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Findings from TransActual’s largest-ever survey show widespread discrimination, unsafe care, and a system many trans+ people feel forced to avoid.
If you’re a trans+ person in the UK, accessing healthcare can feel exhausting before you’ve even walked through the door. You may have waited years for a referral, or been misgendered by a GP who was supposed to be helping you. You may have stopped going to the doctor altogether because the experience felt more harmful than helpful.
This year, TransActual has published the Trans Lives 2025 report, the largest survey of trans+ people ever carried out in the UK, with more than 4,000 people sharing their experiences. What it found confirms what so many in our community already know from living it. And set alongside what has been happening to NHS gender services for young trans+ people, it tells a story that we think everyone deserves to hear clearly and honestly.
Trans Lives 2025, TransActual“Most respondents reported experiencing transphobia or poor care from primary care staff, having low levels of confidence in staff, and commonly avoiding contact with healthcare services when they need them.”
More than half of the trans+ people surveyed, 52%, said they had experienced transphobia or poor care from at least one primary healthcare worker. That includes GPs, nurses, receptionists, and pharmacists, the people any of us need to see just to manage our basic health. For more than half of trans+ people, those appointments carry a real risk of being treated badly simply for being who you are.
GPs were the most common source of poor treatment. A third of respondents reported discrimination from their GP, and the most common reason was that their GP simply did not know enough about trans+ healthcare. Of those who reported discrimination from a GP, 97% said their GP lacked basic knowledge about trans+ health issues. This is a significant failure running through the entire system.
Among those who experienced discrimination from a GP:
It’s important to state that these are not rare or extreme stories. They’re ordinary appointments of people going to their GP with ordinary health concerns, and being turned away, dismissed, or actively harmed. These are unacceptable experiences for anybody, yet tens of thousands of UK trans+ people are living this reality.
For those who do get a GP referral to a Gender Identity Clinic (GIC), the wait for a first appointment is extraordinarily long. People currently being seen through the NHS have already waited up to eight years just for their initial consultation. One Scottish clinic, at its current rate, has a projected waiting time of 224 years.
This means that NHS gender-affirming care is not a realistic option for most trans+ people. Those who can afford to go private face average costs of around £5,573 for transition-related procedures, according to TransActual’s earlier research.
Most of the people who responded to the Trans Lives 2025 survey had household incomes below the UK median. For them, private care is not a realistic alternative either.
The result is people self-medicating or going without care they need, for years, with all the consequences that brings for their mental health, physical health, and quality of life.
While the picture for trans+ adults is increasingly concerning, what is happening to gender-affirming care for trans+ young people is a fast-moving crisis.
In February 2026, the Medicines and Healthcare products Regulatory Agency (MHRA), the government body that oversees medical trials, stopped the NHS Pathways trial into puberty blockers for trans+ young people. This was the last remaining way for trans+ young people to access puberty blockers through the NHS. It had £10 million of NHS funding behind it, was being run by King’s College London, and had been just weeks away from taking on its first participants. Then, in March 2026, NHS England stopped new referrals for hormone treatment for 16 and 17-year-olds.
Puberty blockers are medicines that pause the physical process of puberty. They have been used safely for decades, including for cisgender children who go through puberty unusually early, the exact same medicines, used in the same way. For many trans+ young people, access to blockers at the right time can be life-changing.
They create space and time to understand your own identity, time to grow without the distress of watching your body change in ways that feel distressing and wrong. For some young people, that space is lifesaving.
The justification given for removing both puberty blockers and hormone treatment for trans+ young people is that the evidence base is not strong enough.
However, that conclusion deserves to be heavily critiqued. What it actually reflects is decades of failure to fund research into trans+ healthcare, and the government is now using that failure as a reason to take care away from those who urgently need it. The absence of research is itself a policy choice. Successive governments have had decades to invest in this research and have chosen not to, and trans+ young people are the ones living those consequences.
The 10 evidence reviews NHS England published alongside its announcement reveal something extremely concerning about how the conclusion of “not enough evidence” was reached. Rather than reviewing all available research on hormone therapy for trans+ young people, NHS England divided the question into ten separate, very narrow reviews, split by hormone type, and then again by whether the patient identified as binary or non-binary. The result was that 547 studies were screened, and just 17 were included. A 97% exclusion rate, not because the research doesn’t exist, but because the reviews were structured in a way that ruled most of it out.
Among the studies excluded was the largest study of trans+ young people ever funded by the US National Institutes of Health, published in the New England Journal of Medicine in 2023. Also excluded was research published in JAMA Network Open in 2022, which found that trans+ young people receiving hormone therapy had 60% lower odds of depression and 73% lower odds of suicidality.
