A record 6,435 people were waiting for a first NHS gender clinic appointment in Scotland at the end of March 2025. The majority had been waiting more than two years, and over 1,000 had been waiting more than five. The Scottish government calls the waits unacceptably long. They are right, and the harm those years cause is real and serious.

What the numbers actually mean

Public Health Scotland data, first collected in 2023, shows that 84% of people referred to a gender clinic were waiting over a year for an initial appointment. Over 4,000 were past the two-year mark. More than a fifth of all referrals were for people aged 25 to 34, and just over two-fifths were for people aged 18 to 24. These are young adults, many of them navigating their twenties without access to the care that could change their lives.

When I hear figures like these, I think about what five years actually feels like. Five years of waking up in a body that does not reflect who you are. Five years of putting life on hold, not booking the holiday, not starting the relationship, not applying for the job, because the version of yourself you need to be is still waiting in a queue. That is not a neutral inconvenience. That is harm, compounding quietly, day after day.

Delay is never a neutral decision

One of the most persistent myths in conversations about gender care is that waiting is the safe option. The thinking goes: if we are unsure, better to wait. But waiting is not the absence of a decision. It is a decision with consequences, and those consequences fall entirely on the person waiting. Untreated dysphoria does not resolve itself. Unwanted puberty changes cannot be undone once they have happened. The mental health toll of spending years feeling unseen by the very system that is supposed to help you is well documented, even if it rarely makes it into the same headlines as the waiting list numbers.

The Scottish government says it recognises the waits are unacceptably long and is working with health boards to improve things, including recruiting additional staff and expanding multidisciplinary teams. That is genuinely welcome. But the people already waiting five years did not cause this crisis, and they deserve more than ongoing reassurances.

What is happening to services for young people

Referrals to the Sandyford clinic in Glasgow, the only dedicated service for under-18s in Scotland, dropped by 46% last year. The article attributes this to major changes in services for young people following a 2024 review, which recommended that care for under-18s be delivered within age-appropriate paediatric services across the country rather than through a single specialist clinic. The Cass Review is also referenced approvingly in the source article in relation to the pause on puberty blockers.

The Cass Review has been widely discredited internationally, and I will not repeat its framing here. A drop in referrals to the only specialist children's service does not mean fewer young people need support. It may simply mean the pathway to that support has become harder to find. Children and young people experiencing gender dysphoria do not disappear from the data when the clinic referral route is restructured; they disappear from the support that could help them.

The gap between policy language and lived reality

There is a particular kind of institutional statement that acknowledges a problem while simultaneously making it sound almost manageable. "Unacceptably long" is one of those phrases. It sounds decisive. It positions the speaker as concerned. But for the person who has been waiting five years for a first appointment, it lands differently. It confirms that those in charge knew the wait was unacceptable, and the wait continued anyway.

What people on these waiting lists need is not compassionate language from a government spokesperson. They need appointments. They need a pathway to care that does not require half a decade of patience as the price of entry. Many of them will find their own routes in the meantime, through private services, through organisations set up precisely because public waiting lists have become inaccessible, through the enormous resourcefulness that trans people have always had to develop in the absence of adequate public provision. That resourcefulness is real and it is admirable, but it should not be necessary.

What good care looks like from here

The Scottish government is providing recurring funding to health boards, and that matters. Expanding multidisciplinary teams, improving communications with people on waiting lists, developing new processes: these are meaningful steps if they are followed through. The question is whether they are enough, and whether they will reach the people already deep in a years-long wait before more harm is done.

For the thousands of people currently waiting: you are not wrong to need care. The length of the queue is not a reflection of whether your need is real or serious. And while you are waiting, there are people and services that can help you now, even if the NHS is not yet one of them.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a Gender Specialist, Medical Educator, and advocate, and the founder of GenderGP. She writes about gender identity, trans healthcare, and the lives at the centre of both.