In England, Lengthy Waits for Gender-Affirming Care Led to Tragedy

The mainstream press in the United States has been quick to tout England’s removal of care from vulnerable youth, but the dire consequences don’t fit the narrative.

by Evan Urquhart

A young trans woman who sought gender-affirming care as a minor died of suicide years later, still on the waiting list for treatment that never came. According to reporting in the BBC and Pink News, Alice Litman came out as trans at 16 and was referred to the Gender Identity Development Service in 2019. She died in May 2022, having been on a waiting list for more than 1000 days. In the intervening time the young woman had attempted suicide twice. Litman’s devastated family believe she could be alive today if the gender-affirming care she needed had been provided in a timely fashion by the NHS.

An official inquest being conducted into Litman’s death includes a written statement from Dr. Caroline Litman, the mother of the deceased girl, provides a window into the neglectful treatment young people with gender dysphoria in England face.

screenshot from the BBC

Waiting lists that stretch on for years are the hidden scandal of the anti-trans backlash in the U. K., where the hate and fear that has been fomented towards trans people has resulted in a severe and worsening neglect of their healthcare needs. The conservative government’s overall neglect of the NHS system has been exacerbated in the case of trans healthcare by political hostility to the trans community in the U. K. In England, this has manifested as ever-lengthening waits for trans people to start receiving care. As waits stretch on and on, young trans people in the country have been left to cope with the consequences of gender dysphoria, known to include psychiatric symptoms like anxiety, depression, and dissociation, unaided and alone. Such consequences are universally disruptive and sometimes, as they seem to have been for Litman, life-threatening.

Back in the United States, however, several notable mainstream outlets have painted a different, one might even say false, picture of the state of gender-affirming care in England. In the Atlantic, Helen Lewis has had nothing but praise for England’s approach. In a piece in May of 2023, one full year after Alice Litman’s death, Lewis claimed that England and other European countries were providing thorough assessments and counseling, rather than years long waits.

screenshot from the Atlantic

Claims that other countries are providing better care is a plank in the argument that the U. S. is doing something wrong. Because Americans are famously ignorant on international issues, these false narratives are relatively easy to promote. While it has long been clear that the years-long wait times for a young person to have a first appointment in the U. K., ideologues like Lewis choose not to mention them, or the political environment of transphobia that gave rise to the issues in the first place. In truth, it’s long been clear that multiyear waits for treatment in England has muddied the waters, making it impossible to tease out whether observations of psychological distress on the part of young patients is primarily due to the lack of timely treatment, or if other factors are at stake.

Lewis also praised England’s approach to gender-affirming care (and ignored the well-known issues) in an essay for the Atlantic last month titled “The Gender War is Over in Britain.” In this piece, Lewis exults in the fact that the transgender community has been forsaken by leaders on the left as well as the right. Of course the rosy picture of an orderly and evidence-based process Lewis paints is completely at odds with the reality of her home country, where vulnerable young people have lost hope of accessing treatment at all.

It’s not only Lewis who has written misleadingly about the grave situation for trans young people in the U. K. for an underinformed American audience. The New York Times also hopped on the propagandist bandwagon, painting a falsely bright picture of decisions in England which have increased wait times and limited access to care. When the closure of England’s only youth gender clinic was announced in June 2022, a month after Litman’s death, Azeen Ghorayshi for the New York Times claimed that new clinics would “expand the country’s gender services while making sure children are adequately treated for autism, trauma, and mental health issues.”

screenshot from the New York Times

It soon became clear that the closure of the Tavistock was a complete disaster, but the NYT never updated their readers with those facts. Other outlets stepped in to do that job, such as a report by Vice in February that exposed the total lack of preparation for any new service to take Tavistock’s place. Since the Vice report the clinic’s closure has been delayed until at least March 2024, but continues not to accept any new patients. That means as months have turned into years young people with gender dysphoria in England have had no treatment at all. Further, there is no reason to believe wait times in the new clinics will be substantially addressed, with experts repeatedly sounding the alarm that no plans have been made to address this fundamental problem in the system yet. Ghorayshi went on to draw false parallels between the issues with the Tavistock in Britain and an American clinic in St. Louis which did not have years long wait times for a first visit or any of the problems that stemmed from those long waits.

screenshot from the New York Times

In sum, American readers have been completely misled by commentators and reporters into a false picture of the very real, and very serious, problems with the NHS treatment of trans youth. In order to push a narrative that the problems with gender-affirming care lie in it being provided too quickly and easily, a system where at least one patient died by suicide while on a years-long waitlist has been falsely portrayed as a higher-quality and more evidence-based system than we have in the U. S.

Instead of looking critically at what the reality is, biased American journalists have repeated claims that the U. K. system was being overhauled for the better. In truth, the profound neglect has only worsened in that country, and there’s currently no end in sight. This neglect has tragic consequences for young people whose gender dysphoria is going completely untreated for years on end. In the case of young Alice Litman, the result was an entirely avoidable tragedy. Thus far Litman’s story has gone uncovered by a mainstream U. S. media who seek to portray Europe as an enlightened bastion of reason, detached from politics, with higher standards of care than exist here. These journalists spare no thought for the patients suffering under a political climate of suspicion and transphobia, whether at home or abroad.