Becky had been receiving gender affirming healthcare for years when she received a text from her GP saying that her prescription would not be renewed
Trans rights campaigners gather in St Peter’s Square in Manchester(Image: Jake Lindley / Manchester Evening News)
“Going back having had the opportunity to know what I can feel – I couldn’t exist in that place,” said Becky.
Becky is a trans woman, and receives a prescription of hormone replacement therapy (HRT) as part of her ongoing treatment. Without it, she would be at risk of dangerous side effects, and her body would begin to revert to how it was pre-transition.
But despite the medical need for Becky to receive HRT for life her GP refused to renew her prescription, leaving her in limbo.
Becky had been receiving the treatment for years when she was told it would not be renewed after her GP refused to work on a ‘shared care agreement’, a partnership with a specialist, to renew the prescription.
She is not alone.
Emily had opted for a private practice at first, but then found out that her GP was no longer willing to prescribe the HRT she had been receiving for some 20 years.
Getting gender affirming care at all is an extremely arduous process in the UK, involving multiple assessments, referrals to specialists, and diagnosis before someone is prescribed HRT, to say nothing of further care such as surgery.
Becky said that starting HRT was “the best decision I’ve ever made”.
“It seems cliched, but it felt like the first time I felt truly happy,” she said. “I started to feel comfortable in my own skin, I started to make plans for the future. It felt like a reawakening.”
Once you’re on HRT, you need it for life or you could be at risk of side effects such as osteoporosis and cardiac conditions.
Both Becky and Emily were in severe distress when they were left having to fight for their healthcare. We spoke to both of them to hear their stories.
Becky
Becky was referred to Greater Manchester’s gender service Indigo in 2019 and has been receiving HRT since February 2023.
But when Becky went to renew her prescription in February 2025 she received a text message from her GP informing her that her prescription would not be renewed. This left her in a position where she would urgently need to find another way to receive her medication.
Becky told how she had first been referred to Indigo in 2019. She had her first appointment with the service in 2022 and was then prescribed HRT in February 2023 including testosterone blockers and oestrogen.
After getting the prescription following assessment at Indigo, Becky had renewed the prescription, which she will need for life, through her GP.
This had continued without any issue for two years until she received the text halting the care. This is a period of time during which HRT can change someone’s body substantially, as it is intended to do.
“It feels like being forcibly de-transitioned,” Becky told the Manchester Evening News.
“That’s not something I am ever going to let happen, but gender affirming care becomes a lot more complicated to access if the NHS isn’t involved.”
(Image: Jake Lindley / Manchester Evening News)
She added: “The biggest fear is what if I can’t access HRT, what would I do?”
In the text message, the GP said that they declined Becky’s request as they were “unable to accept shared care”, referring to Indigo.
Shared care is where a GP will agree to work together with a specialist provider, in this case the Indigo gender clinic. It allows patients to maintain continuity in their care, for example a repeat prescription, without having to go to a specialist every time.
When Becky moved home she went out of her way to find a GP which accepted shared care with gender clinics, and chose this GP for that specific reason. In theory this would mean that after her referral from Indigo she would be able to renew her lifelong medication through her GP, but her GP had other ideas.
Becky questioned the decision, and was told in a further text message: “This is a specialist medication as recommended by Indigo and as such should be prescribed by the specialist.”
This meant that Becky would have to go back to the already over-subscribed specialist clinic just to renew her prescription, despite having previously been able to renew it through her GP with no issue due to the shared care agreement.
Indigo can provide a prescription in the interim, but this is not a long term solution and Becky is now trying to find another GP which will meet her healthcare needs.
She said: “I’m disappointed I’m being put in a situation. Is anything going to be done or is healthcare going to become a postcode lottery?”
Advice issued by the BMA to GPs was shared with the M.E.N., and said: “Participating in a formal shared care agreement is voluntary, subject to a self-assessment of personal competence, and requires the agreement of all parties, including the patient.”
This means that GPs are not obliged to enter shared care agreements with specialists, so despite it leaving vulnerable patients like Becky in the lurch they are within their rights to refuse to prescribe.
Emily
Emily’s story begins before she moved to Manchester.
“I started transitioning 20 years ago,” she said. “I was with a private specialist doctor at the time.
“Everything was going well. In about 2016 my specialist retired, and gave me a heads up beforehand. The GP I had at the time also retired, and the new GP was getting funny with me.
“They kept calling me in for reviews more regularly than needed. And they said we are going to stop prescribing. At this point I had been on hormones for 11 years, so that was worrying.”
Emily said that her GP acquiesced to renewing her prescription when she highlighted the medical risk of stopping it, but she never got to renew there.
“Before I renewed they said their catchment area had changed and I had to find a new GP.”
Emily went to Gender GP, a private specialist, and was able to get her HRT prescribed there, and find a new GP who would agree to renew the prescription.
But then there was a problem. Gender GP came to the attention of the national media after a report claimed that the clinic was not subject to the regulatory safeguards placed on healthcare providers in the UK due to being headquartered in Singapore.
Guidance issued to GPs and published by the Telegraph appeared to warn GPs against accepting prescriptions from the clinic, it said: “The company is not registered within the UK nor is it an NHS Commissioned and regulated service. Gender GP do not provide physiological or psychological support or follow up of patients.”
