Just weeks ahead of the closure of the Tavistock clinic—U.K.’s only gender identity clinic for youth—NHS sources told VICE that there are “no locations, no staff, and no services” in place for trans youth in the U.K.
The potential care gap has advocates greatly concerned. “The system is already in crisis, with waiting times that can span multiple years,” a spokesperson from U.K.-based LGBTQ+ organization Stonewall UK told Xtra in a statement. “If the transition between the Tavistock and interim service providers is not handled with great care, children and young people will be left without support, and at risk of significant harm.”
In July 2022, NHS England announced that the Tavistock Gender and Identity Development Service (GIDS) clinic would close by Spring 2023 after it was criticized in an independent review for high caseloads and poor leadership. The service said that it would be replaced by at least two regional service centres that would purportedly reduce waiting times. The author of the review, leading pediatrician Dr. Hilary Cass, clarified that “the purpose of the regionalized model is to improve access, networked care, research capacity and workforce development.” A representative from NHS England told VICE that the regional centres would be ready on time and that the NHS is still assisting trans youth with gender care.
However, many NHS staff believe that this deadline is unrealistic and will leave trans youth seeking services in limbo. “We’re six months down the line, and NHS England has still given us no indication whatsoever about what’s happening to our jobs, or our pay and whether we’ll be able to transfer into the new services,” said a clinician working at GIDS, who wished to remain anonymous, speaking to VICE. The clinician claims that as a result of this lack of communication, many staff members have left GIDS.
Another doctor, who also wished to remain anonymous, claims that “staff with years and years of experience dealing with transgender kids, and children dealing with gender identity problems” are being pushed out—which is concerning, because “trying to recruit qualified people into these services is an absolute nightmare.”
“There are no employees signed up to move, there is no training for wider NHS staff and our waiting lists are paused. The reality is that we have to accept there is currently no NHS service for transgender young people, and there is unlikely to be any service made available to them in the near future,” one anonymous senior doctor told VICE, adding that “[all they] can really do now is wrap these trans kids up in cotton wool through these difficult years with no support, and then get them as ready as possible to get into adult gender services when they hit 18.”
GIDS was first launched in 1989 to help queer and trans youth. In recent years, there have been several attempts to shut it down by former staff and former patients. The clinic has also been plagued with management issues and a long waiting list of over three years. In 2022, Alice Litman, a 20-year-old trans woman from Brighton, died by suicide after waiting nearly three years for gender-affirming healthcare at the GIDS. Her parents believe that she died partly because of the inaccessibility of gender-affirming healthcare in the U.K.
According to Reuters, other trans youth stuck in limbo are turning to puberty blockers and hormone therapies on the private market with organizations often based overseas—which come with their own drawbacks. Miles Pitcher, a 17-year-old trans youth, turned to private provider GenderGP, which is registered in Singapore and beyond NHS supervision, to get testosterone after languishing on the GIDS waiting list for three years. However the two doctors who run the private online clinic have both been sanctioned by official medical tribunals for gender care for not properly assessing patients.
Teens like Pitcher might find it even more difficult to get gender-affirming care under the new NHS draft guidelines released in October (the NHS has declined to clarify when they will be implemented). Per the guidelines, if NHS professionals decide a patient should not be taking puberty blockers or hormone treatments obtained on the private market, they can initiate “safeguarding protocols” that inform representatives of the police, medical and social services professionals responsible for a child’s welfare. “No one should be purchasing illegal, unknown and potentially life-threatening drugs online,” said NHS England medical director Dr. Stephen Powis to Reuters in a statement earlier this week
These measures run counter to the guidelines of the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that works closely with the WHO to draw up the most widely adopted standards of healthcare for trans youth. WPATH’s guidelines state that a young person’s exploration of their gender identity should be supported, and that medical interventions at or after puberty should be an option after a comprehensive assessment.
Advocates are very concerned about the situation of trans youth in the U.K. “Trans and gender-questioning children and young people, along with their families, deserve high quality, timely access to care that is provided close to their homes,” said the Stonewall UK spokesperson. “The Department of Health and Social Care and NHS England have a duty of care to these young people. They need to guarantee that no deterioration or gap in care will occur.”
In the meantime, trans youth continue to be impacted by the hostile public discourse around their lives. “The political climate is really disheartening,” said Jay, a trans youth from Warwickshire to The Guardian, “and the media presents this image of trans people being a threat to your everyday lives, whilst I’m scared about going to a pub with my colleagues because I don’t feel safe in either toilet anymore. I would love to be out and proud every day, but at the moment that’s just not possible.”
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