A shortage of doctors qualified in helping people to transition is potentially leading to increased mental and physical ill-health, The Herald has reported.
Statistics have revealed that several hundred Scots are waiting for up to a year for treatment due to a chronic shortage of specialised medical staff.
The inevitable results of delays in receiving treatment are increased levels of mental ill-health among many seeking to transition, as well as many turning to the internet to purchase unlicenced hormones – which may carry deadly side-effects.
The Herald has confirmed that Scotland has only five specialist consultants who are qualified to give trans people hormones, authorise surgical intervention or issue gender recognition certificates.
Furthermore, there is only one part-time specialist in the entire country able to treat under-18s.
The statistics reveal that in the twelve months between June 2014 and June 2015, 853 people in Scotland were commenced on treatment, with a further 350 on the waiting list to receive help to transition.
The lack of suitably qualified clinicians is creating a situation where demand is outstripping resources, and this is clearly unsustainable. Part of the problem appears to be attracting doctors to what is an extremely specialised field, as David Gerber – the lead clinician for the national gender identity clinical network for Scotland – explains:
“If we placed an advert tomorrow for 10 [medics who specialise in gender] we probably wouldn’t get any applicants.
“Glasgow’s [clinic] is the biggest one, we have the most patients and the most number of clinicians [three of the five full-time doctors]. Edinburgh only has one part time doctor who works there…Aberdeen used to have a service but the doctor retired so that doesn’t exist anymore, but they’re looking to re-establish it.
“There is Inverness but that is a very small service. There is one clinic a month the doctor does there.”
This results in people outside Glasgow having to wait longer or opt to travel to Glasgow, increasing the pressure on the clinic there. gerber admits that, in the circumstances, it is hard to know where best to refer people for the help they need.
He said: “It’s all falling to me and my small team in Glasgow. It bumps up the waiting times and you are getting people who are coming from quite far away so it’s difficult to know what local services they can tap into.
“I’ve been doing this for a while so you have an idea of what services there are around the country but it does create some difficulty.
“Because of the other people coming to our service it creates delays for people in our own health board area.”
The long wait can have a serious impact on trans people who are desperate for help, both mentally and physically.
Gerber also highlighted the human costs: “It can be distressing and there are reports of people committing suicide as a result of that.”
A number of people anxious for treatment have resorted to looking elsewhere for help – including Edinburgh-based Steph Bell who told her health board she was seriously considering buying hormones via the internet.
Having been on the waiting list for nine months without being seen, Bell – who has an anxiety-related illness – believes her mental well-being has been negatively affected by the wait for hormone therapy to begin.
She said: “They told me it was originally six months wait, but then they said it would be longer.
“I said I was going to get hormones online and they said they would put me on a September appointment because of the danger of doing that…I still haven’t heard anything.”
“I want to be on hormones so I can look more feminine, not worry when I go out the door…I want to be able to go outside and people not know [that I’m transgender], and get on with my life as a female.”
Dona Milne, Deputy Director of Public Health and Health Policy at NHS Lothian, advises patients to “seek support from their GP or one of the voluntary sector agencies such as The Transgender Alliance, LGBT Health and Wellbeing and LGBT Youth whilst they are awaiting their appointment with the gender clinic. We would advise against ordering drugs from the internet.” She also admitted that a cobination of staff sickness and an increase in referrals has had an effect on waiting times.
Other patients have highlighted the physical difficulties they’ve experienced as a result of delays. Oliver Ross, 20, is four months in to his 11-month wait for an appointment. As a transgender man, he wears a chest binder to disguise the appearance of breasts. However, the effects of wearing it for long periods can result in damage to tissue and internal organs.
Ross said: “I have asthma and I’d like to get on hormones and be referred for top surgery as binding is quite painful. “I work 12 hour shifts sometimes and I know I shouldn’t be wearing [the chest binder] for that long but I can’t help it if I’m working.
“It can cause a lot of rib problems. I’ve seen a lot of people who have been binding for years and they have deformed ribs from the constant compression.”
“At the moment all I can think about it getting on hormones.” he explained. “Obviously there will be other things but I know I’ll be able to do day-today activities like work and studying a lot easier.
“As a trans guy it’s easier to go out and live my life, but a lot of people can’t do that. They can’t until they get these hormones.
“There’s an assumption that trans people need more time to decide but once you’re out there you’ve made the decision.
“It’s horrible being in that limbo. I know it’s not as easy as getting more staff but something needs to happen.”
A parliamentary select committee has recently launched an inquiry and is liaising with transgender groups to consider ways to challenge the barriers to full equality. The Liberal Democrats have also picked up on the issue of transgender and intersex rights and will use their forthcoming conference in Bournemouth to promote what amounts to an action plan to improve the rights and health outcomes for transgender and intersex people.
The Scottish Transgender Alliance has made key recommendations for reducing waiting times and dealing with the consequences of lengthy waits. James Morton, the STA’s coordinator, advocates removing the statutory need for trans people to obtain medical and psychiatric letters to legally change their gender.
Criticising current arrangements as archaic and insulting, Morton said: “You shouldn’t have to submit psychiatric and medical reports, it should be done as a simple administrative process the same as you’d change your name.
“Having to send in a psychiatric report is really insulting to people. Even the gender identity specialist doctors agree these reports should not be required to change legal gender. It’s needlessly intrusive.”
He added: “This makes their government records a mess with conflicting gender details recorded in different places. When it comes to the crunch, trans people who haven’t changed their birth certificates are at risk of not being treated [according to] the gender they identify and live as.
“This can result in insurance policies and civil partnerships/marriage ceremonies being inadvertently invalidated, being ‘outed’ as trans, and other red tape nightmares.”
A spokesperson for the Scottish Government stated: “The Scottish Government recognises any wait can cause anxiety for patients. We are supporting Boards to ensure waiting times are as short as possible for all patients.”