Waiting for gender-affirming care: five years on the NHS – or 48 hours, bitcoin, and the black market

Across the UK, more than 37,000 people are on waiting lists for gender identity clinics (GICs), with an average wait time of nearly five years.

Kieran McGrane is a transgender man living in Yorkshire. He first requested to see a gender specialist at 16. Now, seven years later, he is 23 and has only just had his initial consultation.

At the appointment, the staff told Kieran that the wait to receive hormones on the NHS would likely be another three years. He said:

Gender dysphoria is so paralysing, and we have this known, very easy fix — gender affirming care and hormones.

Waiting times vs black market testosterone

The average wait time for an initial appointment with a GIC is 59 weeks, or 4 years and 11 months. This is far longer than the wait for every other NHS specialism.

However, GIC waiting times vary wildly by location. The longest is in the South East, at 99 weeks, or 8 years and 3 months.

The NHS does not consistently record the number of people on these waiting lists. However, reports suggest the list for young people in England and Wales alone sits at around 6,000 people. In Scotland, there are 5,640 people on waiting lists. Kieran said:

Honestly, it’s gutting. The number of people that I have met who are waiting and waiting. It’s like they’re waiting for their lives to start.

The outrageously long waiting lists are causing some transgender people to resort to the black market to start their medical transition.

After Kieran posted about his initial consultation on TikTok, Eli*, a 22-year-old transmasculine individual, reached out and offered him DIY testosterone. Kieran has been taking it for three weeks and is already “much more confident” speaking out loud. He said:

I’m noticing these slight changes already. It feels like there’s actually progress being made. . . Even six months ago, I don’t think I would have been able to dream that at this point I would actually be starting my medical transition.

Taking matters into their own hands

Eli has been taking DIY testosterone for six months, after a year and a half on the waiting list.

After realising it would be nearly seven years to see their closest GIC, they decided to delve into DIY testosterone. They said:

I was really, really hesitant to do that because I was aware of the risks, especially with home-brewed gels, there is a risk of sepsis and end-organ damage.

But that risk was outweighed by my risk of suicide if I didn’t do anything.

Eli felt bad recommending something that “could be dangerous”, but offered it because it “really helped”. Kieran accepted it straight away.

Whilst anabolic steroids, which include testosterone, are a class C drug in the UK, it is legal to buy or possess them for personal use. But selling, distributing, or giving them to friends is illegal. The penalty is an unlimited fine or a prison sentence of up to 14 years if caught.

However, the impacts of not receiving gender-affirming care can be catastrophic.

Eli is not worried about the legality of supplying friends with testosterone. They said:

It crossed my mind, but it’s the least of my worries. I’m not hurting anyone. I don’t actually really care if I’m going against the law if it means that my friend’s not going to be suicidal anymore.

In my experience, anyway, most trans people know someone who has died by suicide on the waiting list for the NHS.

The risks

Black market hormones are unregulated. Meaning they could be mislabelled, expired, or of poor quality. There’s no guarantee that the ingredients listed on the label are actually what’s in the vial, and the dosing may be inaccurate. Furthermore, without regular monitoring and blood tests, which are standard in NHS gender care, there are risks of overdose, hormonal imbalances, or other serious side effects. These can often go undetected until it’s too late.

Eli said that for some trans people, it’s a choice between taking dangerous hormones or dying on NHS waiting lists. The potential health risks were why Eli didn’t turn to DIY hormones sooner. They said:

It eventually got to the point where, genuinely, the risks to my health were completely outweighed by the benefits that it had. . .

I’ve been eating better, sleeping better, I’ve been able to engage with my course at uni, and I’ve been able to go to the gym. I’m actually healthier, even though I’m taking something that could be dangerous.

Previously, a bodybuilder died after taking black market testosterone. It caused an enlarged heart, cardiac arrhythmia, and congestive heart failure. These are widely reported side effects of steroids.

DIY testosterone

Kieran and Eli’s hormones come from a free mutual aid project run by a group brewing and distributing their own hormones. Eli said:

I know more people who take DIY hormones than who take actual gender clinic hormones.

Surprisingly, a quick Google search shows you all you need to know about the ins and outs of DIY hormones. From dosing and sourcing to how to inject safely, it is all there in guides created by the trans community.

The black market is surprisingly easy to access. After a brief search online, I found a body-building site that allowed me to order a 10ml vial of 300mg/ml Testosterone Enanthate for only £45.50, with recorded 48-hour delivery. The website notes that the product was made in an ‘underground lab’.

Additionally, no account, age or identity check, or prescription was necessary, and payment was via Bitcoin.

Less than 48 hours later, it arrived.

At the time of writing, we were unable to independently verify the contents of the vial.

‘Completely unacceptable’

Trans and Non-Binary Connect is a Community Interest Company created to support Transgender and Non-binary communities. They are deeply concerned about the rise in DIY hormones and said it’s “heartbreaking” that so many people are forced to take these “serious risks” because the healthcare system is failing. They added:

This isn’t just a matter of inconvenience; it’s literally a matter of life and death for some people, and the lack of timely care can have devastating consequences.

Feature image via HG