A long and painful wait ... just five doctors in Scotland to help trans men and women change their lives for good

In Scotland there are just five specialist consultants who can give trans people hormones, authorise surgery or provide gender recognition certificates.

For under 18s, the situation is even worse with just one part-time specialist to treat young people in the whole country.

Between June 2014 and June 2015, 853 people started on treatments in Scotland, with 350 currently waiting for help to transition.

David Gerber, the lead clinician for the national gender identity clinical network for Scotland, said his medical field was so specialised that "if we placed an advert tomorrow for 10 [medics who specialise in gender] we probably wouldn't get any applicants". Gerber's clinic in Glasgow has three of the five full-time doctors.

He added: “Glasgow's [clinic] is the biggest one, we have the most patients and the most number of clinicians.

“Edinburgh only has one part time doctor who works there...Aberdeen used to have a service but the doctor retired so that doesn't exist anymore, but they're looking to re-establish it.

“There is Inverness but that is a very small service. There is one clinic a month the doctor does there.”

Patients from Edinburgh are now having to wait longer or travel to Glasgow for an appointment which Gerber says is “absolutely” putting a strain on his clinic.

With an influx of patients from across the country, Gerber said it can be difficult knowing where to refer people to for help.

Gerber said: “It's all falling to me and my small team in Glasgow. It bumps up the waiting times and you are getting people who are coming from quite far away so it's difficult to know what local services they can tap into.

“I've been doing this for a while so you have an idea of what services there are around the country but it does create some difficulty.

“Because of the other people coming to our service it creates delays for people in our own health board area.”

The long wait can have a serious impact on trans people who are desperate for help, both mentally and physically.

Gerber admitted: “It can be distressing and there are reports of people committing suicide as a result of that."

Steph Bell, from Edinburgh, said she was so desperate for treatment that she told her health board she was thinking of buying hormones online, as she couldn't face waiting months for help.

The 29-year-old claims after she told the Lothian health board her plans they agreed to move her up the waiting list, but nine months later she has still not been seen.

Bell, who has a mild form of Asperger’s syndrome, said she avoids going out alone and struggles with anxiety, made worse by her wait for hormone therapy.

She said: “They told me it was originally six months wait, but then they said it would be longer.

"I said I was going to get hormones online and they said they would put me on a September appointment because of the danger of doing that...I still haven’t heard anything.”

Despite friends and family accepting her choice to transition, Bell said members of the public are often not so understanding.

After suffering verbal abuse and feeling ridiculed for wearing a wig, she now avoids going out alone as much as possible.

“I had one woman who came up to me in the street and said ‘You do know everyone is staring and laughing at you?’,” she explained.

“I want to be able to go out on my own. I don’t go out on my own because when I wear my wig people laugh at me.

"I want to be on hormones so I can look more feminine, not worry when I go out the door…I want to be able to go outside and people not know [that I’m transgender], and get on with my life as a female.”

Dona Milne, Deputy Director of Public Health and Health Policy at NHS Lothian, said she could not comment on individual cases, but advised: “We would encourage patients to seek support from their GP or one of the voluntary sector agencies such as The Transgender Alliance, LGBT Health and Wellbeing and LGBT Youth whilst they are awaiting their appointment with the gender clinic. We would advise against ordering drugs from the internet.”

She also said the Edinburgh clinic has been working at a “reduced capacity because of staff sickness" and added: “Unfortunately waiting times have increased as a result of this alongside a significant increase in referrals.

“We apologise to all of those patients affected and expect that normal service will begin to resume in four weeks time. We are very grateful for staff from NHS Greater Glasgow and Clyde for providing some interim cover for us.

“We have written to all of our patients individually to make sure they are aware of the changing situation and we continue to regularly meet with support groups and other charities to keep them informed throughout. We are working with NHS Boards across Scotland to consider how best to increase gender services in Scotland.”

Oliver Ross, a 20-year-old student who was born a woman from Glasgow, is four months in to his 11-month wait for an appointment at the Glasgow clinic.

