Trans men “left in limbo” between gender affirming surgeries take legal action

Delays have created a huge backlog of individuals, many of whom are part way through a complex surgical process, waiting years for the next stage of their surgery.

Transmasculine genital surgeries include metoidioplasty (creation of the penis from existing genital tissue) and phalloplasty (creation of the penis from skin grafts from other parts of the body). These are both complex procedures which require multiple surgeries (commonly three) and are most often accessed by trans men and nonbinary people who were assigned female at birth.

At the start of 2020, patients waiting for the second or third stages of their surgeries were told that they could expect to wait approximately 6 months for their next operation. However, due to the issues with commissioning, many are now facing waits of at least three to four years.

Law firm Leigh Day is currently investigating a legal claim on behalf of patients affected by the delays to their healthcare. The firm believes hundreds of trans men could be eligible to join the investigation.

The firm say their clients have reported significant distress in waiting for transition related surgeries, which can significantly improve a person’s sense of identity and provide gender affirmation. Clients tell Leigh Day they are living with damaging physical and psychological symptoms, with some feeling they have been left with indeterminate genitalia. It is understood that the NHS has not offered specific mental health support for those on the waiting list.

Timeline of delays

The NHS did not formally recommission St Peter’s Andrology Centre when its contract expired at the end of March 2020.

Despite pressure from activist groups and those affected, a new provider, New Victoria Hospital, was not appointed until September 2021. Priority surgeries resumed in December 2021, meaning there was no formal NHS service provision for patients for around 18 months. This means that many individuals who consented to embark on their surgical process in 2020 are still only part way through this process.

In addition, patients have been informed that New Victoria Hospital will not perform stage two of metoidioplasty surgery (hysterectomy and genital reconstruction) in one procedure, meaning that patients in-between surgeries now face an additional surgical procedure (up to four procedures in total). On the other hand, it appears that another provider which has been recently appointed by the NHS is providing all the stages in just one surgery but only for those who have not had any surgeries.

Patients have been left with unspecified waiting times. According to a Freedom of Information Act request by TransActual, as of February 2022, there were 1,944 trans men on the waiting list for masculinising genital surgery. Patients are still awaiting their first surgery, or are in-between surgeries, and yet more are waiting for treatment for complications.

The legal investigation is looking into claims against St Peter’s Andrology Centre and NHS England on behalf of patients to hold those responsible to account and prevent these mistakes from happening again. Claimants could be entitled to compensation if the claims are successful. 

Leigh Day client Oliver Lloyd said:

"For the last three years, my life has been completely on hold, and I remain in limbo, waiting for the next two stages of my surgery, which I have now been informed by the new provider, will actually be a further three stages. Another surgery will mean an additional general anaesthetic which has its own medical risks, additional time off work, and the additional physical and emotional effects of surgical recovery. 

“I am appalled and disgusted at the way transmasculine people have been treated, and particularly that it took 18 months for NHS England to contract a new provider for these surgeries, leaving hundreds of patients without any access to urgent and important services, let alone mental health support to bridge the gap. I am desperate to move on with my life but have been left alone in a dark and vulnerable position with no end in sight."

Another client, who we have called Matthew, said:

“I have now been living for three years with an incomplete penis reconstruction. This continues to have vast negative impact on my mental health. My confidence has disappeared, I haven’t been able to socialise like I used to, travel, or gain new employment. I find it hard to trust people now. I have been hugely affected by stress which has resulted in other knock-on health issues such as anxiety, depression, insomnia, hair loss and suicidal ideation.

“The knowledge that one operation is now possible, compared to the four operations I am now forced to have over the course of three years and counting, has completely devastated me, and I am having to have regular therapy to cope with this. Aside from the physical strain of four procedures versus three or even one, each procedure sees me having to fund travel and accommodation in London and months off work to recuperate, resulting in major loss of earnings as well as physical, emotional and mental suffering. All of this, in the current climate of widespread hostility and transphobia in the UK, is unbearable.”

Leigh Day senior associate solicitor Kate Egerton, who is leading the claim, said:

“The breakdown in the commissioning arrangements with St Peter’s Andrology Centre, the failure to have any other service provision in place, and the delay in recommissioning a new service, means hundreds of patients have been left in limbo with significant physical and psychological consequences. Our clients were not informed that they could be waiting for years for their next surgeries, nor that they would have to undergo an additional surgical procedure. We consider that these failures may be negligent and a breach of our clients’ human rights.

“The ongoing delays put those affected at risk of increased gender dysphoria and physical complications which could negatively affect their mental health, personal relationships, and work life. Being left part way through these surgeries is inhumane. As far as we are aware, NHSE has not provided those on the waiting list with adequate mental health support. Our clients want to hold those responsible accountable for the harm they have caused patients and to ensure these mistakes cannot happen again.”

Supporting this action, Chay Brown, a director of TransActual, said:

“This case is about the law and access to medical treatment and an industrial scale failure on the part of the NHS.

“But it is also about far more. It is about patients traumatised by the wait for treatment. Worse, it is about patients who began treatment on the basis that "start-to-end" would be no more than 18 months, and who have been left in limbo - sometimes in extreme pain - because that promise was not kept. So, they have been betwixt and between for three to four years or more.

“Beyond that, it is about a faceless service that has failed to explain to patients what is happening and has not even had the decency to apologise for the misery it has inflicted.”