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National Health Service (UK) and transgender people

The United Kingdom has nationalized healthcare through the NHS (National Health Service). While some trans and gender diverse people have found the care to be adequate, many have experienced long wait times, sometimes a decade or more, for a referral to a specialty gender clinic. For that reason, many choose to make a gender transition outside the NHS system through private providers, through foreign providers, or through do-it-yourself options like ordering hormones online.

Background

The National Health Service (NHS) was established in 1948, founded on the principle of providing free healthcare at the point of use for all UK residents. Initially, the NHS focused on universal access to general and specialist medical care, but it did not formally address the needs of transgender people.

In the 1960s and 1970s, pioneering clinicians began offering support and medical interventions for transgender patients. The Charing Cross Gender Identity Clinic in London, established in the 1960s, became one of the first centers in the world to provide specialist gender care, including hormones and surgery. Charing Cross clinicians included John Bulmer Randell, Harold Delf Gillies, J.O. Dalrymple, Ashley Robin, Peter Philip. and Richard Green.

Throughout the late 20th century, transgender healthcare remained limited and inconsistently provided across the UK. Legal and social reforms, such as the Gender Recognition Act 2004 and the Equality Act 2010, helped secure rights and protection for transgender individuals, prompting the NHS to expand gender identity services.

In the 21st century, demand for gender-affirming care has grown rapidly, highlighting long waiting times and regional disparities. One clinic was reported to have a wait list with delays of over 200 years.

Healthcare for young people

Trans and gender diverse minors have faced special challenges under the NHS.

The Tavistock Gender Identity Development Service (GIDS), founded in 1989 within London’s Tavistock and Portman NHS Foundation Trust, became the UK’s only NHS clinic for children and young people questioning their gender. Initially small and research-oriented, it expanded rapidly in the 2010s amid rising referrals. Concerns grew over long waiting lists and the use of psychological assessment before medical intervention. Clinicians like Marcus and Sue Evans began openly criticizing the clinic, and anti-trans journalists like Hannah Barnes began writing pieces and books critical of clinical practices around the use of puberty blockers. In 2020, the Bell v Tavistock case challenged consent procedures for puberty blockers. Soon after, several anti-trans groups began actively campaigning to restrict or even ban all healthcare for minors.

Following a 2022 interim report of an independent review by pediatrician Hilary Cass, the NHS announced GIDS would close in 2023, replaced by regional centers. In 2025, NHS announced tightly controlled clinical trials for puberty blockers, to be managed by the Children and Young People’s Gender Dysphoria Research Oversight Board.

References

Sugg, Aaron (October 13, 2025). NHS conducting review as suicide of 17-year-old trans girl is deemed ‘preventable’ by coroner. Attitude https://www.attitude.co.uk/news/nhs-adult-gender-dysphoria-services-review-trans-suicide-499716/

Hansford, Amelia (October 6, 2025). Trans adults in the UK are waiting a third of their life for an NHS gender-clinic appointment. PinkNews https://www.thepinknews.com/2025/10/06/gender-clinic-wait-times-scotland-glasgow/

Collington, Faefyx (October 8, 2025,). Trans people have to wait an average of 25 years for care in the UK, new report finds. LGBTQ Nation https://www.lgbtqnation.com/2025/10/trans-people-have-to-wait-an-average-of-25-years-for-care-in-the-uk-new-report-finds/

Resources

NHS (nhs.uk)

The Cass Review (cass.independent-review.uk) [archive]