The number of trans people in Scotland crowdfunding to cover medical costs has increased by 65 per cent since last year due to excessive waiting times, gaps in provision and what fundraisers characterise as “institutional transphobia” within the NHS.
Scottish Trans Alliance said the data, shared exclusively with The Ferret by crowdfunding platform GoFundMe.com, was “unfortunately unsurprising” and that private healthcare remained the only option for many trans people in Scotland.
There are currently more than 100 live fundraisers on the platform based in Scotland which are raising money for medical services including gender confirmation surgery, hormones, facial surgeries and to access an initial diagnosis of gender dysphoria privately.
Fundraising goals range from around £1000 to £30,000, with some fundraisers stating they hope to use the money in order to access procedures abroad.
The 65 per cent increase was calculated by searching the platform for all fundraisers in every Scottish postcode, which included terms relating to gender identity and relevant medical procedures and then comparing the number launched so far in 2022 to all of 2021.
Jasmine, 28, from Edinburgh, launched a fundraiser in April this year for £20,000 to access private healthcare including hormones and facial hair removal, as well as facial feminisation surgery, a procedure not universally provided by the NHS in Scotland but one which many trans women seek to access as a priority.
She first tried to access healthcare related to her gender identity during the pandemic, having suffered from poor mental health since puberty and while experiencing suicidal feelings. She was warned of a three-year waiting time for an appointment to receive an initial diagnosis of gender dysphoria which would enable her to access further treatment.
Jasmine joined the NHS Scotland waiting list in February 2021, but was able to begin hormone replacement therapy the same year by travelling to see a specialist at University College London Hospitals with a referral from her private healthcare provider.
“I was suicidal every single day before I started hormones,” she told The Ferret. “Within 24 hours I was not anymore, and I haven’t been since. If I’d had to wait all that time I wouldn’t have survived. My choice was to fundraise or to possibly die.”
Having to ask for money can be difficult, said Jasmine. “It’s a bit degrading, begging for people to help you with being who you are. And I’m not exactly optimistic – my target is such a big number and nobody has any money at the moment,” she added.
At the time of writing, Jasmine had raised £2,575 of her £20,000 target. The funds raised so far have helped her to access a consistent supply of hormones but, she explained: “I’m scared that with the cost of living crisis, I might have to use that money just to survive.”
There are currently four NHS gender identity clinics (GIC) in Scotland: Glasgow Sandyford GIC, Edinburgh Chalmers GIC, Aberdeen Cornhill GIC and Inverness Raigmore GIC. Glasgow’s Sandyford is the only clinic in Scotland to provide services for young people as well as adults.
According to the Scottish Trans Alliance, the current waiting time for a first appointment is around a year and a half in Aberdeen and Inverness, and two and a half years in Edinburgh.
The waiting time at Sandyford is estimated to be over three years. Earlier this year, NHS Scotland confirmed that the number of under-18s on Sandyford’s waiting list had risen from 151 in 2017 to 903 this year.
Vic Valentine, Scottish Trans Alliance manager, said it was inevitable that many trans people have to crowdfund for care due to high levels of discrimination and unemployment.
“Excruciatingly long waits make turning to private healthcare the only option for many,” they said. “And we know that trans people face high rates of discrimination when applying for jobs and in the workplace, with UK government research showing we have higher rates of unemployment than the general population. This makes trying to crowdfund for care inevitable for some.”
Valentine argued that long waits were the result of underfunded services, but also services that are too centralised and specialised.
“Psychiatrists often provide routine appointments and have to sign off low level treatments like hair removal – things that could be just as safely managed by nurses,” they pointed out. “This is due to services being designed at a time when being trans was thought of as a mental illness, rather than trans people being a normal part of a diverse society.”
Many fundraisers reviewed by The Ferret also highlighted transphobia within the NHS as a motivation for seeking private healthcare, on top of waiting times and gaps in provision.
“I’m traumatised by my interactions with the NHS,” said Jasmine, who recalled being misgendered and called ‘sir’ multiple times when she first contacted her GP to seek a referral to the gender identity clinic. During that conversation, she was promised follow-up phone calls to check up on her mental health but, she said, they never came.
“I have far more knowledge about transition-related healthcare and NHS guidelines about trans healthcare [than GPs]. They’re dismissive of me and try to justify the NHS’ failings towards trans people,” she said. “Even my treatment for non-trans related issues has worsened since I came out.
“The NHS treatment of trans people isn’t just because of underfunding; it is institutionally transphobic.”
A Scottish Government spokesperson said it recognised the need to improve access to and delivery of NHS gender identity services.
“It is important that trans people, and anyone exploring their gender identity, are able to access the right support at the right time when they need it,” they said.
“In December 2021 the Scottish Government published a framework for NHS gender identity service improvement. As set out in that Framework, we have committed to a number of actions which are inclusive of working to improve current provision, reduce waiting times and better support those waiting to access clinical services. This work is ongoing.”
But for Jasmine, who estimates a wait of at least three more years to either be seen by the NHS or meet her fundraising target, the impacts are already being felt.
“Being trans is beautiful. I wouldn’t change being trans for anything,” she told The Ferret. “If a magical genie asked me if I wanted to be cis, I would say no.
“But I feel like I already lost my childhood and teenage years and now I’m losing my 20s and probably a large chunk of my 30s not enjoying my life as me.
“It’s a really hard psychological position to be in, always waiting for the next thing that’s going to make it better – because it’s so hard to access anything at all.”
Pictures thanks to Jasmine, who asked that her last name was not included here. Her fundraiser can be found here.
I think on the evidence provided I could make a case that the NHS is also biased against cerebral palsy and osteoarthritis. There are similar waits for people with these and many other problems causing significant physical and mental health problems. In these problems the assessment and investigations could be streamlined but the problem is not a decision to delay or defer but a lack of capacity. Highlight one group without putting it in the wider context is not up to your usual standard.
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