UK surgeries are seeing patient numbers rise as more people seek to undergo gender reassignment procedures.
Statistics have shown that some surgeries have seen demand shoot up over the past decade as society became increasingly accepting of trans-sexuality, but what is it and what is involved?
What is gender reassignment surgery?
Gender reassignment surgery is a surgical procedure where a transgender person can alter their existing characteristics to resemble that of their identified gender.
Genital surgeries may be performed on the individual who wishes to pursue sex reassignment surgery.
The surgery is part of treatment for gender dysphoria in transgender people, where a person experiences distress due to a mismatch of their biological sex and their gender identity.
It is also sometimes referred to as gender identity disorder (GID), transgenderism or gender incongruence.
Caitlyn Jenner revealed she "underwent gender reassignment surgery in January 2017" in new memoir The Secrets of My Life.
Until 2015, Caitlyn had been known as Bruce Jenner before revealing she was transgender during an interview with American TV journalist Diane Sawyer in April 2015.
Can you get gender reassignment surgery on the NHS?
Yes, gender reassignment surgery is available on the NHS, but may be subject to waiting lists.
Imperial College Healthcare Trust stated that as of April 24, 2017, there were 280 patients on the list for surgery, with 111 patients actively attending outpatient clinics or awaiting surgery. Another 169 patients were under the Trust's care but not currently ready for surgical procedures.
NHS gender identity clinics offer transgender health services but people will usually need to be referred by their GP.
GP referrals for gender dysphoria treatments are usually followed by an assessment by a psychiatrist or another specialist doctor before treatment begins.
In 2014 there were 172 sex operations on the NHS— double the 83 of a decade earlier — costing taxpayers at least £2million.
On average, the waiting time for a sex change therapy is nine months for adults and half this time for kids.
TRANS WOMEN SURGICAL OPTIONS MAY INCLUDE:
- Breast implants
- Removal of testicles (orchidectomy)
- Removal of penis (penectomy)
- Creation of a vagina (vaginoplasty)
- Creation of a clitoris (clitoroplasty)
- Creation of labia or ‘lips’ of the vagina (labioplasty)
- Facial feminisation surgery
- Trachea (or Adam’s apple) shaving
How much does gender reassignment surgery cost privately?
The costs for gender reassignment surgery can vary depending on the complexity of the surgery.
A quote will be made to a patient following a consultation with a surgeon.
According to ITV, the cost of gender reassignment is £19,236 per patient, this figure includes support as well as surgery.
FOR TRANS MEN SURGICAL OPTIONS MAY INCLUDE:
- Chest surgery/ breast removal (double mastectomy)
- Removal of the womb (hysterectomy)
- Removal of the ovaries (oophorectomy)
- Removal of the vagina (vaginectomy)
- Construction of a phallus (phalloplasty) or ‘micropenis’ (metoidioplasty)
- Creation of a scrotum with testicular implants (scrotoplasty)
How does gender reassignment surgery work?
Gender reassignment works by changing genital organs from one sex to another.
Converting a male to a female requires removal of the penis and the reshaping of the genital tissue to appear more female to create a vagina.
Female hormones will then be given to reshape the body and stimulate the growth of breasts.
Female to male surgery involves the creation of a functioning penis from smaller clitoral tissue.
Breasts will often be removed to create a masculine chest area.
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Transgender people in some parts of the UK face a wait of nearly three years for appointments on the NHS.
There are seven Gender Identity Clinics across the UK which help people deal with their medical needs around transition.
All of the clinics have reported an upswing in referrals in the past few years, as more trans people come forward to seek treatment.
However the growth in demand without a significant increase in capacity has led to growing backlog of referrals, leaving transgender people waiting far beyond the NHS 18-week target for all appointments.
Data compiled from NHS transparency releases shows that the Northampton Gender Identity Clinic in Daventry has the longest wait time of all GICs.
Trans people referred to the Northampton clinic face a staggering 30 month wait before their first appointment.
The shortest advertised waiting time is at Northern Region Gender Dysphoria Service, Newcastle, but even there transgender people are left waiting for 12 months to see a doctor – far in excess of the NHS targets.
London’s central Charing Cross Gender Identity Clinic has a 14-month wait time. All other GICs have a waiting time between one and two years.
The extensive wait to even start the medical transition process is compounded by further backlogs in specific services, with trans people facing further waiting periods if they choose to have surgery.
