The London Gender Identity Clinic has just updated its waiting list information: as of July 2023 it was making first appointments for people first referred in July/August 2018, five years ago. With 324 new referrals each month and 55 first appointments offered per month, it’s clear that that five year figure is only going to increase.

Maths isn’t my strong point. But a service that’s only seeing 20% of new referrals each month is a service that’s adding 80% of new referrals to a waiting list that’s already five years long. So if you’re referred today, your waiting time won’t be measured in months, weeks or even years; it’ll be decades.

In Scotland, where the population is smaller and we have a different NHS, things are marginally better: the Edinburgh gender service is currently making first appointments for people referred two years ago. However in Glasgow, which covers a much bigger area (and oversees all surgery-related care for Lothian, Tayside and Grampian NHS areas too) and is the largest such clinic in Scotland, the waiting list for adults is around five years, up from four years in late 2022.

Gender services are not bound by the same Referral To Treatment (RTT) and Treatment Time Guarantees (TTG), which mandate that patients should not have to wait more than 18 weeks between referral and the beginning of treatment. Rather, the care for trans people is best illustrated by a small but telling detail: if you believe that the wait for an appointment is affecting your mental health, NHS Scotland will direct you to a page of mental health resources on the Sandyford website. When you visit the page you’ll see a short, simple message: “The page you requested was removed.”

One of the reasons that waiting lists are growing (other than the fact that trans healthcare is centralised when most of it could easily be handled by GPs) is because where there are vacancies, as there are in Sandyford, the current viciously anti-trans climate makes vacancies hard to fill: in the case of the Sandyford you don’t just have to brave online abuse but run a gauntlet of bodycam-wearing Christian extremists to get in the front door on some days. And while the wider faults in trans healthcare have been glaringly apparent for many years now, no politician is going to demand the improvements that are so desperately needed when you know exactly how the press and pressure groups would spin it.

I’d love to live in the fantasy world the bigots describe, where you simply refer yourself to a clinic and have hormones and surgery the same day. It’s much nicer than the reality, in which our healthcare is little more than a link to a web page that doesn’t even exist.