The research that forms the foundation of trans+ youth healthcare standards used worldwide was excluded too. NHS England’s own data confirms that 98% of its patients had followed precisely the treatment pathway that every single one of these reviews was designed to exclude.
Gordon Guyatt, the researcher who created the evidence-rating system used in these reviews, has described using that system in this way to justify banning gender-affirming care as “egregious and unconscionable.” Trans+ young people are being held to a standard of proof that is simply not applied to any other group of children in the NHS.
The MHRA’s decision to pause the Pathways trial came after the appointment of a new chief medical and scientific officer, Professor Jacob George. It later came to light that Professor George had a history of anti-trans posts on social media. He had called trans people a “militant minority,” praised well-known anti-trans campaigners, and publicly questioned the gender of a cisgender female Olympic athlete. He was removed from any involvement in the trial. However, the pause he had triggered was not lifted.
Dr Hilary Cass, who had led the original review recommending the trial, said publicly that no new scientific findings had emerged and that it appeared the MHRA had been responding to political pressure rather than evidence. Professor George did not appoint himself. His role was created and approved by government ministers. The hormone treatment review that followed was sanctioned at ministerial level.
Again and again, the reviews, panels, and processes that determine whether trans+ people can access healthcare are shaped by people who have not included trans+ voices in any formative way.
In some cases, people who hold openly anti-trans views are brought to the table. When that happens, the outcomes are not a surprise, and it is young trans+ people who are the most affected.
The Trans Lives 2025 report found that 64% of trans+ people avoided going to their GP, even when they were unwell. Nearly two-thirds of trans+ people in the UK believe that the risk of being mistreated outweighs the benefit of getting help.
This avoidance extends far beyond GP appointments:
This is what a broken system looks like from the inside. Not just individual bad experiences, but a community that has learned, from years of evidence, that seeking care often causes more harm than it prevents.
The impact of that on trans+ people’s long-term health, on conditions left undiagnosed, on emergencies left untreated, cannot be overstated.
While these challenges affect trans+ people across the board, the research clearly shows that some communities face significantly more than others. Trans+ People of Colour, trans+ intersex people, and disabled trans+ people are all more likely to face discrimination, to receive poor care, and to avoid healthcare as a result.
These are not separate issues running alongside each other. Racism, ableism, and transphobia intersect, interact, and compound one another. Any serious attempt to improve trans+ healthcare has to take that seriously. Addressing transphobia alone will not be enough if the same structures continue to fail trans+ people who also face other forms of discrimination.
One of the most important things to understand about what is happening to trans+ youth healthcare is that it has created a system divided by money. If your family can afford private healthcare, you may still be able to access puberty blockers and hormone treatment. If you cannot, you cannot. Access to gender-affirming care is now determined by wealth, and it is trans+ young people from the least well-off families who are losing the most.
When NHS gender services were cut back after the Cass Review, there was a documented rise in suicides among trans+ young people. Families who had waited years watched their children’s distress deepen as puberty continued.
It’s important to know that this may not stop with young people. Buried in NHS England’s own equalities impact assessment, published alongside the evidence reviews, is a statement that NHS England is separately reviewing the evidence for hormone treatment for trans+ adults, with a consultation expected later in 2026.
If that review follows the same approach as the reviews described above, the same manufactured gap in evidence could be used to restrict or remove gender-affirming care for trans+ adults, too.
The Trans Lives 2025 report is a call to action, and its recommendations are clear. Every healthcare professional who may treat trans+ patients, which means virtually every healthcare professional, needs mandatory, high-quality training in trans+ inclusive care, built into their training from the start and maintained throughout their careers.
GPs need to be supported and empowered to prescribe and manage hormone therapy, so that trans+ people are not forced to wait decades or spend thousands to access care they urgently need.
There needs to be a dedicated NHS plan to reduce trans+ health inequalities, built in genuine partnership with trans+ communities, not designed around them, without them.
There also needs to be a serious, honest move away from the centralised Gender Identity Clinic model towards locally provided, informed consent-based care that actually reaches the people who need it.
For trans+ young people specifically, what is needed is not more reviews designed to exclude the evidence. There needs to be a genuine commitment to funding research, restoring access to care, and putting the voices of trans+ young people and their families at the centre of every decision that affects them.
This piece draws on the Trans Lives 2025 report. Our thanks to TransActual UK for the work and dedication it took to bring this research together.
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