Being trans in the UK ‘feels impossible’. That’s why those who can are leaving this transphobic island
One of the difficulties in reporting on trans communities in the UK is finding the right balance: between how hard and exhausting it is to be trans here, and how powerful and joyful it is to be trans.
Too much of the first risks making being trans sound terrible, particularly to young trans people, too much of the latter risks glossing over the realities of living on this transphobic island.
It is also much nicer to write about trans joy. However, over the last few days, two exhausting and enraging things, which sadly no longer surprise most (any?) of us, are doing the rounds again. The first is the calculation that there is now a 26-year wait for a first appointment at London’s NHS gender clinic. The second is a thread by a young trans woman announcing she’s “leaving the UK because being trans here is nigh on impossible”.
She’s not the first and she won’t be the last – most of the trans people I know have given serious thought to leaving. And who can forget the trans woman who was granted New Zealand residency in 2017, on the basis that she would face “unduly harsh” persecution for being trans if returned to the UK? But what I’d add to the young trans woman’s powerful testimony is that it’s not being trans that’s impossible, in and of itself: it’s being trans AND poor.
While every trans person is different, some of us want – need – some form of gender-affirming healthcare. This might be therapy with a trans-aware counsellor, speech therapy, hormone therapy, electrolysis, or one or more gender-affirming surgeries. For trans people with gender dysphoria, we know that this healthcare is not just life-changing, it is life-saving.
The young trans woman who is leaving the UK has been waiting since she was 18 for an appointment at an NHS gender clinic. She’s now 23. After five years, she’s given up.
There are many others who’ve been waiting this long. Tens of thousands of trans people languish on NHS gender clinic waiting lists. There are seven in England and Wales, and wait times vary. But whether you’ve been referred onto a waiting list that is six years in Exeter or 26 years in London or to a gender clinic that doesn’t exist yet in Northern Ireland, who can actually wait that long? For those rich enough, you don’t have to – a growing number of private trans healthcare clinics offer a much faster service.
After your first appointment on the NHS, you wait another year or so for your second appointment. Then it’s roughly one to three years more before being prescribed hormone replacement therapy or referred for gender-affirming surgery, if those things are part of your transition. If you want surgery, you’re then put on another waiting list – it varies by location and by surgery, but from my own experience in London I know that the current wait time for top surgery is two years, plus however long the COVID-19 pandemic added to that, which is a currently unknown figure. If this list of wait times feels tiring and confusing to read, just imagine how it feels trying to navigate this healthcare system.
But if you go private, you could have your first appointment within months. Your second appointment could be weeks later, even, and with that a prescription for hormones.
The catch, obviously, is that each of these private appointments costs a couple of hundred pounds. And you’ll be paying for your hormones every month, as well as regular blood tests, instead of them being free on the NHS. You can even go from top surgery consultation to top surgery in a matter of months – if you’ve got five to 10 grand to pay for it. Other gender-affirming surgeries, like facial-feminisation surgery, cost several times that.
There are various pricing models privately and NHS wait lists vary by gender clinic, so it’s hard to give exact figures to compare a free NHS transition versus a private one. But what we can say is this: if you want to medically transition in the UK, you either need to be rich or capable of waiting upwards of five years.
The latter option is clearly unfeasible, not just for the young trans woman who’s leaving but as evidenced by the proliferation of crowdfunders set up by trans people raising funds to go private. As non-binary writer Radam Ridwan reported for Vice last year: “Trans-related healthcare has effectively ground to a halt across the country… Trans people wouldn’t have to turn to crowdfunding services like GoFundMe if there was adequate support elsewhere – but right now there isn’t.”
And trans people aren’t just crowdfunding for their transitions – right now, trans people in the UK are asking for money on crowdfunding websites to help pay their rent, unexpected bills, and for food and survival costs.
This should not comes as a surprise. One in three UK employers have openly admitted that they wouldn’t hire a person they knew was trans. Sixty per cent of trans people have a yearly income of less than £20,000, according to the government’s 2018 National LGBT Survey – and that was before the pandemic, which has had a disproportionate economic impact on lower-paid people. One in five trans people has had to claim government financial support during coronavirus.
Clearly, very few trans people can access private healthcare without crowdfunding for it. But relying on this community support does not guarantee you’ll raise enough funds, or the timeframe you’ll raise them in – there’s a sad joke about how we’re all just passing each other the same £20, round and round and round. But what are the other options?
When other countries have free trans healthcare that doesn’t take several years of waiting, better legal recognition, and better employment opportunities, the choice between staying and leaving is a no-brainer – if you have the resources to move. Some countries even have a government and media that aren’t virulently transphobic.
My friend C, a non-binary journalist, is moving to Australia next month. As well as being devastatingly sad on a personal level to see them go, their departure speaks to the unworkable reality of being trans and wanting medical transition in the UK.
“I am unbelievably lucky to have dual citizenship, so I have somewhere to go,” C explains, “but I wish it didn’t feel just straight up unrealistic to stay here and do the things I have wanted to do for my transition.
“It’s cheaper and easier to move to the other side of the world than it is to interact with the health economy here… being trans in the UK feels impossible.”
But however hard and exhausting the UK can be, it hasn’t stopped trans people supporting each other. Trans-led activist group We Exist started a national health fund for trans healthcare. During the pandemic, rather than hoping the state or charities would help, trans mutual aid groups sprung up. Trans artists like Travis Alabanza tackle transphobia with sell-out plays. Trailblazers like actor Ki Griffin and model Jude Guaitamacchi are on our screens and in our magazines. Queer activists fundraise to provide free therapy to Black trans people. Trans women like Katherine Foy run for election. Trans love is real.
Living on this transphobic island hasn’t stopped us from feeling joy, though it’s often more fleeting than it could be. That’s on cis people. It should be possible – is possible – for trans people to live liberated, joyful lives here.
And that’s what I’d like to be reporting on in future, please.
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