How the pandemic has affected transgender healthcare in Northern Ireland

Transgender people in Northern Ireland are experiencing years-long delays in accessing life-affirming healthcare. With a waiting list of up to five years, many are being forced to travel to England for private healthcare.

One Belfast man, who had surgery just before the pandemic, says he has been left in limbo. Tom*(25), needs to stay anonymous due to his job in the legal sector. He describes his experience of accessing healthcare as “an actual nightmare”.

He had top surgery just before the pandemic, which needed surgical revision after a complication. Tom said “it’ll be two years in February, and I still haven’t been given a date. The thing that’s annoying is the surgeries are actually going ahead in England”.

Pre-pandemic, Tom waited five years for his top surgery. He says “I hated it. It was just a really awful, horrible process to go through.”

He is also supposed to have his bloods measured every six months due to his medication. He stated “I’ve been on testosterone now for five years and I’ve been seen twice.”

At the beginning of his transition, Tom waited for years for his appointment at the clinic. Eventually, Tom “went privately because it was just taking so long to get seen. They don’t tell you how far along the waiting list you are. There’s really no information given.”

He had to go to a clinic in London, where he was prescribed testosterone. He had to pay “£100 each couple of months”, and £250 for flights and his appointment with the therapist. At the time, he was a university student.

The mental health consequences of gender dysphoria can be devastating. According to a survey by the Rainbow Project, a quarter of trans people living in Northern Ireland have experienced a suicide attempt. Around a third have self-harmed, compared to 13% across the rest of the UK.

As well as having negative health outcomes, Tom tells me that life can be much safer for a trans person if they can “pass”. In this context, passing is a term that means the trans person looks like they are the gender they identify as, instead of the gender they were assigned at birth.

Before Tom could pass, he tells me he experienced much more aggression than he does now. He has been assaulted in a nightclub during this time, and he says “I’ve had people tell me they’re not going to call me my real name.”

We also spoke to Jennifer Clifford, 70, a transgender woman and activist. “Gender dysphoria is a killer”, she says, having attempted suicide before she moved to Derry to transition “thirteen, fourteen years ago”. At that time, she “was seen in about 4 weeks… about 4 and a half years later, I was done and dusted.’”

She says things are very different now – “On average, transition should take 5 years… It’s a lot worse now. You’re looking at 4 years, before you get your first appointment. That’s not an assessment, that’s just your first appointment to meet the team. It’s madness.”

The mental health consequences of gender dysphoria can be devastating. According to a survey by the Rainbow Project, a quarter of trans people living in Northern Ireland have experienced a suicide attempt. Around a third have self-harmed, compared to 13% across the rest of the UK.

Jennifer volunteers at the Brackenburn Clinic, Northern Ireland’s only gender identity clinic. “It’s not fit for purpose,” she says, “part of it is COVID, part of it is there’s always not been enough staff.” Pre-pandemic, the Clinic did not take on any new patients between 2019 and 2020.

However, she makes it clear that the staff themselves are “brilliant, they work as hard as they can.” Of the effect these delays have on transgender people, she tells me “the amount of depression it causes, self-harm, suicidality – it’s tough, really tough.”

According to Jennifer, “Most trans people are like everybody else. We want two weeks holiday a year, a nice car, a nice house. And the only issue is that they may have had issues with their gender. But we’re human beings like everybody else.”

She continues, “There’s so much variance in the human race, as a whole. And all that trans and LGBT people are is just part of that variance. It would be a poor world without the LGBT people in it.”

When approached for comment, Belfast Trust said,

“Unfortunately, the current longest wait for assessment at the Gender Identity Clinic is 4 years and 9 months. Regrettably, waiting times for all elective surgery have also increased considerably due to the postponement of elective services as a result of the Covid-19 pandemic. We apologise to patients who are experiencing a longer wait than we would like and reassure them that every effort is being made to address capacity issues within the service.”