How we’re supporting the needs of trans and gender variant Londoners

There is a long way to go for trans rights, but two gender identity clinics in London are making a positive difference for people who have gender dysphoria, says Dr James Barrett, Consultant Psychiatrist and Lead Clinician, Gender Identity Clinic, West London Mental Health NHS Trust

Gender identity holds a fascination for the media and the public. Even so, there are often basic misunderstandings and a general ignorance about how trans and gender variant people feel about themselves, and what treatments are available for those who suffer dysphoria around gender.

Cultural climates take time to shift. While stigma around gender transition has lessened over the years there is still a long way to go before we eradicate transphobic stigma completely: global outpouring of support for Caitlyn Jenner’s decision to live as a woman aged 65, for example, did not wholly drown out her detractors.

The first step is to help members of the public to better understand the condition and to guide those who are struggling with their gender identity to sources of information and support.

Some people wrongly assume that gender dysphoria is a psychiatric illness, a sexual disorder or a ‘lifestyle choice’. It generally isn’t a conscious choice at all, nor is it a hobby, a fetish or a phase. It manifests as a sometimes unbearable sense of unhappiness, distress or discomfort that someone feels about the mismatch between their apparent bodily sex and inner sense of one’s own gender.

There are two gender identity clinics in London: the Charing Cross Gender Identity Clinic, part of West London Mental Health NHS Trust and the Tavistock Clinic in North London, which offers treatment for children and adolescents.

The Charing Cross Gender Identity Clinic, established in 1966, is the oldest clinic of its kind, it’s also the largest in the world. People from all over the UK, the Channel Islands and the Republic of Ireland are treated at the clinic. It currently receives 1600 referrals a year, a number that has doubled every 5 years since 1966.

Coming to the clinic is an important milestone for many.  Some are seeking advice: they are uncertain about how they feel and are questioning or exploring their gender. Some are more certain, with a very clear idea of themselves and the life they feel they should be living.

Previously around 80% of those transitioning were trans women (assigned male at birth but female in their inner identity). However, in the last decade, there has been an increase in the number of trans men (assigned female at birth but male in their inner identity). Some people identify as gender-neutral, neither male nor female, or androgynous, incorporating elements of both. 

Untreated gender dysphoria can be debilitating and associated with persistent and chronic psychological ill health, social and occupational underperformance and high rates of deliberate self-harm.

The feedback from people attending the West London clinic over the last six months has shown that 97% are satisfied or highly satisfied with the clinical care they have received. Treating gender dysphoria is transformative. There seems to be no ill effects from lifelong cross sex hormone treatment. Effective treatment also increases psychological and social functioning, employment status and income. Ultimately, people leave the clinic feeling happier in themselves and functioning better in society.

No one knows what proportion of the general population experience gender dysphoria but there has been a worldwide steady increase in people seeking help with it. Gender dysphoria might not manifest immediately – it can occur at any stage of life – and it does so in different ways, depending on the individual. 

In London, we are committed to giving this serious and potentially disabling condition the recognition and treatment it deserves to support trans people on their journey. 

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