There have been a number of heated discussions about HRT waiting times for MtF in the UK again, so I thought I would take another look at the more recent reports on UK sites here.
This information is only based on a trawl thorough a few larger sites and looking at more factual reports. I would also comment that the reports I looked at were from transitioners well over the age of 18, and therefore making their own healthcare decisions. I did not look at Scotland, where I understand the situation, and funding to be significantly better than England where I am based.
As expected, most comments were on CHX in London, but then it is still the largest so this is to be expected. Other regional clinics seemed to have less discussion, but overall, similar timescales were discussed.
Starting from scratch with no RLE, the first visits to a gender clinic seem to be 3 to 6 months after initial visits to a GP doctor. This usually also involved a "local" assessment by a local "general" physiologist before referral to the clinic.
Most clinics seem to be operating on around 3 months between assessment, with most not providing HRT letters until after 6 to 9 months (2 or 3rd appointment). The only exceptions seem to be where undisputable documented proof of extended RLE before attendance was provided, or in some cases where extended self medication was involved. I use the word "assessment" rather than therapy, as the session reports seem to be very heavily gatekeeper orientated with little counselling. In a number of cases an extended RLE period before HRT was required.
Most commonly 1 to 3 more months for tests and prescription/letter from a specialist, with treatment normally starting with androgen blockers, and estrogens not added until after a further 3 months or more.
Final prescription and ongoing blood monitoring usually being carried out by a local GP doctor between clinic review visits.
....So as a baseline, in the US system you can usually get on balanced HRT after around 3 months of therapy/counselling and a trip to the endo = 4-6 months. Usually if you have a healtcare plan, you can get at least some of the HRT and therapy paid for. GCS can be completed within 18 months from starting but you need to raise the funding.
In the UK NHS system you can expect to wait 10-18 months to just get blockers. It is then quite possible to string this out to 2 years or more if you have any questions in your head.... and of course that is just for HRT. GCS waiting figures vary wildly; but the best seem to be at around 3 years with many at 5 years or more. Yes we can go private, but we don't get an NHS redbait, and our system can still refuse us care after elective/international treatment for any condition.
It just goes to show why there is still so much discussion in support groups/forums about self medication and private treatment in the UK, where healthcare is supposed to be "free". It also shows why for many in the UK, it is still not uncommon for individuals to have completed years of RLE without the support of a clinic or medication.
I should also comment, that the NHS problems are not limited to gender issues, and that while we still have a large number of excellent and dedicated practitioners, the funding issued and excessive spends on admin overheads are crippling the system.
I did find a couple of exceptions worthy of note, one good ...one bad:-
One case where someone had managed to "buck the system" and talk their local GP into prescribing Estrogen HRT for an extended period, with monitoring, and without a visit to a clinic. On attending CHX for the first time they were worried that the clinic would stop the script, but they didn't (I'm not sure what words were exchanged with the GP though).
Oxfordshire PCT (healthcare fund allocation) seems to have a very bad reputation at the moment as they are publically opposing the UK health service directives on gender issue "treatment" funding.
I'm sure there will be a number of other reports of exceptions, but I believe the above timescales to be realistic as a general overview.
Chrissty
