NHS Gender Clinics Face Unprecedented Backlog as Transgender Patients Wait Decades for Care

A recently published report has laid bare the scale of the crisis facing transgender patients seeking care at NHS gender clinics in the United Kingdom. According to the findings, waiting lists for essential services—including hormone replacement therapy (HRT) and initial gender dysphoria assessments—are not only growing each year but have reached unprecedented lengths, with some individuals in Scotland and Northern Ireland facing waits nearly three times longer than the average British life expectancy for a first appointment. In Glasgow, the backlog is so severe that patients could theoretically wait up to 224 years before being seen .

The report, compiled through a Freedom of Information request by advocacy groups QueerAF, What the Trans?, and Claire’s Trans Talks, reveals that as of March 2025, more than 48,000 people were waiting for their first appointment at one of the UK's 15 gender clinics. For every person seen in 2024, four new patients joined the waiting list, underscoring the rapid escalation in demand .

While the average estimated wait for most areas in the UK is 25 years, regional disparities are stark. In Nottingham, patients wait approximately three years, but in Belfast, waits extend to 41 years, and in Glasgow, the projected wait is a staggering 224 years . Demand for services such as HRT prescriptions rose by 12.5 percent over the previous year, indicating both a growing population of transgender individuals seeking care and the inadequacy of current service provision .

Claire Prosho, founder of Claire’s Trans Talks, described the figures as “disappointing but unsurprising,” highlighting the failure of the NHS and the government to improve access to vital, life-saving healthcare. Prosho called for a shift away from the current diagnostic service model to a simpler informed consent approach, aligning with international best practices and community consultation .

The consequences of these delays are profound. Evidence shows that transgender people experience higher rates of mental health conditions, including depression and anxiety, which are exacerbated by prolonged waiting times for care . NHS England has acknowledged the unacceptable waits and launched a new wellbeing pilot, backed by £125,000, to provide clinical and emotional support to adults on waiting lists. This includes access to digital mental health resources and community-based services prior to their first appointment .

Professor James Palmer, NHS England’s medical director for specialised services, noted, “We know there are unacceptably long waits for many of these services. This is why we have commissioned an independently led review into the operation and delivery of the adult gender dysphoria clinics, alongside work already undertaken to introduce new care models that are making significant progress in helping to bring down these very long waits” .

Over the past five years, the NHS has doubled its investment in gender dysphoria services and opened five new clinics. However, these efforts have not kept pace with the increase in demand. In the south-west of England, for example, patients are still facing waits of more than eight years for a first appointment, with over 5,000 people in that region alone waiting to be seen .

The Health and Social Care Secretary, Wes Streeting, remarked on the “unacceptable” waiting times at the NHS England LGBT+ Health Annual Conference, promising further reforms to ensure healthcare is accessible for all, and to “stamp out systemic health inequalities that the LGBT+ community face” .

Stories from those awaiting care illuminate the personal toll of the delays. Several patients recounted feeling “lied to” about expected wait times, with one individual stating, “If I’d known at the time it would be seven years, I would have gone to a different gender clinic” . Many have called for the UK to adopt an informed consent model, now standard in countries such as Ireland and Canada, which allows transgender people to access gender-affirming treatment without lengthy diagnostic assessments .

According to advocacy organizations, the complexity and individualization of gender-affirming care, coupled with limited specialist resources, contribute to long wait times. Gender clinics are often understaffed, and the number of qualified specialists, including endocrinologists and surgeons, remains insufficient to meet current demand .

The crisis in NHS gender clinics has triggered a national conversation about the rights and wellbeing of transgender people in the UK. Stakeholders across government, healthcare, and the LGBTQ+ community agree that urgent action is needed—not only to clear the backlog but to overhaul the system and ensure equitable, timely access to life-affirming care.

The NHS is currently conducting a major review into the operation of adult gender dysphoria clinics, following recommendations from Dr Hilary Cass, whose Cass Review highlighted the challenges and failures in adult services. Patients on waiting lists will now have access to online cognitive behavioural therapy through the NHS’s Silvercloud service, as part of efforts to alleviate the mental health burden while broader reforms are implemented .

Advocates continue to urge policymakers to listen to the voices of transgender people and adopt evidence-based, community-informed strategies for care. As the debate evolves, the central message remains clear: timely, compassionate healthcare is a basic right for all, and the current failure to deliver it demands immediate and sustained attention.