Intended for healthcare professionals


Trans health needs more and better services: increasing capacity, expertise, and integration

BMJ 2018; 362 doi: (Published 08 August 2018) Cite this as: BMJ 2018;362:k3371

Gender dysphoria: assessment and management for non-specialists

I am your trans patient

Long term hormonal treatment for transgender people

  1. Ingrid Torjesen, freelance journalist, London, UK
  1. ingrid_torjesen{at}

Gender dysphoria clinics have seen a 240% increase in referrals in five years. Ingrid Torjesen reports on the steps towards better provision for the 1 in 50 set to question their gender

“No other specialised service has seen this growth, nowhere near it,” says James Palmer, medical director for specialised services at NHS England. He told the Westminster Social Policy Forum in London in June that a 240% increase in referrals to gender dysphoria clinics over the past five years means “there is absolutely not sufficient capacity in the system … There are currently around 7500 adults waiting for a first appointment.”

This is not a funding issue, Palmer added. Services received a 50% boost a couple of years ago, which had “limited impact.”

The problem is workforce: there are not enough staff in specialised clinics, and general practitioners feel ill equipped to deal with questions about gender. For example, many transgender patients require hormone therapy for life, which some GPs are reluctant to prescribe because the drugs must be used off-label; some trans people therefore decide to self prescribe and buy the drugs through the internet.

A lack of specialists has led to a spike in self medicating and mental health crises, says Jack Doyle, press officer and advocacy coordinator for Action for Trans Health, the largest UK based campaign for trans healthcare reform and support. “I know four trans people who have attempted or died by suicide in the past year while waiting for NHS care.” He adds that a lot of trans people are forced to seek out private options in the UK and abroad because of the rising waiting times.

A report on transgender equality published by the House of Commons Women and Equalities Committee in January 20161 found “serious deficiencies in the quality and …

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