Gender Dysphoria: Health Services
The question
To ask the Secretary of State for Health and Social Care, whether his Department has commissioned research to improve understanding of factors determining the number of referrals to gender identity services across the NHS.
Answered by Karin Smyth
The final report of the Cass Review, published in April 2024, gave a thorough assessment of factors determining the number of referrals to National Health Service children and young people’s gender services and the characteristics of referrals into these services.
The review concluded there is no single reason but rather several factors including the changing demographics of those likely to be referred and the prevalence of coexisting conditions this new cohort presents with: neurodiversity; mental health; and challenging family and social backgrounds.
The Cass Review used various methods to form its findings and recommendations, including evidence reviews, analysis of clinical data, audit, and evidence gathering from United Kingdom and international clinicians and academics. In response to the Cass Review, NHS England has established a National Research Oversight Board for Gender Services, which leads on identifying future research and evidence gathering priorities relating to paediatric and adult gender services.
As well as this, the review into the operation and delivery of NHS Adult Gender Dysphoria Clinics, led by Dr Levy, was published on 18 December 2025 and undertook a comprehensive examination of all nine NHS-commissioned adult Gender Dysphoria Clinics (GDCs) in England. The review specifically considered issues of access to clinics, reviewing both the volume of referrals and the length of waiting times for initial assessment and treatment. Dr Levy identified that waiting times for first appointments remain lengthy, with a significant increase in the number of people awaiting assessment, and that annual referrals have doubled since 2022/23. The review attributed these extended waits to several factors, including improved reporting as more clinics have joined the national system, as well as a backlog from referrals deferred during the COVID-19 pandemic.
The review also set out that, surgery waiting times also contribute to the problem, as some masculinising procedures have waits of approximately eight to nine years. As a result, many patients require extra GDC appointments because the current service specification mandates follow-up reviews every six months for those waiting for surgery.
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