Genspect Submission to NHS England LGBT+ Health Evidence Review
By Genspect
Genspect has provided evidence to the NHS England LGBT+ Health Evidence Review, which can be read in full below; the consultation closes 31 August and we encourage all relevant organisations to submit their evidence.
This submission presents evidence from Genspect’s Beyond Trans programme, which has supported over 400 adults who underwent medical gender interventions. Our evaluation documents severe barriers to general healthcare for this population.
The majority of female participants are lesbian or bisexual women whose homosexuality was medicalised through transition. They now face significant barriers to care while managing permanent physical changes. One participant reflected that transition “eliminated rather than affirmed” her identity.
1. Population and Service Description
Since June 2022, Beyond Trans has provided weekly online therapist-facilitated support groups (12-15 participants per session) for adults aged 18-60+ who have undergone gender-related medical interventions. This includes those continuing treatment, questioning their pathway, and ceasing interventions. We also support 1,000+ family members.
Key Demographics
Same-Sex Attracted Women:
The majority of female participants are lesbian or bisexual women who describe being “not like other girls” growing up, with “male-typical interests” and “only male friends as a kid.” Most grew up in “traditional, religious communities where gender norms were rigidly enforced.”
Autism Overrepresentation:
Autism is significantly overrepresented, with participants reporting their autism traits were misinterpreted as transgender identity. One participant shared: “Unpacking what makes my female-ness distressing has taken years.”
2. Barriers to General Healthcare
Primary Care
General practitioners have no protocols for hormone cessation or managing post-surgical complications. Patients are referred back to gender clinics they cannot psychologically access. Many avoid all healthcare entirely.
“I’m busy not dying of sepsis” — Participant who delayed emergency treatment due to healthcare avoidance
Mental Health Services
Services either continue affirming identities patients no longer hold or deny regret exists. No trauma-informed therapy exists for medical regret. Underlying conditions—autism, trauma, internalised homophobia—remain unaddressed.
Many report their therapists “failed to recognize” their distress as internalized homophobia, instead “nudging them down the path” of medical intervention.
Sexual Health Services
Services cannot accommodate surgically altered anatomy. No support exists for sexual dysfunction or transition-related infertility.
3. Documented Health Outcomes
Young Adults (18-25) After Puberty Blockers
Adults treated with puberty blockers as adolescents present with severe outcomes:
Bone Health:
One discovered osteoporosis in her twenties: “worse than my grandma, who is in her 70s.” Another reports: “My bone density and natural hormones will probably never recover.”
Sexual Development:
One participant described: “I had never really had a crush on anyone before I went on puberty blockers…I knew I liked her but I just didn’t have any feelings for her, like I didn’t want to kiss her.”
Another reported experiencing “hot flashes and repeated urinary infections” and “knife like stabbing pains” from genital atrophy.
Years later: “Only at the age of 22 have I experienced healthy genitals…While for those six years between age 16 and 22 I thought sexuality was gross, I thought my body was gross.”
One participant reported puberty blockers “eliminated my sexual function with partial arousal and no sense of enjoyment even years after stopping them.”
Educational Impact:
“I couldn’t attend school due to the severity of the physical side effects…My depression skyrocketed and I felt massively behind academically.”
The GIDS Early Intervention Study found “a significant increase” in patients reporting they “deliberately try to hurt or kill myself” after 12 months on blockers.
Same-Sex Attracted Women
Lesbian and bisexual women live with permanent masculinisation affecting employment and relationships. Voice changes, male-pattern baldness, and facial hair are irreversible. Vaginal atrophy causes chronic pain.
They describe how “internalized cultural messages” from their communities led them to believe transition would resolve their discomfort with female-ness. They’re excluded from lesbian spaces while women’s health services cannot accommodate their needs.
As one Women’s Circle participant shared: “I understand the fear and the awkwardness of growing up in a gender role or expression that doesn’t fit you. This is a normal experience for lots of people, and you shouldn’t be made to feel like you need to change your body to be accepted by other people.”
Autistic Adults
Autistic individuals face compounded barriers. Their communication differences prevent healthcare advocacy. Sensory changes from hormones worsen existing sensory processing issues. No services understand the autism-detransition intersection.
4. Effective Support Model
Digital Delivery (Analogue to Digital)
Our online model reaches participants across the UK including remote areas without services. The format provides anonymity and removes access barriers. Three years of consistent engagement demonstrates effectiveness.
Community Support (Hospital to Community)
Peer support prevents crisis presentations by teaching management strategies for complications. Family involvement improves outcomes, particularly when parents understand their child’s distress as homosexuality or autism rather than requiring medical intervention.
Prevention (Sickness to Prevention)
Mixed groups combining those at different stages enable informed decisions. Participants report meeting detransitioners prevented them pursuing interventions they would have regretted. This peer learning provides information unavailable in clinical settings.
5. Critical Messages from Participants
Those who underwent interventions now share crucial messages with young people:
“Give yourself time. Growing up is hard…understand yourself before making choices you can’t undo—you deserve the chance to grow into who you are without regret.”
“You are not always what you think. You are not always what you feel. You are perfect the way you were born. Transitioning creates more problems.”
“I understand these blockers are being presented to you as a ‘pause in time’…it’s not that simple. There is no such thing as pausing time, time flows but it is not like a river that can be blocked. Puberty blockers remove its proper function forever.”
Another, who advocated for medical transition for over a decade, now states:
“Meeting regretful transitioners, especially ones rushed recklessly into medical transition as minors, has broken my faith…It has added avoidable gender dysphoria into the world.”
6. Key Findings and Recommendations
Critical Gaps Identified
- No hormone cessation protocols exist
- Bone health monitoring is absent for puberty blocker recipients
- Surgical revision pathways are non-existent
- Mental health frameworks for regret don’t exist
Service Requirements
Primary Care:
- Protocols for hormone management
- Complication recognition
- Mandatory bone monitoring for puberty blocker recipients
Mental Health:
- Recognition that transition can be regretted
- Trauma-informed approaches
- Treatment for underlying conditions
Sexual Health:
- Services for altered anatomy
- Sexual dysfunction treatment
- Fertility counselling
7. Implications for Sexual Minority Health
This evaluation reveals a hidden crisis affecting same-sex attracted individuals within healthcare. Many participants are gay men and lesbian women whose homosexuality was pathologised through medical intervention. They underwent treatments that erased rather than affirmed their sexual orientation—essentially conversion by medical means.
These same-sex attracted individuals now find themselves excluded from services for gay and lesbian people due to their altered appearance, while mainstream services remain unprepared for their complex medical needs.
Conclusion
Our three-year evaluation reveals that adults who underwent medical gender interventions face severe barriers accessing general healthcare. Many are same-sex attracted individuals now living with permanent changes while excluded from appropriate care.
The NHS must recognise this population exists, understand their needs, and develop appropriate services. Without action, they remain abandoned by healthcare systems while others continue toward interventions without understanding potential outcomes.