Three more months. Minimum.

[CW: institutionalised transphobia in healthcare systems]

I’ve never broken a bone. I’ve never experienced the sickening crunch, the nauseating wrongness that hits a split second before the pain does. The dread that slams into you even before your body can process what has happened, what hurts. 

The closest I’ve come is this.

It’s the end of January, and I’m at my local gender clinic. It’s taken five or six voicemails – the first left mid-November – to get this appointment. I’d begun to worry (to panic, honestly, and begin to think seriously about DIY HRT) that I’d fallen into the cracks of a healthcare system that consistently fails trans people when the gender clinic finally called me back. 

My relief was short-lived. 

You see, before I can get top surgery, I need a referral from a gender specialist. A psychologist – who will almost certainly be cisgender – will assess my eligibility to access a surgery I’ve wanted for more than five years. A surgery I think about every single day.

I’ve been waiting for an appointment to get a referral for more than 18 months now. (NHS England claim that “the maximum waiting time for non-urgent, consultant-led treatments is 18 weeks.”) Last summer, my usual gender clinic nurse assured me that I would have the appointment before the end of the year. 

Spoiler alert: I didn’t. 

During my appointment in January – which was to assess my testosterone levels after moving my shot from every twelve weeks to every eleven weeks – I brought this up. I asked when I could expect to finally have this appointment, to get my referral. I wasn’t ready for the answer.

I knew that Wes Streeting had extended the Conservatives’ puberty blockers ban for trans youth indefinitely. I knew young people were no longer able to access life-saving healthcare in the UK. I was disgusted and heartbroken and outraged, but I didn’t think my healthcare had been affected. Why would I? The Cass Review – a government-commissioned study on UK trans children’s healthcare described by Lee Hurley for Trans Writes as “a thinly-veiled act of bigotry wrapped in the guise of ‘concern’” – is often cited as the evidence for banning puberty blockers, despite not actually recommending a ban on puberty blockers and the report being widely criticised, debunked, and condemned. 

My intention here is not to imply that trans youth are any less deserving of gender-affirming care than trans adults, but to highlight that I didn’t think I had any reason to believe that my access to trans healthcare was under immediate threat. Especially since – at the time of this appointment – I was two weeks away from my 27th birthday. Even those who argue that trans people shouldn’t be able to access hormones or surgery until 25 (because that’s when your frontal cortex is considered fully developed) should no longer be able to claim that I’m not an adult who can make my own decisions about my own body. 

It is hard not to hate my past self for my naivety. 

The nurse my appointment was with explained that Chalmers – the gender clinic I’m registered with – had to temporarily pause all referrals for surgery. They are apologetic but don’t explain why, and I’m too full of despair and panic to think to ask. I filled in the rest of the details later. 

It turns out that in 2024, Chalmers stopped referring trans adults for surgery, and just didn’t tell their patients for several months. Abigail Thorn notes in a piece for Trans Writes that the gender clinic “later said referrals were ‘paused’ pending a ‘review’ but wouldn’t say who commissioned the review, why, or how long it would take.” Scottish Trans explains that assessments and referrals for surgeries that take place in England (masculinising top surgery, vaginoplasty, and phalloplasty/metoidioplasty) were paused for trans people over 25 between May and October, and assessments and referrals for all gender affirming surgeries were paused for trans people aged 18-24 between May and 23rd November. 

NHS Lothian announced in November 2024 that all referrals for gender-affirming surgery would resume. This, of course, explained why I hadn’t had my referral appointment before the end of the year. (Unsurprisingly, it’s an explanation that offers me absolutely no comfort.)

The gender clinic nurse told me that while appointments had resumed, it would probably be at least another three months until mine, and it felt like something broke inside me. I wanted to cry, to throw up, to shout; I don’t know how I sat there for the remainder of the appointment, sitting there calmly as though I wasn’t falling apart. Was this shock, my body shutting down and dissociating so I didn’t have to deal with the pain? Protecting myself until I could get home and crawl under the covers to howl in grief? 

Three more months. Minimum. 

Fuck. 

I’ve worked incredibly hard over the last few years to make sure I’m not putting off actively participating in my own life. I don’t want to wait until I get top surgery to do things I want, to build a life that makes me happy, to be present, to live. But it’s so hard to do that when you’re waiting for something you desperately want, something that will massively improve your quality of life. It’s hard not to put all of my energy into counting down the next three months. Then counting down the years I will spend on a surgeon’s waiting list, waiting for the surgery itself. Wishing my twenties away, desperate for the day I can look in the mirror at the scars on my chest. 

