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The surgeons exploiting trans misery Desperate patients are turning to the private sector

Credit: Getty.


September 5, 2022   5 mins

It’s never been easy to get gender reassignment surgery on the NHS. More than a decade ago, when I was living in Birmingham, I was referred by a psychiatrist to a Gender Identity Clinic in London. NHS England funded seven adult clinics: none of which were anywhere near me. I had to take six days off work just to attend a series of brief appointments at the Charing Cross GIC in Hammersmith. My first assessment came in May 2012, six months after that referral. Four years later, I was eventually discharged after my surgery.

One could hardly call that efficient. But for patients today, my experience is the stuff of dreams. Waiting lists have ballooned out of all recognition. My former GIC in London is candid: “We are currently offering first appointments to people who were referred in January 2018.” Those people have waited four and a half years, merely to get to the starting line. But dig a little deeper into the data and the forward projections look even worse. In May 2022, there were 11,407 people languishing on the waiting list; just 50 of them were offered a first appointment that same month. This figure seems typical: in April it was 56, and in March it was 33. At those rates it will take between 17 and 28 years to clear the backlog. Typically, the clinic receives around 300 referrals every month, so with each month that passes, those waiting lists get even longer.

Elsewhere, the story is much the same. A GIC in Sheffield is offering first appointments to those referred in March 2018, while one in Exeter has seen nobody referred after June 2016. Behind this data, there are people stuck on waiting lists: almost 4,000 at Exeter in a queue that has stopped moving. The message from the clinic is stark: “Please do not contact the clinic to enquire about waiting times as our staff are very busy and we cannot provide any more information than is provided here. Thank you.”

With NHS services grinding to a halt, it’s not surprising that private clinics have sprung up to provide a faster alternative. Some clinicians are moonlighting alongside their regular jobs for the NHS. Consultant psychiatrist Dr Stuart Lorimer was brutally honest about his reasons: “Doctors have mortgages too, and my partner was on the verge of retirement
 I was looking for ways to generate more income.” A tidy income, it seems — Lorimer charges £300 per hour.

Meanwhile, the London Transgender Clinic, a private practice, was established by plastic surgeon Christopher Inglefield in 2015, “in response to a noticeable increase in enquires from transgender and non-binary patients. Many of these patients were unable to access quality and timely care from the overwhelmed NHS gender services.” But his fast-track pass comes at a cost. LTC’s guide price for the management of hormone therapy is £849 for the first year, and £468 per annum subsequently. And that doesn’t include the drugs: “LTC is not a licensed dispensary, therefore, we advise that you take your private prescription to your local pharmacy.” It’s a far cry from the NHS, where a prescription prepayment certificate costs just £108.10, and that covers all your medicines for the year.

While NHS surgery is free to the user, private patients pay the full cost themselves. LTC charges from £27,000 for male-to-female gender surgery, rising to at least £32,000 if a section of colon needs to be used. LTC is perhaps on the pricey side, but their fees are not off the scale. The Parkside Hospital in Wimbledon told me that, “it’s £23,000 for a vaginoplasty”. Alongside their private patients, Parkside has a contract to treat NHS patients — 132 of them in 2019. This suggests the NHS is paying north of £3 million per year to treat around a dozen patients each month.

 

This model is hardly sustainable, with the London GIC alone currently receiving more than 300 referrals per month. Even if the clinic somehow increased its capacity to assess those patients in a timely fashion, what happens next? While it is perhaps feasible for the world’s pharmaceutical industry to step up production of hormone therapy and blockers, surgery is a different matter. Vaginoplasty is a skilled job that few surgeons can do. In 2016, GRS surgeon Phil Thomas pointed out that “there are simply not enough people in Britain who know how to make a vagina”. His colleague Tina Rashid said, “attracting new surgeons into the speciality was extremely difficult
 GRS is a very niche area.”

As a result, the NHS system of Gender Identity Clinics is not only failing to deliver at present; it’s hard to see how it could ever deliver in the future. Even if, say, £100 million could be found every year to fund around 5,000 surgeries, it is futile if there is nobody to do them. A totally new model is needed, and we do not need to look hard for it.

Last month, the Tavistock and Portman NHS Trust announced the closure of their Gender Identity Development Service for Children and Adolescents (GIDS), the clinic for children who think that they might be trans. It was perhaps inevitable after the Cass review criticised the clinic as: “Not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.” It will be replaced by regional centres offering more “holistic care” with “strong links to mental health services”.

