Thread by @DadTrans

A parent on a trans children support group has just said their teenage child has already been waiting for a year to access the @NHSEngland Monopoly service #GIDS @TaviAndPort & wants to know realistic time frames for each stage. Here is my response: 1/

- A minimum of 6 months more waiting for a first appointment (note waiting times have risen 6 months in the last 6 & show no signs of slowing).

- Once in the service there is a minimum of 4 appointments over a 6 month assessment period, this is often longer, rarely shorter 2/

- If your young person wants blockers, they need to be very clear. If they are unable to verbally express their dysphoria, have other conditions or issues, if they are not in full time education, or have an unsupportive family environment there are often further assessments 3/

- @TaviAndPort #GIDS require a minimum of 1year on blockers before consideration for cross sex hormones (this is contrary to @NHSEngland Service Spec). They need to be 'around 16' interpreted as 15 years & 10 months (this is contrary to International Endocrine Guidelines) 4/

- From around 17 years the child might be referred onto waiting list for adult GIC, another minimum 1 year wait (this is faster if accessed through children's service), each adult GIC waiting list differs. GIDS continue to see adolescent until they choose to leave the service. 5/

- If one or more surgeries are wanted (common for gender dysphoric trans young people) then there are further lengthy waits. These vary hugely depending upon surger(ies) & waiting list of GIC - current wait lists are between 18 months & 5 years. All waiting times are going up 6/

In summary:
- If hormonal interventions are desired for a self-harming severely dysphoric adolescent. There is a minimum of 2 years (often longer) from point of referral prior to access to hormone blocking medication, and a further minimum 1 year prior to access to hormones 7/

- In reality there are barriers at every step. The @NHSEngland monopoly service tries to find any reason not to prescribe. E.g. Presentation of neuro diversity, mental health issues, past history of abuse, (in either child or parent/carer), transphobia of clinician, 8/

...Not being in full time education (many trans young people not in school due to bullying/dysphoria), if private treatment has been accessed in parallel, if one or more parent/carers are not supportive, if a child is in foster care or supported living, if child is non-binary, 9/

All of these factors & more have been given for additional delays to the timelines stated above. In practice a young person often has to 'persuade' their clinician's why they need to access medical interventions, & how they have the competence to give informed consent 10/

The reality is that a self harming 14 year old with severe dysphoria presenting at a GP today is extremely unlikely to be able to access any form of medical intervention from the sole UK Provider until they reach adult services at age 18. 11/

The current system is designed as a series of gates which are extremely difficult to pass through even with substantial family support.

Due to the focus upon medical interventions psychological support is minimal. In fact for many service users, sessions increase dysphoria 12/

- In my view the current protocol & the implementation of @NHSEngland Service Specifications (inclusive of the international guidelines WPATH Standard of Care, & International Endocrine Guidance) is unethical, illegal & actively harmful to young people with gender dysphoria. 13/