The mirage of a system: An 83 year long waiting list

Hi! I’m Autumn, a trans woman from Northern Ireland. This post is about the waiting list masquerading as healthcare for trans people in the UK.

It’s primarily focused on Northern Ireland, not just because I lived there, but also because when searching online for information about the system for trans people in the UK, NI is usually either barely mentioned, or just completely forgotten about.

In theory

The way the system is currently set up in the UK, to get your gender legally recognised you must send an application to the government’s Gender Recognition Panel, who decide if you’re “trans enough” to be legally recognised as your own gender.

As part of this application, you are required to have two reports from medical doctors and/or a clinical psychologist, which according to the UK government’s website, “you’ll probably need to pay for them even if you use NHS medical practitioners”¹, plus paying £5 (previously £140) for the application itself. They apparently “look at your application within 22 weeks of applying”². How it takes them almost 6 months to read a few letters, I have no idea.

One of these reports must confirm your diagnosis of “gender dysphoria”, which while real as a feeling, is also very meaningful as a diagnosis and for sure not a case of having to say whatever they expect you to say so they can tick off the right boxes. To get this diagnosis, you must either:

a. attempt to navigate the NHS³ system by getting referred to a Gender Identity Clinic/Gender Dysphoria Clinic by your GP, and get a gender dysphoria diagnosis there, or
b. sign up to one of several private clinics, if you can afford to pay - all online, since none exist in Northern Ireland

Getting access to healthcare, be it hormones, surgery, etc, works similarly, requiring you to go through either a gender clinic or privately.

As an example for how expensive going privately is, one clinic charges: £195 for a “set-up fee”, £30 every month for a “monthly membership”, £65 for a consultation to create your “transition pack”, then £185 for the 45 minute “formal diagnosis session”, for a minimum of £475. That doesn’t even include hormones, blood tests, etc, which I’ve heard from a friend costs an extra ~£40 per month on average.

As for the NHS, there is a single clinic to cover all of Northern Ireland - the Brackenburn Gender Identity Clinic in Belfast.

Even in theory, this system sucks. It’s overly complex, with a whole bunch of unnecessary steps.

• Why are you required to be referred by your GP, when all this does is allow for delays?
• Dysphoria sure is real, I’ve felt it enough, but as a requirement for healthcare it means people to either lie as needed to get the treatment that will help them, or be honest and risk being denied.
• A governmental Gender Recognition Panel reads more like the setup for a joke than part of any system to actually help people, which theoretically should be the goal here.

The process

A couple of years after I realised I was trans, I began attempting to take the NHS pathway. When going to my GP to ask to be referred, I was able to cite the Royal College of GPs’ guidance on “The role of the GP in transgender care”, which they say is “to promptly refer, where appropriate, to a Gender Identity Clinic”. (As in, not refuse, or introduce arbitrary delays, which I have heard from others attempting to do the same).

Thankfully in my case, my GP listened to me, and within a few weeks I received a letter from the Brackenburn clinic (despite the NHS having my email address), asking me to email or phone them to confirm that I did actually wish to opt into the service - an unnecessary step which only serves to add further delays, with the risk of people missing the letter and not added to the waiting list, therefore being forgotten about. A week later, I received another two separate letters from the Brackenburn clinic to say I had been added to the waiting list, and also that they are “unable to provide … a timeframe regarding an initial appointment”.

In an FAQ that has since been removed from their website, Brackenburn state they “endeavour to see people for their first appointment within the set target of 13 weeks”. At time of update (September 2026), I have been waiting for 130 weeks.

(It’s bleak)

Despite being told “we are no longer giving out waiting list position numbers”⁴, I can still make a guess. Last month, I made an FoI request to the Belfast Health and Social Care Trust. After taking longer than the twenty working days they “must”⁵ respond within, I received the latest numbers as of the end of 2024.