Adults deserve no less. Patients who should be assessed, screened for comorbid psychological disorders, and perhaps offered counselling are instead being consigned to seemingly endless queues — and told not to bother the staff. Adult Gender Identity Clinics are another broken system in need of replacement.

There is a certain mystique surrounding NHS gender clinics, but they are NHS services like any other, where clinicians meet with their patients and discuss their treatment plans. At the GIC the options are limited, or at least they were for me. I spent less than four hours in that consulting room. After two one-hour initial assessments, the clinic wrote to my GP to recommend hormone therapy: oral estradiol valerate and an injectable GnRH agonist — a “blocker” — that desensitised my pituitary gland, which in turn shut down the production of testosterone in my testes. Whether this is safe or not, nobody really knows. The drugs are not licensed for these purposes.

I had four further half-hour consultations. During that time, I was referred 200 metres up the road to Charing Cross Hospital for gender reassignment surgery. And that was that. No psychotherapy, and no psychiatry of note. Less than two months after surgery, I was discharged to the care of my GP. If any long-term research is going on, I am not part of it. I’ve had no contact with the clinic since 2016.

If gender dysphoria needs to be treated — and I think it does — then psychotherapy should be the first approach. It seems madness to proceed otherwise. Surely, we need to explore the issues thoroughly with a counsellor before considering hormones and surgery. Therapy can be provided locally and close to home; it certainly shouldn’t need a whole day out in London. And if surgery is what’s needed, it shouldn’t require choosing whether to pay a year’s salary or sit on seemingly endless waiting lists, with no support from the staff. A rigorous, judicious and efficient service is what’s needed. At the moment, it’s failing on every front.


Debbie Hayton is a teacher and a transgender campaigner.

DebbieHayton

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Arkadian X
Arkadian X
1 year ago

I may be a bigot, buy should gender reassignment surgery be on the NHS at all?

Debbie Hayton
Debbie Hayton
1 year ago
Reply to  Arkadian X

Whatever your feelings about the treatment itself, effectively gender reassignment surgery is no longer available to new patients on the NHS. Not for many years, anyway.

Last edited 1 year ago by Debbie Hayton
R Wright
R Wright
1 year ago
Reply to  Debbie Hayton

That’s good. Given that over 80% of those that present as gender dysphoric eventually desist and most figure out they’re merely homosexual the longer the better.

Jeremy Bray
Jeremy Bray
1 year ago
Reply to  R Wright

I know of one case where parents were themselves sent slightly mad by their son’s assertion that he wanted to transition at 18 and was entering the pathway to do so when sanity prevailed with him shortly before treatment started. The limitations of the NHS in this area may be a blessing although it is a pity that proper psychiatric treatment is not more available- but that applies to many psychiatric conditions and the NHS is already buckling under the demand for its services.

Last edited 1 year ago by Jeremy Bray
Lindsay S
Lindsay S
1 year ago
Reply to  Jeremy Bray

What doesn’t help are those who demand that it isn’t mental health disorder. They have little regard for those being misdiagnosed because they help boost their numbers, just collateral damage, i guess.
I would like to be more sympathetic to the plight of the trans people sat on waiting lists but at the end of the day, they are not the only people being failed by the NHS. EVERYONE is being failed by the NHS.

William Cameron
William Cameron
1 year ago
Reply to  Arkadian X

You are not a bigot. The N HS priority needs to be for those in pain and danger.

Arkadian X
Arkadian X
1 year ago

You never know these days…

Steve Jerome
Steve Jerome
1 year ago

I imagine the writer would , rightly, say that psychotherapy is somewhat urgent. Irrespective of outcome in relation to transitioning, many young people in this situation become severely depressed and even suicidal.

N Forster
N Forster
1 year ago

Funds would be better spent teaching people methods, tools and techniques on how to live life in a body which does not accord with their wishes, perceptions or desires.

Allison Barrows
Allison Barrows
1 year ago
Reply to  N Forster

I’d like to have Elle McPherson’s body, but I learned to live with my little 5’ frame all on my own, no one else’s money required.

N Forster
N Forster
1 year ago

I myself my been trying to get the world to affirm that I am as I perceive – as very tall, handsome and rich. Haters insist that this might not be the case.

Allison Barrows
Allison Barrows
1 year ago
Reply to  N Forster

Buy you a cuppa?

