Inequalities in Gender Identity Services.

Will Huxtor (left), the current chair of the NHS England Gender Task & Finish Group, is reported in his latest blog to be wanting to address inequality in the treatment of transgender people.  Unfortunately, there is already glaring inequality though in the way that the NHS commissioning services distinguish between the treatments for transgender women against those offered to trans men and these are weighted heavily in favour of transgender men.

One has to wonder if there might possibly be some sort of patriarchal bias against allowing transgender women equality in access to funding for surgeries which will allow them to transition in the relative safety that transgender men enjoy.

For trans men treatments which are funded by the NHS include:-

• Testosterone therapy (much more expensive than oestrogen therapy)
• Mastectomy (chest surgery)
• Oophorectomy and hysterectomy
• Metoidioplasty
• Phalloplasty (3 stage operation)

It is estimated by some sources that the cost is 4 to 6 times the total cost of treatments for transgender women

For trans women treatments which are funded by the NHS include:-

• Oestrogen therapy
• Limited (8 hours) laser treatment to reduce the amount of facial hair (this is generally insufficient to fully remove facial hair - and if the patient cannot afford private treatments, it will grow back to its former density - thereby wasting the initial money spent)
• Breast augmentation (allowed in selected cases, but not available to everybody)
• GRS (includes orchidectomy, penectomy and vaginoplasty) - cost around £10,000
• Tracheal shave (occasionally - but has to be fought for)

What is not included and is often vital are:

• Hair transplantation (generally low cost surgery)
• Facial Feminisation Surgery (high cost - similar in cost to phalloplasty in f2m patients)
• Vocal cord surgery (only in exceptional cases)

The effects of testosterone for trans men is extremely beneficial - the voice will break naturally to give a very male voice, facial hair will develop so that the person will often grow a beard, hair loss will often result in male pattern baldness. The facial structure (underlying bone structure) will change the features to become far more masculine in appearance because of changes in the bone structure of the face. Features that do not change to a very large extent are the size of the hands or feet.

As a result of all this trans men tend to be assimilated back into society far easier than trans women and can therefore find it easier to gain meaningful employment and to hold down that job.

Although oestrogen therapy does bring about breast development (especially in younger people) very often very little breast development takes place - and funding for breast augmentation is a postcode lottery it would appear.

The NHS will fund 8 sessions of laser hair removal (or electrolysis) this is woefully inadequate in many cases and if the person cannot afford treatments (low income or unemployed) then the facial hair will regrow. This can make it extremely difficult for a trans woman to gain work/hold down a job (despite the EA2010 regarding employment non-discrimination). In many cases an additional 4 to 8 hours treatment would totally eliminate facial hair - and hence NHS money would not have been wasted.

The NHS will not under any circumstances fund hair transplants for transgender women - leaving them at risk of devastating humiliation should an accident occur or if somebody decided to play a “prank” and remove it.

The NHS will not under any circumstance fund facial feminisation surgery. This is as vital to many trans women as GRS. Oestrogen therapy will not reverse the effect of the radical facial masculinisation during a male puberty to any great extent (or reduce the size of hands or feet) which leaves trans women at far greater risk of transphobic hate crime - with the destructive loss of self-confidence which can lead to depression, anxiety attacks, suicide ideation or self-harming.


Whilst it is extremely important not to deny any of the existing NHS treatments that are freely available to transgender men, it is nevertheless vitally important that transgender women have equal access to surgeries which are vital to them and to how that can help them secure employment and assist in a good assimilation back into society.

In a survey which I did a short while back and which I have tried in vain to bring to the attention of Dr. John Dean (who has promised me appointments on two occasions now, but failed to deliver on either) it became absolutely clear that about half of all respondents to the survey felt it was as (if not more) important to allow transgender women to have access to Facial Feminisation Surgery (FFS) as the Gender Reassignment Surgery.

If you think about that, it actually might relieve a lot of the immediate pressure on the chronic waiting list length for GRS as many patients could be switch over to FFS surgeons hence relieving the pressure on the GRS surgeons.

If Mr. Huxtor would like to contact me about this, he can do so via the contact form on my website,