For trans people under the age of eighteen in Wales, key services simply don’t operate. With no plans for their development in the near future, Ben Jones spoke to young trans people and their parents about the struggles they face when accessing gender affirming care.
By Ben Jones. Cover image, Trans+ Pride March in London, by Steve Eason.
The shocking state of trans healthcare in England was recently exposed, showng that it took up to seven years just to get an initial assessment.
But what about the situation in Wales? It’s a mixed picture.
Whilst a Freedom of Information Request submitted by voice.wales to the Welsh Gender Service revealed an improving picture for waiting times for transitioning adults, the situation is far more challenging for anyone under the age of e18.
For adult services, waiting times in Wales have reduced from a peak of 24-26 months in April 2022, to their lowest recorded in August 2023 – down to 13 months. This has happened whilst the demand has risen – from 723 referrals in 2019 to 1242 referrals in 2022.
However, younger people struggle to access any support whatsoever.
Parents of some of those who are transitioning spoke to voice.wales about their own and their children’s experience in dealing with the web of bureaucracy and delays in accessing vital healthcare.
One parent has also revealed that they have faced significant costs after being unable to access support in Wales, saying that they are paying £1,608 annually to support their child.
Charlotte – not her real name – whose daughter was accepted onto the Gender Identity Development Service [GIDS] waiting list in February 2021, said there had been an “absolute lack of support.”
“I would not wish this on any parent to have to navigate and deal with for their young person,” she told voice.wales.
“Financially we are being supported by grandparents to be able to meet our daughter’s needs.”
She faces a significant financial burden, with expenses totalling £1,608 annually, including a £30 monthly subscription, £30 every six months for a GGP Review, £12 every three months for prescriptions, and around £300 every three months for medication. Notably, these figures do not encompass expenses for blood tests.
The most damaging aspect of trans health care for teenagers in Wales is the fact that there simply isn’t any. Instead, they are referred to Tavistock in London, which is closing its children’s clinic.
Without specialised support here in Wales, those needing gender-affirming surgery are forced to travel to England.
As a result, those from Wales who are in need of treatment will share a waiting list with those in England awaiting surgery, which can be up to six years.
For young people, this long wait could be destructive, not just physically but also mentally.
Charlotte shared her daughter’s experience. “She is petrified of going through male puberty. There is just no way we could let that happen for her. The mental health risks and irreversible changes are just too significant.”
Charlotte expressed the lack of support they have encountered, highlighting the challenges parents face when navigating these circumstances for their children.
Her GP has expressed hope for improved gender services in Wales for those under 18, but uncertainties remain regarding the timeline of these developments.
Charlotte also noted potential risks linked to their use of a private puberty blockers service. These risks include the possibility of being referred as a safeguarding concern if seen by GIDS, the requirement for their daughter to discontinue blockers for separate assessments, and the potential refusal of prescribing blockers by GIDS, necessitating continued private payments until adult services are reached, amounting to a substantial £11,000 – £12,000 in total.
The failure also lies with negative attitudes towards trans young people, as she recently experienced first-hand: “We went to see a paediatrician about something unrelated the other day, and he asked me if it was MY choice that my daughter was transgender. I was gobsmacked.”
Dai and their daughter, Sarah – not their real names – also spoke to voice.wales regarding difficulties they have faced in dealing with the Gender Identity Development Service:
“My daughter waited years to see GIDS and is currently going through the very slow process with them,” Dai said. “We have managed to get a slot at Bristol but this is difficult logistically. I have to borrow a car from my father to get there. The travel adds a lot of stress onto my daughter who then has to go through the stressful appointment.”
Dai says that the Welsh Gender Service is generally better than GIDS in England, so the sooner it can be rolled out to young people in Wales, the better.
“Why can’t the service be offered to 16 and 17 years old as a first stage?,” they said. “A lot of young people are still waiting for first appointments at this age and could be seen much faster.”
According to Keira, a spokesperson for Trans Aid Cymru, a group which helps Transgender, Non-Binary and Intersex (TIN) people through mutual aid support, gender services across Wales are on the whole better than those in England, but still need improvement.
Wales has a central clinic in Cardiff and a satellite clinic in north Wales to reduce travel for patients, but for young people it is much more complicated.
“Right now, the children’s pathway for trans healthcare in Wales simply doesn’t exist. There is no healthcare,” she said. “Trans kids are being referred to an English service that doesn’t actually exist yet, and the wait time on that list is 5 years. For most kids, they will have aged out of the service long before being seen.”
“By not working to open a Welsh specific children’s service, the Welsh NHS and WHSSC are letting these kids wait over 5 years for healthcare, that if they do manage to get, won’t even be provided in their own country.”
For trans adults across Wales, waiting times for treatment is around 14 months, according to Welsh Gender Service, with referrals only being processed now for appointments that were made in January 2022. This is despite the fact that people have to travel to England for surgery.
This wait for adult surgery to be undertaken in Wales is also set to continue.
An FOI request by Trans Aid Cymru revealed that as of July 2023, The Welsh Health Specialised Services Committee (WHSSC)had no plans to initiate gender affirming surgeries in Wales.
Keira from TransAid Cymru, added, “The wait for hysterectomy is also incredibly complicated, despite it being a surgery that cis people need as well. The latest timescale we have heard for this surgery is six years.”
According to a Welsh Gender Service spokesperson, the service is classified as an ‘All Wales Service’, and there is, therefore, no difference in waiting time for an initial gender appointment, wherever in Wales a person lives.
