| Verified against primary record | |
| Waiting, England | Over 40,000 people waiting for a first adult clinic appointment at the end of March 2025[1] |
|---|---|
| Wait already experienced | An average of 296 weeks, about five years and seven months, among those seen by October 2024[1] |
| Cross-border supply | A 2024 order restricts supply of certain medicines from prescribers registered in the European Economic Area or Switzerland to under-18s[2] |
| Records read | Two health service reviews and a government announcement, 2 October 2026 |
| Provider-supplied | |
| State funding abroad | Ireland’s national service describes referring patients abroad for surgery not available publicly at home[3] |
| Bands apply only to the rows beneath them. The waiting figures concern adult services; the medicines restriction concerns under-18s. The two populations are not interchangeable. | |
Gender-affirming care abroad is travel to obtain gender-affirming treatment in another country. This entry sets out law, access and the published positions of official bodies, with dates, and attributes contested matters to whoever states them. It takes no position on clinical questions.
Waiting, where it is published
Access figures for this field are rarely published. England is an exception, and the numbers are among the longest recorded for any service in this reference. A review of adult gender dysphoria clinics records that the number of patients waiting to be seen for a first appointment rose to over 40,000 by the end of March 2025, across nine commissioned adult clinics. Among patients who attended a first appointment by October 2024, the average wait already experienced was 296 weeks, which the review gives as five years and seven months. A majority of clinics were projecting waits of fifteen years or more if no improvements were made. Referrals rose across four financial years: 4,331 in 2021 to 2022, 4,933 in 2022 to 2023, 9,001 in 2023 to 2024 and 9,985 in 2024 to 2025.[1]
The 296-week figure needs stating precisely or it misleads. It is the average wait already experienced by people who got through to a first appointment, which is a backward-looking measure of that group. It is not the expected wait for someone referred now, and it is not the average wait of the 40,000 people on the list. The forward-looking figure in the same document is the clinics’ own projection of fifteen years or more, which is a projection rather than an observation.
What the review says about care obtained elsewhere
The same review records that patients and staff repeatedly told it that the long waiting times led a significant number of patients to seek a private diagnosis and hormone treatment, and refers to individuals self-sourcing hormone drugs without proper clinical oversight and monitoring, often involving high-risk places such as overseas online providers.[1]
Two things follow, and both matter. A significant number is testimony reported to a review rather than a measurement, and it should not be converted into a figure, a proportion or a trend. And the reference to overseas providers concerns cross-border supply of medicines rather than travel for treatment, which is a different phenomenon. Nothing read for this entry states how many people leave the country for this care, or measures it.
A restriction aimed across the border
One instrument addresses the cross-border question directly, and it is unusual in this field for doing so. The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 came into force on 1 January 2025. As described in the government announcement, it prevents the dispensing of these medicines prescribed by private United Kingdom-registered prescribers for gender incongruence or gender dysphoria to under-18s not already taking them, and it prevents the sale and supply of the medicines from prescribers registered in the European Economic Area or Switzerland, for any reason, to those under 18. Patients already receiving them on the national health service for those indications, and patients receiving them for other uses such as precocious puberty, are not restricted. The restriction was advised by the Commission on Human Medicines, informed by an independent review and by evidence reviews.[2]
The two limbs have different scopes and should not be flattened into one. The domestic limb is specific to the indication; the cross-border limb applies for any reason. The statutory text itself was not read for this entry, so the instrument is named and dated rather than quoted as statute.
For children and young people, a separate commissioning policy prevents the prescribing of puberty suppressing hormones to under-18s with gender incongruence or gender dysphoria, which the health service states is due to the limited evidence around safety, risks, benefits and outcomes, with a clinical study planned under research oversight. That position follows an independent review published in April 2024 and commissioned in 2020.[4] These are positions held by named bodies on stated dates, and are reported here as such.
A state that funds some of this care abroad
Ireland’s national gender service describes a pathway in which some procedures are available in the public system at home and others are not. According to its own undated page, gender affirming hysterectomy and orchidectomy are offered in the public system, while there is currently no public access to gender affirming top surgery in Ireland. It describes referring patients to Germany, the Netherlands, Latvia, Lithuania, Poland and Spain for chest procedures and to Germany and the United Kingdom for genital surgery, using two distinct funding routes: the cross-border directive for top surgery, under which the patient pays upfront and is reimbursed part of the cost, and the treatment abroad scheme for genital surgery, which funds procedures in public sector hospitals.[3]
That is the service’s own account of its own pathway, undated, and the terms of the two schemes were not verified against the health executive’s own publications. The distinction between the routes is material rather than technical: one reimburses part of a cost the patient has already paid, the other funds treatment in a public hospital, and they are not the same offer.
See also
- Medical travel for LGBTQ+ patients, the wider entry on eligibility law and access
- Medical travel and waiting lists, the legal test and what waiting figures measure
- Government-funded treatment abroad, the two routes Ireland uses
- Medical travel for intersex patients, a distinct subject often conflated with this one
References
- NHS England. Operational and delivery review of NHS adult gender dysphoria clinics in England. Page carries no publication date; data run to March 2025. Verified against primary record: health service review opened and read. Retrieved 2 October 2026.
- Department of Health and Social Care. Ban on puberty blockers to be made indefinite on experts’ advice. Announced 11 December 2024; order in force 1 January 2025. Verified against primary record: government announcement opened and read; the statutory instrument itself was not read. Retrieved 2 October 2026.
- National Gender Service, Ireland. Surgery and surgical referral. Page carries no date. Provider-supplied: the service describing its own pathway; the scheme terms were not verified against the health executive. Retrieved 2 October 2026.
- NHS England. Children and young people’s gender services: implementing the Cass Review recommendations. Page carries no publication date; the independent review was published April 2024. Verified against primary record: health service page opened and read. Retrieved 2 October 2026.
Sourcing note: the two health service reviews, the government announcement and the Irish service page were opened and read on 2 October 2026. The 296-week figure is described as the wait already experienced by those seen, because presenting it as a current expected wait would misstate it. The statement that long waits led a significant number of patients to seek private care is reported as testimony given to a review, unquantified, and is not converted into a figure. The waiting figures concern adult services and the medicines restriction concerns under-18s; neither is applied to the other population. The Irish material is the service’s own undated account and is classed as provider-supplied. Clinical positions are attributed to the bodies holding them, with dates, and are not adjudicated here. No figure is given for how many people travel for this care, because none was located.