As a transgender man, he wears a chest binder which can be damaging to the tissue and internal organs if it is worn for long periods of time.

Ross said the implications of wearing the binder - a flexible piece of fabric which compresses the chest, masking the appearance of breasts - can be severe.

He said: “I have asthma and I’d like to get on hormones and be referred for top surgery as binding is quite painful.

“I work 12 hour shifts sometimes and I know I shouldn’t be wearing [the chest binder] for that long but I can’t help it if I’m working.

“It can cause a lot of rib problems. I’ve seen a lot of people who have been binding for years and they have deformed ribs from the constant compression.”

Along with the physical difficulties, Ross said the delay takes a toll on many people who are stuck in “limbo” while they wait for help.

"At the moment all I can think about it getting on hormones." he explained. "Obviously there will be other things but I know I’ll be able to do day-today activities like work and studying a lot easier.

"As a trans guy it’s easier to go out and live my life, but a lot of people can’t do that. They can’t until they get these hormones.

"There’s an assumption that trans people need more time to decide but once you’re out there you’ve made the decision.

"It’s horrible being in that limbo. I know it’s not as easy as getting more staff but something needs to happen.”

Calder Bishop, an 18-year-old student from Dunfermline also uses a chest binder to make him look more masculine, but worries about the physical implications.

He said: “You have to be incredibly careful about the sizing and stuff. You should only wear them between two and eight hours, you can sneeze and break a rib.

"People puncture their lungs, they can deform your ribs if you wear them for years and years. I understand on the NHS a mastectomy can take years but you might have caused yourself some serious damage by then.”

Bishop said he has suffered depression whilst waiting for his appointment at a gender clinic, but realises he will not be getting help any time soon.

“It’s stressful. It does sometimes get me down, depressed over it." he said.

"It gives me the jitters, makes me anxious...I don't get angry, I get depressed that I'm stuck the way I am and I can't progress and resources are so limited.

"You can't blame anyone, it's not medics fault at all. Trans people now feel like they are able to come out and things are a lot more readily accepted…There is so-called acceptance, but there's not medical support there.

“It's like 'we'll get to you when we get to you'. Coming out was difficult enough, to go to a medical practitioner who is probably going to question everything you say regardless of how legitimate you are, it's intimidating.

“Even once I’m with the clinic I know it will take a long time. Nobody goes into it thinking it will be a short process.”

In Westminster, a select committee is currently taking submissions from transgender groups across the country to try to address equality for trans people.

The Scottish Transgender Alliance put forward a number of recommendations, including suggestions on how to reduce the waiting time for trans people in Scotland and free up the vital medical resources needed to treat people who are waiting for hormones or surgery.

James Morton, manager of the Scottish Transgender Alliance, helped to compile the group's submission, which includes scrapping the medical and psychiatric letters needed for trans people to legally change their gender on their brith records.

Currently only the five registered gender specialists in Scotland can issue trans people letters to confirm they are transgender, which then have to be sent off along with a second medical letter and a number of other documents.

Morton said the process is no longer fit for purpose, and added: “You shouldn’t have to submit psychiatric and medical reports, it should be done as a simple administrative process the same as you'd change your name.

“Having to send in a psychiatric report is really insulting to people. Even the gender identity specialist doctors agree these reports should not be required to change legal gender. It's needlessly intrusive.”

He explained most trans people look at the mountain of paperwork required to change their legal gender and don’t bother, but said it can create difficulties later on.

He said: “This makes their government records a mess with conflicting gender details recorded in different places. When it comes to the crunch, trans people who haven't changed their birth certificates are at risk of not being treated [according to] the gender they identify and live as.

“This can result in insurance policies and civil partnerships/marriage ceremonies being inadvertently invalidated, being 'outed' as trans, and other red tape nightmares.”

A Scottish Government spokeswoman said: “The Scottish Government recognises any wait can cause anxiety for patients. We are supporting Boards to ensure waiting times are as short as possible for all patients.”