N Forster
N Forster
1 year ago

Then you could pretend I’m tall rich and handsome and I can pretend you’re Elle McPherson….

Richard Craven
Richard Craven
1 year ago

“The surgeons exploiting trans misery”
The “surgeons” castrating and de-breasting children are sadistic paedophiles.

Tom Watson
Tom Watson
1 year ago
Reply to  Richard Craven

I think this article’s all about adults – but there are worse Carthago delenda ests you could adopt.

William Shaw
William Shaw
1 year ago
Reply to  Richard Craven

The various factions involving themselves in this controversial issue will never reach an accommodation by resorting to ridiculously false accusations.

Doug Pingel
Doug Pingel
1 year ago
Reply to  Richard Craven

Richard – that’s the second time in a week that you’ve used the ‘paedo’ insult in this parish. As a man of letters I’m surprised that you have fallen into the same trap as Elon Musk. A female, on reaching puberty, is usually of little sexual interest to real “paedos”. How you want to describe those perverts who engage in sexual activities with people between puberty and the age-of-consent (in a particular society/country) is a diiferent matter. My concern over this mis-naming of people is triggered not so much by the Duke of York who whatever else he is (a lot) has not been charged with paedophilia but by the plight of a young woman 3 villages up my valley in Gwent. A mob from the local estate was about to torch her house when is was explained to them that the peado* was actually a Paediatric Nurse and even that job had to be explained to them.
*On a placard, I was told, held by one of the rabble leaders.

Caroline Watson
Caroline Watson
1 year ago

We should not be paying for this at all. It is a form of cosmetic surgery and we should only fund that on the NHS if the individual has a congenital deformity or has been mutilated in an accident or by cancer. The NHS should not be mutilating healthy bodies and the taxpayer should not be expected to fund it.
The current priorities of the NHS should be life-threatening physical diseases such as cancer, heart conditions and strokes.

Sharon Overy
Sharon Overy
1 year ago

A common theme amongst detransitioners is that everything snowballed – there was no real breathing-room, inadequate reflection time, in the process.

Annoying as waiting might be, it may be something of a blessing in disguise.

J Bryant
J Bryant
1 year ago

No doubt, in an ideal world, a person seeking gender reassignment surgery would receive extensive screening and psychological counselling before being referred for surgery. But, of course, we don’t live in an ideal world.
In the absence of adequate resources, perhaps the extensive waiting period before beginning the screening process provides time for a candidate, especially a young person, to thoroughly consider this radical decision and whether it’s right for them.
We read so much about coming scarcity in Europe this winter. It hardly has to be stated that scarcity is a bad thing. But perhaps sometimes scarcity is a blessing when the desired service has such a permanent, life-altering outcome.

John Scott
John Scott
1 year ago

“Vaginoplasty is a skilled job”–no it’s not, it is sadistically experimenting on people that need help.
Castration, ovary removal, and breast removal–these surgeons (and authors) are sadists. What happened to the “Do no harm” ethic?
Condemning people to be medically dependent on drugs for life, removing an individuals ability to have sexual orgasms, destroying their ability to have children, erosion of women’s hard earned rights, and the blatant homophobia being advocated by this authors and money hungry (at least the author is honest about that) “surgeons”.
Come on Unherd. We want some original reporting–not this kind of endless Stonewall propaganda that we are bombarded with by the mainstream media and mindless government bureaucrats.

William Shaw
William Shaw
1 year ago
Reply to  John Scott

This needs to be discussed sensibly.
Not by calling surgeons sadists.

Julian Farrows
Julian Farrows
1 year ago
Reply to  William Shaw

Exactly. I maintain that lobotomists and phrenologists were deeply misunderstood too.

Charles Lewis
Charles Lewis
1 year ago

There is, of course, a world of difference between adult transition, usually done to prop up a failed life with sexual titillation, and the wholesale and permanent wrecking of a child’s body, externally and internally, Sunt lacrimae rerum.

William Cameron
William Cameron
1 year ago

Surely cancer patients should be first. And then hip replacements and heart valves. And when all of those are done and there are no waiting lists the NHS can offer these sorts of services.

Jane Watson
Jane Watson
1 year ago

GRS surgeon Phil Thomas pointed out that “there are simply not enough people in Britain who know how to make a vagina”
.

Where to start?

ormondotvos
ormondotvos
1 year ago
Reply to  Jane Watson

Oh, how about “people with vaginas”?