I’ve never written a ‘30 before 30’ list, but I think I know why. I always hoped I would be able to get top surgery before I turned 30. But how can I write that down as a goal when it feels so impossibly far beyond my control? Getting to the top of the NHS waiting lists for surgery or finding the thousands of pounds necessary to access private healthcare both seem like they’ll take much longer than three years at this point. Why set myself up for disappointment?

Except I shouldn’t have to wait that long, should I? Puberty blockers, HRT, surgery – the healthcare trans people want are safe, evidence-based, and can be genuinely life-saving. I believe the healthcare I have spent half a decade asking for should be free, and should be far more accessible to trans people than it currently is. I cannot put words to the disgust and rage I feel at the hoops trans people are expected to jump through to access healthcare. 

I am not a man trapped in a woman’s body, I am a man trapped in a medical system designed to pathologise who I am and make it as hard as possible to access healthcare. I am trapped in a society that is actively denying me bodily autonomy. The lack of autonomy makes me want to scream.

I don’t scream. I download a countdown app onto my phone and set it for the end of June – the latest possible date I can bear to imagine my appointment for top surgery referral will happen. I can do this; I have to do this.

• I got to be a sexual health nerd and write about foot fetishes and STIs for the February issue of The Skinny! Research shows that throughout history, STI outbreaks correlated with increased evidence of people being into feet. When gonorrhoeal flared up in medieval Europe, poets wrote odes to feet; during the AIDS crisis, queer men attended circle jerk parties. But with STI diagnosis rates in the UK currently rising, I explored whether people are turing to foot fetishes and other kinks to reduce their risk of STI transmission today.

• Lex McMenamin's reporting on how we've lost more trans youth (and federal trans rights in the US) in the year since Nex Benedict's death for Teen Vogue is powerful and important. Their piece delves into how communities are trying to keep each other alive right now, as well as Nex's Native identity and his death as part of the broader issue of Missing and Murdered Indigenous People. "Nex Benedict’s death was confirmation that anti-trans policies and rhetoric have a body count. Is anyone listening?" [CW for transphobic violence and suicide.]
• Abigail Thorn wrote about the pathologisation of trans people by the NHS for Trans Writes with gut-wrenching precision that made me cry. She pulls absolutely no punches in detailing how fucked up it is that trans people need to get permission to transition and how that what they call 'care' is really contol. "Pathologization exaggerates and in some cases wholly imagines the risks of transition to justify denying us the right to weigh those risks and choose for ourselves, and there is no place in medicine for that kind of paternalism."
• On a similar theme, Tabby Lamb's essay about her vaginoplasty consulation appointment really captured the rawness of fighting for healthcare in a system that doesn't see you as human. "i don’t look down, not at the toilet seat, not the funnel, not the jug, not even my junk which had just been manhandled by 6 blue gloved hands as they assessed if i had enough foreskin for a vaginal canal and despite not looking down all i can see are those blue gloves." [CW for discssion of weight loss and suicidal ideation.]
• I'm so glad Ruby Rare addressed the blatent pink-washing of Keir Stamer becoming the first Pime Minister to publicly take a HIV test. They point out how hard it can be to access sexual health services after a decade of funding cuts Labour have no plans to address, and how this PR stunt is designed to paper over the anti-trans actions off a supposedly left-wing government. "If you're not going to stand up for queer rights and trans healtchare, you can't use us as a publicity stunt."
• One of my 2025 goals is to read more romance books with trans and non-binary main characters. I kicked January off with Second Chances in New Port Stephen° by TJ Alexander, and picked up Rules For Ghosting° by Shelly Jay Shore. I loved both books – and I maintain trans authors write the hottest sex scenes. (I'm also really glad I read Rules for Ghosting despite initially assuming I wouldn't enjoy a ghost story, because it was a tender exploration of family and grief that made me cry so many times.)
• Finally, I'm absolutely obsessed with Days of The Week – Marf Summers' incredible set of affirmation boxer briefs. You should absolutely go look though all of the photos and read the caption, which explains how they see this work as: "way to subvert cishetero masculinity with sincere, loving statements of intent."