As of the start of March 2025, there are currently 1,083 people currently on the waiting list. In 2024, only 13 people on this list were seen for initial appointments. This isn’t lower than normal, in 2023 there were also only 13 people seen for initial appointments. At this current rate, anybody joining the waiting list can currently expect to wait over 83 years for an initial appointment⁶. You won’t actually have to wait this long though - many people in front of you in the waiting list will die of old age, or otherwise, before they ever receive their initial appointments.

Also shockingly, not a single person under the age of 18 was seen for an initial appointment in 2024, through the “Knowing Our Identity” service.

Apparently, I have the right to change my legal gender, and the right to access medical treatment. All I have to do is wait until around my 80th birthday.

The system, as it is, does not want trans people to exist in Northern Ireland, unless you can afford to pay for private healthcare. If a waiting list is so long that you cannot expect to ever receive an appointment within your lifetime, the only thing it provides is a misdirected sense of hope.

It doesn’t need to be this way. I am far from alone in saying the UK needs to get rid of the system as it is, remove the waiting lists and requirements to be trans enough by somebody else’s standards, and move to an informed consent model similar to other countries.

No winds of change

I’ve attempted to contact my local MLAs with the following email, not that I expected much to come out of that alone. (Did you know you can contact your local MLAs about transferred matters, including health? You can see who represents you using TheyWorkForYou, and see their phone numbers or email addresses on the Northern Ireland Assembly website!)

I received responses from 3 of my 5 MLAs.

Doug Beattie (UUP) responded to say “I see no meaningful movement on this until there is recurrent funding”, mentioning no plan to do anything to actually get funding. When asked again, he responded “The Finance department is held by Sinn Fein, they have not allocated recurrent funding for the health minister to deal with waiting lists. Until they do, sadly, I can only see the GIC waiting list grown until the funding is found.” Not his fault, that’s fair. He didn’t mention a plan to secure funding - maybe he doesn’t have time to come up with one.

“Nobody is saying that all transgender women are predatory, but, again, the very presence of a male in a space designed for women creates problems”⁷ - Doug Beattie, after proprosing legislation to force trans women into men’s prisons a month before I emailed him. I guess he’s wanting to bring V-coding to NI too.

Eóin Tennyson (Alliance) responded to say “… the Minister of Health has advised that his Department is currently developing a new model of care for gender identity services in Northern Ireland.”, and that “The Minister has further advised … to develop a business case for the additional resources necessary to effectively restart gender identity services in Northern Ireland. … The business case was due to be submitted prior to Christmas, and I will again contact the Department to seek an update on its status.” He also offered to have my individual case raised with the Department directly, below.

I asked Eóin if the new model being developed plans to move towards an informed consent model, as otherwise it will not resolve the fundamental issue of locking treatment and support behind higher standards for trans people that create the waiting list issue in the first place. “Unfortunately, I do not yet have that level of insight in respect of the Gender Review Group’s work which is confidential at this stage.”

Two weeks after my case was raised with the department directly, I was sent the response from Mike Nesbitt (UUP), the current Minister of Health.

“Following significant engagement, my Department has developed a proposal for a new Lifespan Gender Service to create a more efficient patient pathway, a faster patient flow rate through endocrine, to ensure waiting lists decrease and patients receive the care they need in a timely way.

My officials are currently considering the business case for the new Lifespan Gender Service, including its funding requirements. They will shortly provide me with advice for my consideration.“

We will see if the “Lifespan Gender Service” fundamentally changes anything.

John O’Dowd (Sinn Féin) responded to say “Sinn Féin will continue to lobby the Health Minister requesting detail on how his department intends to address this issue.” So it seems that Sinn Féin are blaming the UUP for not doing anything, while the UUP blame Sinn Féin for not providing funding to do anything. (at times it very much seems to me as if the whole political system of Northern Ireland is designed to not function at all)

Over 1 year later, Jonathan Buckley (DUP) and Diane Dodds (DUP) have not yet responded.

We live regardless

We continue to fight and survive, as we always have.

You don’t need somebody else’s approval to exist. If you’re thinking of DIY, https://pghrt.diy/.

Community is more important than ever. Be kind, and support each other.

<3