Becky was prescribed oestrogen by Indigo, and would then renew the repeat prescription through her GP(Image: SCU)
Shortly after this, Emily recalled how they approached her and informed her that they were no longer willing to accept the prescription from Gender GP, but they would refer her on to an NHS gender identity clinic.
All seemed well, but in April 2024 something changed.
She said: “They rang me up and said they didn’t want to prescribe to me. I asked why, after so long.
“They said it’s ‘government guidance’. They’ve had some government guidance about it and decided they’re going to stop prescribing to me.”
Exactly what this government guidance was is not clear. There were significant reviews into gender affirming healthcare taking place at this time, such as the Cass Review which was published in April 2024.
However, reviews of gender affirming healthcare and subsequent government responses have focussed on treatment for patients under 18. They also focus on the prescription of puberty blockers to children and not HRT to adults, so it is not clear what new regulation at that time could have had such an immediate impact on Emily’s treatment.
Finally, after moving in with her girlfriend Emily was able to get a prescription from Indigo, but the instability and anxiety around her medication remains.
“I just feel really vulnerable”, she said. “Imagine if you were diabetic and and they just suddenly said we’re not going to give you insulin anymore.”
Denying gender affirming healthcare can be and has been fatal.
Coroners’ prevention of future deaths reports and conclusions on the deaths of trans women Sophie Williams and Alice Litman both included a lack of access to gender affirming healthcare as factors in their deaths.
A crisis in care
Councillor Chris Northwood, the deputy leader of the Lib Dem group in Manchester City Council, has condemned the denial of care by GPs.
“Everyone deserves to be treated fairly by their GP, and it’s wrong that GPs in Manchester are turning round to trans patients and suddenly denying them care, especially in cases like Becky’s where the GP has been happy prescribing up until recently,” she said.
“For an NHS GP to refuse to follow the recommendations of a specialist NHS service and suddenly withdraw the prescription with no thought as to continuity of care can be extremely dangerous, and it would not be tolerated in any other area of healthcare.”
“Gender Identity Clinics have extremely long wait times as it is, and for someone to wait years to initially get treatment, only to have their GP suddenly withdraw it after several years with no good reason is an extremely distressing situation that no-one should be fearful of happening to them.
“I’ve raised this case within the council and we must reverse this disturbing trend and ensure that the NHS functions for everyone who needs it.”
In December 2024 an investigation by the Bureau of Investigative Journalism found that Indigo kept records of prescriptions that it has recommended. This data revealed that between 2022 and 2023, 8 percent of HRT requests made by Indigo were refused by GPs.
The following year in 2024, this number rose to 11 percent, meaning that more than one in ten patients could not access healthcare through their GP which had been recommended by a specialist NHS service.
Advice from the GMC, which was quoted by the BMA in their guidance, suggested that GPs “should” work with gender identity specialists.
It read: “GMC advises that GPs ‘should collaborate with a Gender Identity Clinic (GIC) and/or an experienced gender specialist to provide effective and timely treatment for trans and non-binary patients.
“‘This may include: prescribing medicines on the recommendation of an experienced gender specialist for the treatment of gender dysphoria, and following recommendations for safety and treatment monitoring’”.
The guidance added: “This advice reaffirms that GPs should approach shared care and collaboration with gender identity specialists in the same way as they would any other specialist.”
NHS Greater Manchester Integrated Care Board confirmed to the M.E.N. that there is nothing in the national GP contract which directs GPs to accept prescriptions from gender identity clinics.
The transgender community will hold protests across the UK on Saturday(Image: Getty Images)
Asked about GPs refusing to provide crucial healthcare, the ICB said that care must be delivered “in a safe manner”. It added that transgender healthcare is commissioned by NHS England.
When we approached NHS England they declined to comment, but told the M.E.N. that a number of “pilot clinics” are being set up to support “adults with gender dysphoria”, as well as “more than doubling” investment in “gender dysphoria services”.
Language such as this has been criticised by transgender people and their allies, including actress, educator, and campaigner Abigail Thorn.
Thorn described bodies like NHS England viewing transitioning as a medical response to a diagnosed condition, “gender dysphoria”, which Thorn criticised as “pathologising” being trans.
She wrote that this “exaggerates and in some cases wholly imagines the risks of transition to justify denying us the right to weigh those risks and choose for ourselves”, adding that “there is no place in medicine for that kind of paternalism.”
In other words, doctors should have no say on whether or not an adult is allowed to transition, and the role of doctors should be confined to ensuring that someone can transition safely.
Withdrawing HRT, especially from a patient who has been taking it for several years as in the cases of Becky and Emily, also carries serious health risks including cardiac problems and osteoporosis.
After being off HRT for some time, the effects of it will also wear off which can cause severe distress to a patient.
These clear risks beg the question of why GPs are refusing prescriptions, a question which remains unanswered beyond the message that Becky received about ‘specialist care’, though the impact of it is clear.
Getting gender affirming care is already an extremely difficult and lengthy process. High demand and inadequate staffing means that waiting lists for GICs can be years long, leaving people with their lives on hold.
It’s a frustration which is all too real for the trans community.
Becky said: “We just want to exist, be loved, and not have to fight the system just to get recognised.”
The Manchester Evening News has changed names to protect the identities of individuals featured in this article.