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Transgender healthcare inequality: The life and death battle for adequate treatment

Claire T. Coulthard explores the inequalities within our healthcare system for transgender patients.

The right to universal healthcare without discrimination, and the ability to access such healthcare, has been a point of major contention for the transgender community within the UK for decades, with progress towards this goal achingly slow and often times intermittent. Lack of reliable data, poor understanding of transgender bodies and prejudices within the medical community are cited as some of the pivotal areas at the heart of the problem. Yet, this barely encapsulates the whole picture or the severity and gross negligence of care for transgender people in the UK. 

So close but yet so far, trans visibility and awareness has arguably never been more prevalent than it is now; tireless efforts made by trans activists and groups like Stonewall have ensured that these conversations are now etched into public consciousness. Current waiting times on the NHS for those seeking services at gender identity clinics are at a minimum of 3 years, with no promise of immediate treatment after the initial appointments. It is therefore no surprise that those of the trans community who can afford it, choose to seek privatised healthcare. 

“I personally have not gained much through NHS gender services and am planning to go private for it in future, however as a disabled person in a working class family, getting the funds required for this is likely to take me many years, if I ever can”, says Ali, an 18 year old student. Ali is certainly not alone in this respect, with nearly half of the trans people surveyed in a report by Stonewall echoing the same sentiment, that they simply cannot afford the medical expenses associated with transitioning. “I don’t personally know anyone who uses the NHS services and the general consensus seems to be that you don’t use the NHS unless it’s absolutely unaffordable to go private”, says Arthur, a 24 year trans man. Arthur recently opted for private healthcare and has been on testosterone for 4 months, being charged nearly £70 a month for his hormone therapy. This, however, is nothing in comparison to the estimated £18,000 he will need to allocate towards gender reassignment surgery. 

The process of transitioning can be a daunting one which is not helped by interacting with healthcare personnel who are openly prejudiced against trans people or gatekeep medical treatments. A new report by TransActual UK found that 1 in 7 transgender people have been refused care by a GP in the UK. Even for medical students who understand the necessity of this branch of medicine, very few training providers offer courses pertaining to transgender healthcare. There are still large gaps in understanding how trans bodies react to medication; for something as serious as anesthesiology for example, determining how much dose is required for a trans person is essentially guesswork, purely because there is not enough research to support comprehensive care. 

Oftentimes, when seeking services for their general healthcare needs, trans people find GPs have a tendency to relate their illnesses to any hormone medication they may or may not be using. “I went in for stomach issues once and pretty much the first question was whether it could be related to the hormones, but the symptoms started before the HRT so that explanation was ruled out”, says Avah, a 21 year old trans woman. This problem is exacerbated even further for trans people of colour who are twice as likely as their white counterparts to experience transphobia when accessing trans-specific healthcare. Taking the human factor out of the equation, transgender people still struggle with an out-of-date medical record system.

It is clear that unacceptably long wait times, costly treatment and poor general care are endangering transgender people who encounter roadblocks to treatment at all stages. The light at the end of the tunnel, so to speak, is fueled by the success stories of trans people who have received their treatment or have had positive experiences with medical professionals. 

Alfred Ellis, 23, who works full time as a staff trainer at a care home and has been openly trans for 1.5 years said: “We are living in a time of major reform to healthcare and human rights for LGBTQ+ people. Past generations have had many different struggles which we are now improving. Accessing healthcare as a trans person is still hugely difficult for many, but we have overcome some major milestones and the research has led to huge discoveries into different types of surgeries etc. which suit a lot of individuals far better and have greatly improved results… I’m positive that future generations will come into a world that is more aware of the trans community and has more resources to give.”

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