In recent months, mounting evidence suggests that transgender adults in the UK are experiencing an alarming rollback in access to gender-affirming healthcare. An increasing number of transgender men and women have reported that National Health Service (NHS) general practitioners (GPs) are either refusing to initiate hormone replacement therapy (HRT) or are withdrawing it altogether. This trend has left many individuals, who rely on these medications to live authentically, in a state of uncertainty, distress, and fear for their future well-being.
A Critical Lifeline Under Threat
HRT is a cornerstone of the medical transition process for countless transgender people. For trans women, it typically involves administering oestrogen alongside anti-androgens to help feminize the body, including promoting breast growth and redistributing body fat. For trans men, testosterone therapy fosters masculinization by encouraging muscle development, a deeper vocal register, and facial hair growth. These interventions often serve as a critical lifeline, enabling transgender individuals to align their physical characteristics more closely with their gender identity, alleviate gender dysphoria, and improve their overall mental health and quality of life.
But now, multiple sources—ranging from NHS gender clinics to primary care providers—are reporting that cases of delayed, refused, or abruptly discontinued HRT are becoming more frequent. The reasons cited are varied: an apparent lack of funding; confusion among GPs over whether they are permitted to continue prescribing; and the chilling influence of the controversial Cass Review, which critics say has introduced unwarranted caution and emboldened a culture of reticence in providing gender-affirming care.
Personal Stories of Sudden Withdrawal
Emily, a transgender woman, received a terse text message from her GP practice earlier this year. After two years on HRT—two years in which her life began to feel comfortably “ordinary”—her prescription was suddenly halted without warning or consultation. The message stated that her GP practice could no longer “safely support ongoing prescribing or monitoring” of what it termed a “specialist drug.” If Emily wanted to continue, the onus would be on her to seek costly private healthcare, something she simply could not afford.
“It felt like the rug had been pulled out from under me,” Emily said. “My mental health was in a precarious position already, and losing my HRT made me feel that I was no longer in control of my own body or future.” Her experience is not unique. The Bureau of Investigative Journalism, in partnership with The Independent, uncovered numerous similar accounts of trans people having their HRT withdrawn—sometimes even after receiving consistent, specialist-backed prescriptions for years.
Likewise, Elijah, a 33-year-old trans man who initially circumvented long NHS waiting lists by seeing a private gender specialist, found himself cut off when he moved house and registered with a new GP. His fresh doctor declined to continue his prescription of testosterone, a hormone he had safely and happily taken for two years. “I felt powerless,” Elijah said. “I had no say in a decision that directly impacted my ability to live authentically. My mental health took a serious hit.” Such abrupt terminations of care are devastating, forcing many to consider dangerous alternatives such as obtaining hormones through unregulated online channels or sharing medication within their communities—risky strategies born out of desperate need rather than choice.
The Cass Review’s Controversial Impact
The Cass Review, commissioned to examine the provision of gender-related healthcare services for children and young people, was published in April. While it focused on minors, adult services and transgender adults in general appear to be feeling its ripple effects. The report called for “extreme caution” in prescribing hormones to anyone under 18 and highlighted a supposed lack of robust long-term evidence about the effects of hormone interventions on youth. Following its publication, the UK government banned the routine prescription of puberty blockers to minors, pending further research and a proposed clinical trial.
However, many transgender healthcare advocates criticize the Cass Review as being guided more by political and ideological biases than by genuine clinical expertise in trans healthcare. They argue that the panel included individuals who either lack direct experience treating transgender patients or hold openly anti-transgender views. The result, these critics say, has been an atmosphere of heightened reluctance and fear among healthcare providers who worry they might be scrutinized or penalized for offering appropriate and necessary care to transgender adults. While the Cass recommendations were ostensibly directed at children’s services, their ambiguous wording—coupled with intense media and political pressure—has fueled a broader chilling effect on adult care as well.
Dr. Duncan, a GP working with the Sussex Gender Service, notes that the Cass Review has complicated matters for practitioners. “GPs are genuinely scared,” he said. “They’re caught between wanting to help their patients and fearing that by prescribing HRT they’re somehow breaking new rules or could be held accountable for harm. This is compounded by the fact that some of the people shaping these policies either haven’t treated transgender patients or harbor biases against them. The end result is a reluctance to continue care that patients depend on.”
