NHS urged to fix ‘deadly’ years-long waits for trans masc bottom surgery

Trans men and trans masculine people are being forced to wait years for lower surgery (phalloplasty or metoidioplasty) on the NHS.

The UK’s trans healthcare system has been in crisis for years, with little action taken. Currently, trans people seeking any gender-affirming care on the NHS must be seen by a Gender Identity Clinic, all of which have years-long waiting lists.

Some adults are being forced to wait more than five years for an initial appointment at London’s Tavistock and Portman NHS Foundation Trust GIC, which is seeing patients referred to them as long ago as 2018. 

The waiting time is longer in other regions of the UK: the Devon Partnership NHS Trust’s GIC is only now seeing people referred for an initial appointment in 2016.

Those seeking lower surgery, or the surgical creation of a penis, face even longer waits.

Activists at Transgender Action Block have warned that, if referred today, trans and non-binary people could be waiting “as long as four years” for phalloplasty or metoidioplasty.

The Block staged a protest outside NHS England in London on Sunday (2 April) to demand urgent action.

Pamphlets circulated at the protest explained that “severe mismanagement on behalf of the NHS” is behind the delays.

NHS-funded phalloplasty was suspended during lockdown, but in April 2021 PinkNews reported that contractual issues meant they had not resumed.

The NHS has contracted out the provision of such surgeries to St Peters Andrology, which operates at private hospitals. It was reported that St Peters failed to secure a contract with a hospital site to carry out the operations in time.

TransActual later reported that, according to an FOI response, the contract with St Peters ended on 31 March 2020.

The contract was later tendered and the NHS currently lists three London hospitals as providing “masculinising genital surgery”.

“Masculinising genital surgery has resumed now at New Victoria Hospital [in Kingston upon Thames], but there is a massive backlog due to the NHS’s mismanagement of the St Peter’s contract,” said Transgender Action Block.

“The waiting list has also been closed for new patients, and new referrals are being held by the Gender Dysphoria National Referral Support Services (GDNRSS).”

In March 2022, TransActual reported that 967 were on the wait list for lower surgery, with 1003 awaiting an appointment. At the average rate of the current provision, it said, the wait time would be four years,

Transgender Action Block said that hysterectomies were performed during the second surgery. However, they added, the New Victoria Hospital team “now performs hysterectomy as a standalone surgery, no longer as part of stage-two phalloplasty or metoidioplasty”.

This has added further waiting times and caused “additional dysphoria over having hysterectomy as a standalone procedure”, they added.

The group continued: “The NHS’s response to the situation has been completely inadequate. Waiting four years is not acceptable, people die on these waiting lists. Dysphoria can be deadly, and through the NHS’s incompetence, vital healthcare has been withheld from over 1,000 people on the masculinising genital surgery waiting list.”

Transgender Action Block is calling on the NHS to apologise to patients, offer mental health support and to fund surgery abroad for the people on the waiting lists. 

The group also demanded the NHS compensate trans and non-binary patients, especially those “who have suffered worsening complications due to the NHS’s mismanagement”; to prioritise patients with “severe complications who have been made to wait years” and offer NHS consultations as soon as possible so that trans people can “begin the long process of hair removal or weight loss if necessary”.

They also want NHS England to “recombine hysterectomy and stage-two phalloplasty and metoidioplasty”.

Transgender Action Block vowed continue to fight for the trans community because they have “nothing to lose but our dysphoria”.

The impact of such delays in treatment can be life-altering and traumatising for trans people

Access to gender-affirming healthcare can be life-saving for trans adults and young people, drastically decreasing the chances of suicide, depression and anxiety.

NHS England has a statutory requirement that at least 92 per cent of patients using the healthcare service should have a referral-to-treatment wait of no more than 18 weeks. But this isn’t happening for trans adults, who are waiting years to get their appointments. 

Consequently, a growing number of trans and non-binary adults have begun crowdfunding to raise money for private healthcare, travel abroad for treatment, or even turn to self-medication in a bid to continue their transition. 

In 2022, a group of trans people, trans-led charity Gendered Intelligence, and the Good Law Project were given permission to mount a historic judicial review against NHS England over the waiting times. 

In January, the High Court ruled that the waiting times were lawful but the groups are said to be appealing that judgement. 

PinkNews has contacted NHS England for comment.