Transgender patients feel ‘forced’ to transition using hormones bought from the dark web because NHS waiting times are so long.
Some patients are on a list for three years, in Belfast, before they finally see a specialist at a gender identity clinic, a BBC investigation found.
Desperate to start taking hormones to transition to the opposite sex, patients are turning to unregulated sources to find testosterone and oestrogen pills.
‘Do-it-yourself hormone replacement therapy’ is a gamble with their life because the drugs often come from outside of the UK, and could be fake.
NHS England, which has a target waiting time of 18 weeks, said demand for gender identity services is rising. But there is a gap in specialists in the field.
Transgender patients wait up to three years to get an appointment at a gender identity clinic after referral (Belfast). A Freedom of Information request by the Victoria Derbyshire programme shows patients in Nottinghamshire wait a maximum of two years and nine months (145 weeks). NHS Highland’s gender identity clinic, in Scotland, has the shortest maximum wait of 32 weeks. Some countries have target times – NHS England’s is 18 weeks
A Freedom of Information request by the Victoria Derbyshire programme show the stark differences in wait times across the UK.
The longest wait from referral to a gender identity clinic is in Belfast, where patients wait a maximum of three years (166 weeks). Their target time is one year (52 weeks).
Second worse was Nottinghamshire at two years and nine months (145 weeks) followed by Northumberland with two years and five months (127 weeks). Their target time is 18 weeks.
In Wales, patients wait up to two years (104 weeks).
NHS Highland’s gender identity clinic, in Scotland, has the shortest maximum wait of 32 weeks. Scotland and Wales have no target wait time.
Tavistock and Portman NHS foundation trust, Britain’s first gender identity clinic, could not provide data.
However, its children service has treated more than thirty times more patients in the space of a decade, data shows.
A law student who only gave her first name, Kara, told the BBC’s Victoria Derbyshire programme she began buying hormones online last summer.
She has been waiting to see a specialist at an NHS gender identity clinic, where she would be prescribed oestrogen tablets, for two years. It is not clear where she lives.
Kara has been using oestrogen – the hormone prescribed to trans women -so she could start transitioning from a male.
But she said she was ‘absolutely petrified’ of the effects the unregulated pills could have on her.
She felt ‘forced’ to do so in order to dampen her natural male sex hormones, which cause facial hair, for example.
She said: ‘I don’t know anything about the tablets [that I buy] specifically, if they are what they say they are. So it’s kind of a guessing game with your life.
‘I was so low before, it basically felt like a choice between suicide or self-medicating, because I couldn’t deal with the thought of further masculisation.’
Lucas, who began transitioning six years ago aged 29, also decided to use testosterone bought online.
When his GP referred him, he had been told he would face a two-and-a-half year wait for an appointment.
He said self-medication was ‘scary and unpleasant’.
‘I suspect a few of the doses were effectively nothing,’ he said.
‘For example, I didn’t actually start growing any facial hair at all until I moved onto prescribed testosterone.’
Lucas revealed he knows of at least one person who has taken their own life due to the ‘distressing and dehumanising’ wait to be seen.
Kara said she was ‘absolutely petrified’ of the effects the unregulated pills could have on her, but that she felt ‘forced’ to buy them because she has been waiting to see a specialist for two years
Lucas revealed he knows of at least one person who has taken their own life due to the ‘distressing and dehumanising’ wait to be seen
More than 13,500 transgender and non-binary adults are on waiting lists for NHS in England, previous BBC research has found.
With an agonising wait to be seen, patients’ decision to manage their transition outside of a doctor’s care may become more common.
Many of the sketchy websites selling hormones are not based in the UK, and demand pay by Bitcoin or bank transfer.
It’s illegal to sell testosterone drugs, but it is not illegal to buy or possess them for personal use. Many patients may turn to oestrogen hormones marketed to menopausal women in order to get their dose.
There are huge health risks of taking hormones without doctor supervision, experts stress.
Those who take oestrogen could experience a pulmonary embolism, whereby a blood clot travels to the lungs and blocks an artery.
Liver damage could also occur if patients are not being monitored.
They may also feel disheartened if the drugs do not give the desired effect, because they are actually fake.
The Royal College of Physicians, which represents GPs, raised concerns about the consequences of rapidly increasing referrals in 2019.
It reported gender identity clinics in England have seen a 240 per cent overall increase in referrals over five years.
In a statement, the RCOP said: ‘There is an urgent need to increase the capacity of gender identity specialists and clinics and expand the understanding of gender variance issues across the entire health system.’
It is understood that wait times are part due to a lack of medical professionals wanting to specialise in trans healthcare. A new ROP pathway had been established for this reason.
NHS England told the BBC in a statement: ‘As more people feel able to seek support and treatment, the demand for gender identity services has greatly increased.
‘In recent years we’ve increased investment to respond to the rising demand, with staff working hard to support patients to get the right care as quickly as possible.
‘From the spring a new service will be piloted in London that will increase capacity in gender identity services.’
A spokesman for the Scottish government, of which NHS Health Scotland is a branch, said long waiting times for patients were ‘unacceptable’.
He said: ‘Gender identity clinics are a very specialised resource, and while people are waiting to be assessed they still have access to a full range of community mental health and well-being services appropriate to their situation and needs.’
NHS Wales and Belfast NHS Trust have not yet responded to requests for comment.