Trans people wait years for gender health care as demand increases stock photo

LONDON / ATLANTA – When British tattoo artist Eva Echo mustered the courage to declare herself transgender, she quickly sought specialist medical attention to help her transition. More than four years later, she is still waiting for her first date.

Echo, who is part of a potential court challenge by England’s National Health Service (NHS) over wait times, said the delay “drowned” her in gender dysphoria – the distress caused by the gender identity of a person that does not match their body.

“There is no way of knowing where I am on the list or when I am likely to be seen,” said Echo, 41, who lives in Britain’s second largest city, Birmingham.

“I feel like I’m in limbo – my life is on hold. “

As greater awareness and acceptance lead more people to come across as trans around the world, wait times for gender care are skyrocketing, even in wealthy countries with health care benefits. relatively generous funds financed by the State.

Britain has public health and gender clinics, specialist centers that assess people for cross-sex hormones and refer to procedures such as hair removal and gender-affirming surgeries, but long waits push. many trans people go private.

Some trans patients and rights activists say the delays amount to discrimination and neglect.

Echo estimated that she had spent around 30,000 pounds ($ 40,000) on private doctors since her first visit to her local doctor in August 2017.

She is one of four people, two under the age of 18, supported by legal advocacy group Good Law Project (GLP) who are considering legal action over the wait for an initial consultation of up to four. or five years for adults.

“We are now preparing to launch judicial review proceedings against NHS England,” a GLP spokesperson said.

“We think they haven’t done enough. Trans people have heard this story many times and the situation continues to deteriorate. “

The NHS said it was doing its best to respond to strong growth in patient numbers.

“We have seen a significant increase in demand for gender identity services as more and more people feel able to ask for help,” a spokesperson said via email.

“People are desperate”

Trans people have to “jump over major hurdles” to getting transitional health care in many countries, said Masen Davis, executive director of human rights group Transgender Europe (TGEU).

“Long waits for publicly funded or subsidized health care, challenges in finding a doctor, and providers and insurances forcing trans people to justify why they need care are common around the world,” he said. he declared.

Advocates of systems that force trans people to wait for certain care or to have a psychiatric diagnosis of gender dysphoria claim this reduces later regrets, but many trans advocates criticize what they call “babysitting.”

A Cornell University research summary found that between 0.3% and 3.8% of people regret going through a medical transition, with most data showing that it has improved their well-being.

Sam, who uses them and them pronouns, has been trying to access gender reassignment surgery in New Zealand since 2012 and has been on the waitlist since 2014.

“I still have no indication of when I might have surgery,” they said, asking not to give their real names for reasons of confidentiality.

Just over 300 people are awaiting the procedure, the health ministry said on October 31 on its website. Five surgeries were performed in 2020 by the country’s only surgeon, after COVID-19 delays, and nine so far in 2021.

In 2019, the government pledged NZ $ 3 million ($ 2.1 million) over five years to address the backlog.

“The ministry is currently working on capacity enhancement,” a spokesperson said via email.

Sam had to take testosterone first and have a double mastectomy, known as upper surgery, though doctors said wait times made it a long shot.

Eventually traveling to Thailand to undergo the procedure privately in 2014, Sam noted that the COVID-19 pandemic had prevented other transgender New Zealanders from going abroad for treatment, further lengthening waiting lists. at their home.

“People are desperate,” Sam said.

Years of waiting

Long delays in England to access care for transgender people under the age of 18 – who have a waiting list of at least three years, according to the website of England’s only gender clinic for young people – have already sparked complaints from transgender children and their parents.

But Echo and other activists also want to highlight the plight of trans adults who wait years to see a specialist.

More than 21,000 people are currently on the waiting list at the seven adult care clinics in England, according to information on their websites or access to information requests posted on various platforms.

Patients have to wait just over four years on average for a first appointment, according to a Thomson Reuters Foundation analysis of the hours listed on their websites.

Those waiting for multi-stage penile construction surgeries have had longer delays in starting or completing procedures, with long waits for follow-up or correction operations, according to an October survey of 193 people by the advocacy group TransActual UK.

“It’s been two years and a month since I had my stage 1 surgery,” said Chay Brown, director of TransActual, who learned this month that “more” surgeries would resume in March after changing. practically stopped for two years.

“As a group of people, we’ve been completely ignored,” Brown said.

An NHS spokesperson said by email that doctors began consultations with patients last week and “surgery will start shortly”.

Last year the UK government announced three pilot clinics it said would cut waiting lists by at least 1,600 by 2022 and later added a fourth program.

Elsewhere in Europe too, policymakers are striving to align their health policies with the demand for gender identity treatment.

In Germany, which has a public-private health care system, the new center-left coalition government has pledged pro-LGBT + policies, such as requiring insurance companies to fund gender-affirming care. , including surgeries.

German insurers now often deny funding for surgeries, forcing patients to appeal and leading to wait times of up to five years, according to Bundesverband Trans *, an advocacy group.

Spain’s government has also proposed that gender-affirming healthcare be fully state-covered in an LGBT + rights bill submitted to parliament earlier this year.

‘Life and death’

In the United States, most insurance policies cover hormones, but do not count surgeries as “life-saving care,” which means patients must provide additional documentation, such as a diagnosis of gender dysphoria, to be diagnosed. persuade insurers to cover them.

“It just reduces the availability of this care, so it’s really a systemic problem,” said Dallas Ducar, managing director of Transhealth Northampton, a trans clinic in Massachusetts.

For Scottie, a trans woman from Minnesota who declined to give her last name, that meant nearly two years of calls to try to access facial feminization surgery, a process that she says l ‘had made one feel “sub-human”.

After she finally convinced her insurer to pay, it turned out the surgeon had left the state, meaning she had to find a new one and start the appeals process all over again.

“Facial feminization for me is life or death,” said Scottie, who now has a surgery date of 2022, having further delayed it by COVID-19.

“Unfortunately… dysphoria is still seen as a trend. “

($ 1 = 0.7436 pounds)

($ 1 = NZ $ 1.4399)


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