Unacceptable waits for adult gender clinic appointments, review says

Waiting times for adult gender clinics are "unacceptably long" with patients waiting an average of five years and seven months for a first appointment, according to a review of services.

Dr David Levy, a cancer specialist and former medical director, visited all nine gender clinics in England as part of his inquiry.

He said services for adults seeking gender care were "falling down" with long waits, inconsistent assessments caused by a lack of shared policies across the clinics, and a lack of data about the results of the care people received.

His report, published by NHS England, said unless improvements were made some patients would end up waiting 15 years for a first appointment.

The nine Gender Dysphoria Clinics (GDCs) offer ongoing assessments and treatment for adults who are distressed about a mismatch between their biological sex and the gender they identify with. They can provide medication to patients, including hormones, but they do not carry out surgery.

Dr Levy described the waiting times for patients to be seen at these clinics as "shocking" and said the "distress some patients experience" is often "exacerbated by unclear waiting times and a lack of communication".

He found that the number of referrals to the clinics had more than doubled from 4,331 in 2021/22 to 9,985 in 2024/25, with around 40,000 people waiting for a first appointment by March 2025.

However, the review said it was impossible to get an accurate picture of the numbers waiting as each clinic had its own list, and some people would have been referred to more than one service, either by themselves or by GPs.

The clinics reported that "there have been significant changes" in the age of people referred to them. Previously patients tended to be older, but the "majority of referrals are now 18 to 25 years old".

The review said the clinics found "the new, younger cohort of patients has a higher proportion of additional neurodevelopmental conditions", such as autism spectrum disorder and a range of other conditions, including mental health issues and trauma and abuse during childhood.

The review said about a quarter of referrals were for 17 to 19 years-olds. Some had transferred from children's services, including many who had "aged out" because long waits meant they would not be seen before their 18th birthday.

Criticism of the Tavistock clinic, which used to run the only children's gender services in England, led to its closure in 2023. A number of new multi-disciplinary children's gender clinics are being set up.

The changes followed recommendations made by the Cass review into children's gender care. Its final report, published in April 2024, also called for a review of adult gender services.

Dr Levy who began his review in July 2024, described carrying it out as a "minefield you have to walk through," but said the clinics had been "very good" and that they "talked about this as an improvement journey."

"This is about getting things better for the patients, getting things better for the staff," he said.

The report found a wide variation in services across the country and said while more money had been put in to help them recruit extra staff, that was not always reflected in an increase in the workforce.

It also said some clinics did "little or no improvement work or knowledge-sharing".

Health and Social Care Secretary Wes Streeting welcomed the report, and said that further services would be commissioned, self-referrals would be stopped and existing services would be improved.

Trans rights organisation, TransActual, welcomed recommendations "for a more streamlined, patient-centred care pathway", but raised concerns about ending self-referrals and said requiring a first assessment to be done by a senior clinician "risks unnecessarily hampering efforts to reduce waiting times".

Translucent, a transgender advocacy group, said the report makes clear that "trans healthcare is in crisis" and called for more trained trans-people to be involved in designing and running gender care services.

Sex Matters, a gender critical human rights organisation, said the review failed to consider whether the treatments offered by the clinics were effective. CEO Maya Forstater said: "It is a wasted opportunity to rethink a failed treatment model."

Dr Levy will now chair a new national improvement programme for adult gender services, starting in 2026.