3.2 Supporting clients who are waiting to transition

As a therapist working with a trans client, it is likely you will be supporting them through periods of ‘stuck-ness’, enforced waits, and lack of resolution. There are many reasons for waiting to transition, including feared or experienced rejection from family, work and the wider public.

But for those who want to access medical transition services and who cannot afford private care, the issue of waiting and stuck-ness is massively exacerbated by the fact that the adult waiting time just to the first (assessment) appointment for gender-affirming medical treatment on the NHS is 4–5 years. It can take months – or years – beyond that to access hormones.

Research shows that increases in waiting times for medical treatment (in general) are associated with increased anxiety, depression and poorer quality of life (Gagliardi et al., 2021) and that waiting for years for trans-affirming care causes significant distress (Grant et al., 2025; see also Zaccaro and Fagg, 2024 [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ). In order to understand more about what the ICTA project found out about the impact of waiting to access gender-affirming treatment, try the following activity.

Activity 3.3: The impact of waiting for ICTA participants

Timing: Allow 10 minutes

In the following activity, match the quotes with the impact of waiting.

Two lists follow, match one item from the first with one item from the second. Each item can only be matched once. There are 4 items in each list.

  1. Feeling life is passing by

  2. Loss of relationships

  3. Loss of psychological resilience

  4. Suicidality

Match each of the previous list items with an item from the following list:

  • a.‘I can’t form relationships, I can’t find any kind of a relationship, because I’m still in this interim if you like, this ridiculous half world that I inhabit at the moment. I’ve lost, certainly feel like I’ve lost seven years… I’ve lost two relationships because I’m not transitioned.’

  • b.‘Even if you consider yourself to be pretty resilient, and if you think of yourself as a resilient person and that your mental health is strong, it still gets exhausting, and the wait is just interminable…’

  • c.‘I’m going to be dying of old age before I actually… get my first appointment… and I’m just wanting to live, I feel like I’m in limbo waiting. Time’s running out but I’m not getting anywhere… which is really frustrating.’

  • d.‘[If I hadn’t been able to get private healthcare] I'd be dead. Straight up, I'd be dead… It's the underside. It's the side that people like to pick on when they're talking about transgender health, you know, these people are crazy, they're all suicidal. No. The lack of treatment for many dealing with gender dysphoria, it's abhorrent, for lack of a better term. It is absolutely abhorrent. Those feelings I had in late 2016, I never ever, ever want to experience again. If I hadn’t have gone with [private service A], I'd be dead.’

The correct answers are:
  • 1 = c,
  • 2 = a,
  • 3 = b,
  • 4 = d

Discussion

The quotes from ICTA participants suggest that the multi-year waits to access medical transition healthcare through the NHS creates a considerable mental health burden for trans people. Therapists can offer psychological support while people wait but this does not solve the problem. It may help to:

  • Signpost clients to community resources that can support them while they wait.
  • Support clients to get on the Gender Identity Clinic (GIC) waiting list at the earliest possible opportunity if they are considering transition (they can always change their mind later).

3.1 Supporting clients around medical transition

3.3 Patrick’s experience of waiting