Critics warn that this atmosphere could easily cross borders. With the re-election of Donald Trump in the United States—a political figure who has consistently attacked transgender rights—there are concerns that the current UK climate may presage a global rollback of trans healthcare access. Just as transphobic legislation in the U.S. has influenced other countries, the UK’s cautionary stance may encourage like-minded political actors elsewhere to enact similarly restrictive policies, jeopardizing the health and well-being of trans individuals far beyond Britain’s shores.
Widening Healthcare Gaps and Urgent Needs
The NHS does not publish comprehensive data on how often HRT prescriptions are withdrawn. Still, staff at multiple NHS gender services report a rise in these incidents. The Indigo Gender Service in Manchester, for example, saw an eight percent refusal rate in HRT prescription requests in 2022-23. This has already climbed to 11 percent in 2023-24. Other renowned clinics such as the Tavistock and Portman and the Leeds Gender Identity Service confirm frequent occurrences of GPs refusing to initiate or continue treatment, though they lack precise figures.
Some GPs justify their refusal by citing a lack of training or specialist knowledge. The British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) have expressed concerns about overstretched practices and inadequate funding for transgender care. While the General Medical Council (GMC) maintains that prescribing HRT to trans adults does not require highly specialized expertise, the current climate—fueled by political pressure and media scrutiny—has made many practitioners reluctant to engage in this aspect of care.
As a result, transgender patients find themselves trapped in an administrative maze. They face long waiting times for appointments at NHS gender identity clinics and often turn to private services out of necessity. But private care is expensive, placing those without the means at a severe disadvantage. The situation forces people to decide between risking unmonitored, unregulated hormone access or enduring intense dysphoria without medical support. Neither scenario is acceptable, especially when safe, evidence-based treatments exist and should be readily available.
A Global Warning Sign
Transgender advocacy groups warn that this rollback of access to HRT is not just a British issue; it could set a precedent for other countries, particularly as global anti-trans sentiment appears to be on the rise. The specter of Donald Trump’s re-election in the United States is especially concerning. During his previous term, the Trump administration attempted to roll back LGBTQ+ protections in healthcare, education, and the military. When he returns to office, many fear these policies will intensify, and the UK’s increasing hurdles for transgender healthcare may inspire more restrictive measures abroad.
These worrying developments underscore the importance of robust, patient-centered guidelines and the need for medical bodies to stand firmly against politically motivated interference. Many transgender rights advocates, along with healthcare professionals dedicated to trans well-being, emphasize that decisions about medical treatment should be grounded in clinical research, informed patient consent, and compassionate care—not shaped by fear, stigma, or political expediency.
An Urgent Call for Accountability and Change
The current situation demands accountability at every level. NHS England insists that prescribing decisions are made locally, urging GPs to work in cooperation with gender clinics. But local decision-making, without clear, supportive national guidance, leaves room for discriminatory refusals. The RCGP, having released and then revised statements on transgender healthcare post-Cass Review, now pledges its commitment to improving services. Still, these commitments must translate into tangible changes: more training, more funding, and a system that protects rather than punishes doctors who support their transgender patients.
Meanwhile, organizations such as Genspect UK, LGB Alliance, Thoughtful Therapists, Transgender Trend, and other groups have called for the NHS to pause its forthcoming clinical trial of puberty blockers for minors. They argue that the safeguards promised after the Cass Review are insufficient and that a lack of robust research combined with ideological underpinnings spells danger for the most vulnerable youth. While the trial’s design remains under scrutiny, activists highlight that the Cass Review failed to meaningfully engage with transgender healthcare experts who possess direct clinical experience treating trans patients. Instead, it appears to have given voice to political and ideological actors who have little understanding of what is truly at stake for these communities.
For transgender individuals, their families, and allies, the message is clear: now, more than ever, solidarity and vigilance are needed. This moment calls for increased advocacy, sustained pressure on policymakers, and the reassertion of a simple truth: transgender people deserve competent, compassionate, and uninterrupted healthcare. Denying access to HRT, a core component of gender-affirming medical care, not only harms physical and mental health but also sends a chilling message about whose lives and identities are considered worthy of support.
In the UK and beyond, transgender communities have weathered many storms. Yet, these setbacks can be reversed through informed advocacy and persistent engagement with healthcare institutions. By centering the voices and experiences of those most affected, it may still be possible to push back against the rising tide of caution and fear. The lives and well-being of transgender individuals depend on it, and the world is watching.