In a statement to PinkNews, a spokesperson for Northamptonshire Healthcare NHS Foundation Trust admitted that its clinic was unlikely to meet the “extremely ambitious” NHS 18-week target.
It said: “We know that the most important aim for patients is to commence medicinal treatments or have a referral for surgery as soon as possible.
“With the exception of a ‘Welcome Workshop’ provided to explain the pathway of transition through our service, we want to ensure that the first clinician the patient sees will be one that can complete a diagnostic assessment to start the treatment pathway.
“Unfortunately there is a lengthy wait time between initial referral and first diagnostic appointment, at all times we are open and honest about this to avoid setting unrealistic expectations.”
It added: “We saw an unprecedented demand for services in mid-2015 which reached a peak of over 80 referrals per month. Even now, we receive an average of 45 referrals per month.
“Given the relatively small size of our GIC, demand outstrips supply. We must also factor in that once people are accepted by our clinic we need to allocate our clinical resource accordingly, to progress their treatment in line with NHS England guidelines.
“The current NHS target of an 18 week referral to treatment (RTT) is extremely ambitious in the face of such high demand and this is also the case for the other GIC’s operational in England.”
The clinic continued: “The 30 month wait time displayed on our website is a ‘worst case’ scenario based on the number of clinicians, who are sufficiently competent to provide diagnostic assessments and recommendations for treatment of the service, remaining at the current rate.
“One of our aims is to grow our workforce however there is a national shortage of these specialised clinicians which has meant external recruitment has proven ineffective.
“We are in the process of providing supervised professional development in-house as a form of ‘growing our own’ capable clinicians.
“To this end, we have been successful in recruiting additional psychology and nursing posts to provide this broader range of supportive and diagnostic interventions, which we believe will ultimately result in reducing waiting times.”
An NHS spokesperson added: “‘Demand for gender identity services has risen sharply in recent years as more people feel able to come forward for support and funding for services has been increased to reflect this.
“The NHS continues to work with those who provide gender identity services to reduce their waiting times as quickly as possible.”
Trans activists took to Twitter to condemn the growing waiting times.
Fox Fisher of My Genderation said: “As you can see, waiting times are too long. This can have major effects on the well-being of a trans person.
“For me, the wait was also too long. I ended up taking hormones that weren’t prescribed. I longed to be under the wing of the NHS.
“I ended up spending money I didn’t have, after a really long wait, for a private appointment.
“Is it any surprise that self harm / suicide rates are so high in the UK when waiting times are so long?”
The UK’s health watchdog last year recommended an urgent expansion of London’s gender identity services, warning that patients were being let down by limited capacity.
The Care Quality Commission praised the standard of care available at the clinic, it warned that waiting lists were well in excess of the NHS-wide statutory targets.
The report said: “There were long delays between people being referred to the service and having an assessment and treatment.
“The target timescale was 18 weeks but people were waiting 10-14 months. Action plans had been developed with commissioners but these were still being implemented.”
The CQC inspectors also warned that a number of administrative shortcomings have made things more difficult for trans people accessing the service.
The report added: “Administrative systems were causing problems for people who used the service. There were delays in
letters being sent to people who used the service and to other professionals.
“Appointments were being cancelled, sometimes at the last minute when people were already travelling to the clinic.
“People using the service were not always told why appointments were cancelled and would sometimes have to wait long periods of time for appointments to be re-arranged.”
“The trust must ensure they follow through the action plan agreed with commissioners so that patients are assessed within 18 weeks of being referred to the service. This includes the recruitment of staff.”
Many NHS services relating to gender identity have seen a rapid upswing of people seeking treatment in the past few years as a growing number of trans people seek help.
The only clinic to deal with transgender young people has seen a 500% rise in people seeking treatment, while adult services have seen a similar rise.
Dr John Dean, chair of the National Clinical Reference Group for Gender Identity Services, warned previously that waiting lists must not be allowed to spiral out of control.
He said: “Not treating people is not a neutral act – it will do harm.
“There are a number of studies that report evidence of suicide and self harm among trans people who are unable to access care.
“It is an intensely demeaning and frustrating experience to have to live in a social role in a body that is incompatible with your deepest inner sense of self.”
Parliament’s Women and Equalities Select Committee also sounded the alarm on the issue last year, warning that services with year-long waiting lists were in violation of statutory limits.
However, little has changed about the waiting time backlog despite the repeated warnings.
The surgeon who previously performed the majority of the NHS’s gender reassignment surgery previously warned that backlogs for surgery are ‘spiralling out of control’.