a huge sense of wondering about what exactly does come next. The government has a record on long inquiries but little being made of them. In fact, I’m starting to think that’s how our ridiculous bureaucracy was founded. The system of bureaucracy is gatekeeping trans identities.

The endless forms and confusing system is made to try to show that they are doing something while doing absolutely nothing, except leaving trans people isolated. This includes everything from obtaining a GRC to being able to access healthcare and if you’re non-binary you can practically forget your identity being recognised in any legal way. Endless documentation and loop-jumping is required for the state to give trans people what they are entitled to: recognition and support. Yet this is a system of crisis. Minor tinkering has not been enough and trans lives have been left to flounder; open to abuse by the public or being unable to access much needed support so that depression and self loathing often endanger lives. The risks of depression and lack of support can be shown clearly through the statistics: trans people are far more likely to die by suicide if they are not able to be able to transition than if they are.

The endless forms and confusing system is made to try to show that they are doing something while doing absolutely nothing, except leaving trans people isolated.

We’ve got our priorities upside down. Pride marches and the right to marry are important but why isn’t there as much attention for the fundamental issues causing agony and death to our community? Health care is the priority. Without good health care people die and that’s true no matter what the identity, so why is poor health care somehow acceptable for trans lives? The message (intentional or not) is that trans lives are worth less. Being able to access medical support to be able to transition should be seen as a form of emergency medicine, because it is. It’s an emergency intervention to stop depression, try to limit dysphoria and allow trans people the freedom to be. There was slanderous uproar when junior doctors went on strike this week (even though hospitals were covered) because of the perceived risk to patients lives yet there has never, ever in the history of the United Kingdom been enough doctors specialising in trans issues.

Without good health care people die and that’s true no matter what the identity, so why is poor health care somehow acceptable for trans lives? The message (intentional or not) is that trans lives are worth less.

The lack of funding has not helped this situation; as more people are waiting to be able to get an appointment at a Gender Identity Clinic there has little progress been made on how to fund these services. There is still the attitude by wider society that being able to transition is a “luxury” which the public should not pay for and this is perhaps why, or because once again trans lives just aren’t counted. Without funding though the situation will continue to stagnate.

Furthermore, there just isn’t the training so that even when trans people access healthcare not specifically related to gender (i.e. going to a local GP surgery) misgendering is common, as is a lack of confidentiality, humiliation by staff and a hostile environment which feels unsafe. That would be enough to damage anybody’s trust in a healthcare system which is supposed to protect people but trans people often have to go through this time and again to try to have any chance at being able to access the healthcare and support they need. It is a matter of life or death and the NHS is failing. It’s failing in its duty of care by allowing a culture of transphobia and not enforcing or bringing in appropriate training.

That would be enough to damage anybody’s trust in a healthcare system which is supposed to protect people but trans people often have to go through this time and again to try to have any chance at being able to access the healthcare and support they need.

There is also a lack of clarity and consent entrenched in the culture of trans health care. Examples of this include not being fully informed of medications and being called into a GIC but without being given a clear reason before which is about as daft as a GP demanding you pop in and scaring the life out of you as you have no idea what news or developments to expect.

The NHS also rarely consults with trans organisations which immediately gives the impression that they are not interested in supporting trans people. Trans communities know their bodies and issues and the NHS would do well to listen to them, particularly in light of the many criticisms it has received during this inquiry. There is a fundamental problem with a body of cis people dictating the medical treatment and future of trans people and not being willing to even engage with trans people. Unfortunately, the inquiry only goes part way to challenge this by not endorsing the Informed Consent model.

There is a fundamental problem with a body of cis people dictating the medical treatment and future of trans people and not being willing to even engage with trans people.

Gender Identity Services are still classified as being under mental health which immediately pathologises  trans identities. Trans people need to feel confident and safe within the NHS and so the first message they receive is not that they have a mental health issue as that is entirely different to their experiences. Many trans people do end up living with depression (due to society’s transphobia and the pressure they face in a lot of cases) but that is a mental health condition and different to experiences of gender dysphoria.

Young people also risk being left behind. Often unable to access the services they need or dismissed as not knowing what they want. There is little being done to tackle this as the prevailing belief in society seems to be that parents know best and young people cannot possibly understand themselves- despite children regularly asserting that they may be LGBTQ+. The culture of not accepting children and their identities is from the same branch of not accepting trans people in general. Children often bear the brunt of this as they are seen as possessions of their parents so their autonomy is routinely denied yet studies show the quicker someone is able to access the healthcare they need the less likely they are to experience depression. To withhold or deny access to services then is to cause harm and if we want to talk about protecting children then let’s really be honest about it and not let the sensibilities and moral conservatism of parents cloud what children really need.

There is little being done to tackle this as the prevailing belief in society seems to be that parents know best and young people cannot possibly understand themselves- despite children regularly asserting that they may be LGBTQ+.

The Trans Inquiry was fairly comprehensive but a collection of the changes needed is just the start that should have been made a long time ago. There needs to be pressing changes now and a commitment from the government (and MPs in general). They are supposed to serve all members of the public and not just the cisgender members. While we wait for MPs to come around and get over their own egos and bigoted ideas, trans people are dying.

Follow Stephanie on Twitter (@StephFarnsworth)

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