Hardee Hodges
Hardee Hodges
1 year ago

psychotherapy” – Most certainly. Surgery seems like the most drastic step one could take and I would imagine it more like cosmetic work than not. As such should the public be on the hook? A lot of transition involving only hormone control seems adequate and the drugs are cheap. A GP can generally examine blood markers for control to avoid serious complication. Given many men now have moobs unless overly endowed, what’s the point of removal for F-M? Nobody cares much anyway and padding for M-F seems OK to fit a style.
Of course, I’m not in the group so hardly appreciate the issues involved. I’ve had M-F friends who were mannish women but were quite comfortable in their chosen style.

Rasmus Fogh
Rasmus Fogh
1 year ago

A long discussion including some good and measured contributions has disappeared. Could we get it back, please? Even if the starting comment was a bit on the rough side?

Now fixed. Thanks.

Last edited 1 year ago by Rasmus Fogh
Michael Friedman
Michael Friedman
1 year ago

Can anyone? in good faith, question the wisdom of insistence of (seriously) competent and licensed therapists to perform a holistic evaluation of someone who presents with gender dysphoria before even considering such drastic interventions as hormone treatment or surgery? Why would anyone rush?

Michael Friedman
Michael Friedman
1 year ago

Thanks so much for this

Martin Johnson
Martin Johnson
1 year ago

Let’s get real. The huge spike in numbers of people seeking reassignment surgery is almost certainly in large part due to social pressures. Even if I stipulate, arguendo, that they all should be seen promptly regardless of how “real” is their condition (unknown on an individual basis before they are seen), how reasonable is it for NHS to enormously increase its capacity in this area, at the expense of everything else, when it is quite likely that this social situation will change in a year or two or five and leave them with a lot of misallocated funds and underutilized vaginoplasty specialists while other needs like cardiac or cancer care are not being addressed?
These things are complicated and deal with an unknown future. Allocating funds between needs is not a simple moral issue with a clear answer..

Last edited 1 year ago by Martin Johnson
William Shaw
William Shaw
1 year ago

“The surgeons exploiting trans misery“
A headline chosen to attract views I assume? An unworthy artifice.
If it were true then the same thing could be said about plastic surgeons performing nose jobs, face lifts, liposuction and breast implants.
In fact the same nonsense claim could be made about any doctor treating cancer patients or anyone else who is ill and suffering.
Whoever chose the heading needs to do better.

Last edited 1 year ago by William Shaw
Julian Farrows
Julian Farrows
1 year ago
Reply to  William Shaw

There is a world of difference between non-essential cosmetic surgery and cancer treatment.

William Shaw
William Shaw
1 year ago
Reply to  Julian Farrows

The trans issue certainly produces strong and uncompromising opinions in bystanders.
I refer the question to Debbie and would like to hear her opinion on this point.
Does she agree with the wording of the headline?
Are surgeons truly exploiting trans misery, or are they simply doing their job, filling a gap in NHS services, and helping sometimes desperate people get the help they want?
Elsewhere in this thread John Scott called them sadists
 a description I consider to be extremely unhelpful and with which I disagree. I’d be interested in her opinion on this point too.

William Shaw
William Shaw
1 year ago
Reply to  William Shaw

You started this Debbie.
What’s your opinion?
I’d like to know/

Penny Adrian
Penny Adrian
1 year ago

Thank You Debbie. It seems as if trans people are being failed in every way by the medical profession.

Julian Farrows
Julian Farrows
1 year ago
Reply to  Penny Adrian

Yes, that is the deepest tragedy of this eugenics movement: thousands of people needlessly allowing themselves to be genitally mutilated because of a social media trend.

ormondotvos
ormondotvos
1 year ago
Reply to  Julian Farrows

Corrective eugenics? Isn’t that a contradiction in terms?
No genes are bing altered or suppressed.
Maybe it’s body dysphoria, not “gender dysphoria”
When I was sixteen, and living in Key West, snorkeling the reefs, I deeply resented having to come up for air.
I’m over it now.

R Wright
R Wright
1 year ago
Reply to  ormondotvos

It’s eugenics because when you’re chemically castrated oestrogen a la Alan Turing you’re unable to produce gametes and are therefore sterile. Some people have called the trans movement a disguised anti-autist eugenics programme given that so many gender dysphoria victims have ASD.