£14 Million to Question What the Rest of the World Already Knows
New research from Australia proves gender-affirming care saves money on mental health. The UK has spent nearly £14 million reviewing and re-studying what the evidence already shows.
This week, researchers at the University of Melbourne published findings that should stop every health policy make1r in their tracks. Using whole-of-population data tracking transgender and gender diverse Australians over more than a decade, they showed that gender-affirming care does not just improve lives. It saves money. Significant amounts of it.
The government's contribution to funding a single gender-affirming surgery is recouped within three years through reduced mental health costs. Hormone therapy pays for itself within five years. If applied across the whole population, the savings could free up $42 million in mental health funding.
Let that sink in for a moment. And then consider what the UK has chosen to spend its money on instead.
What the UK chose to spend
A Freedom of Information request2 dated 22 February 2025 revealed that the Cass Review cost the NHS £3,062,010.22. Over three million pounds spent since 2020 on a review that produced no new evidence, funded no new treatments, and has been used to justify withdrawing healthcare from some of the most vulnerable people in this country.
On top of that, the Pathways trial3, commissioned to study the effects of puberty blockers in young people, has been funded at £10,694,902.24. That is nearly eleven million pounds to re-study a treatment that has been used safely around the world for decades, that the rest of the international medical community considers well-established, and that could have continued to be provided while the research took place.
Combined, that is nearly £14 million spent questioning what the rest of the world already knows. Nearly £14 million that could have been spent on care.
What the evidence actually shows
The Australian research, published in the International Journal of Transgender Health and the Lancet eClinicalMedicine, tracked the mental healthcare use of transgender and gender diverse people seeking gender-affirming care between 2013 and 2024. It found that annual government spending on mental healthcare decreased by AU$430 per person after chest surgery and AU$884 per person after genital surgery. These reductions persisted for at least six years after treatment.
Hormone therapy showed similar patterns, with a reduction of AU$30 to AU$260 per person after treatment, with the greatest savings seen in people who had the highest mental health costs before starting hormones.
This is not a surprise to anyone working in this field. We have always known that when you help someone align their body with their gender identity, their distress reduces. Their need for mental health support decreases. Their quality of life improves. Their ability to work, to socialise, to participate in everyday life goes up. This is not new information. It is simply being confirmed, again, with rigorous population-level data.
The treatments we are withholding save money too
What the Melbourne data confirms is part of a much wider picture. Puberty blockers, which the UK has banned and is now spending nearly £11 million to re-study, do something profoundly simple and profoundly cost-effective.
They press pause. They give a young person time to breathe, to be supported, and to continue through their childhood without the distress of watching their body develop in a way that feels deeply wrong.
For a trans girl, puberty blockers prevent the deepening of the voice, the growth of facial hair, the development of a masculine bone structure. Without blockers, that young person may eventually need facial feminisation surgery, years of laser hair removal, voice therapy, and will live with the stigma and danger of being visibly recognisable as trans in a world that is not always kind. For a trans boy, blockers prevent breast development that may later require chest surgery. They prevent the distress that comes with menstruation in someone who knows, with certainty, that this is not who they are.
Every one of these later interventions costs money. Every one of them carries surgical risk. Every one of them could have been avoided, or significantly reduced, by the timely use of a well-understood, reversible medication.
The cheapest and safest intervention is the earliest one.
Hormone therapy, too, allows someone to develop a body that matches their gender identity. The Australian data shows clearly that this reduces distress, reduces the need for ongoing mental health support, and more than pays for itself within five years. In the UK, the annual cost of providing hormone therapy through the NHS is remarkably low, somewhere between £300 and £500 per person per year, making it one of the most cost-effective treatments the health service provides.
The solution is already here
The guidelines for providing gender-affirming care exist. They are published, peer-reviewed, and endorsed by every major international medical body. WPATH, the Endocrine Society, the American Academy of Pediatrics, UCSF, the Royal Children’s Hospital Melbourne, and clinicians in New Zealand, Europe, and beyond have all published comprehensive, evidence-based standards of care.
This is not complicated medicine. Gender-affirming hormone therapy involves prescribing well-known medications, oestrogen and testosterone, that GPs already prescribe every single day for other indications. Monitoring involves routine blood tests. The clinical pathways are clear. The only thing missing in the UK is the willingness to let primary care get on with it.
I know this because I did it. For years, as a GP, I provided gender-affirming care to patients who could not access it through the NHS because the waiting lists were already impossibly long. I educated myself, I followed the international guidelines, and I provided safe, effective, evidence-based treatment. My GMC Tribunal found that I could, and I quote4:
“The Tribunal was in no doubt that Dr Webberley had immersed herself in the field of transgender healthcare to the extent that she could properly be described as a GP with special interest in gender dysphoria, both in respect of the psychosocial and the endocrine facets of this field of medical practice.”
If I could do it as a single GP working largely on my own, imagine what the NHS could achieve if it actually trained and supported GPs to do the same. The infrastructure is already there. The medications are already in the formulary. The blood tests are already available. The guidelines are already written. All that is needed is education, confidence, and the political will to let it happen.
It is already happening in some places
Yesterday, I received a message from Julian, a Consultant Nurse Practitioner in Primary Care working in a surgery in Hampshire. He asked me to share it, and I am going to, because it shows exactly what is possible when a primary care team simply decides to care.
Julian wrote:
“As a practice we embrace everyone’s choices in understanding and following their gender and experience since being born, into whatever sex was described at that time. We ensure with consent that each patient is addressed by their chosen pronoun and name. We add notes that appear to ensure this happens.
“Might sound menial but it’s also vital.
“We have a beautiful open dialogue through trust to discuss medical issues that require different and holistic approaches. And we are not afraid to ask a patient to educate us.
Here is to a future of being who we are – safely and without restriction.”
Julian and his team are not waiting for permission. They are not waiting for a review, or a trial, or a policy document. They are providing compassionate, inclusive primary care right now, today, in Hampshire. They are using their existing skills, their existing consulting rooms, and their existing relationships with patients to make people feel seen and supported.
This is what primary care does best. This is what GPs are trained to do. And if we invested even a fraction of that £14 million in training and supporting more practices to do what Julian’s team is already doing, we could transform gender healthcare in this country overnight.
Let us do the maths
The Cass Review cost £3 million. The Pathways trial costs nearly £11 million. That is £14 million spent reviewing, studying, and questioning treatments that the rest of the world provides as standard care.
Meanwhile, Australian researchers have shown that a single gender-affirming surgery pays for itself within three years through reduced mental health costs. Hormone therapy pays for itself within five years. Puberty blockers, by preventing the need for later surgical interventions, could save even more.
If we had spent that £14 million on care instead of on reviewing care, we could have funded ten years of hormone therapy for up to 4,600 people. Or over 2,000 top surgeries. Or 700 to 1,400 vaginoplasties. Or a national training programme for every GP practice in England.
Every single one of those investments would have reduced mental health spending. Every single one would have improved quality of life. Every single one would have generated long-term savings that far exceeded the initial outlay. The Australian data proves it.
Instead, we spent the money on a review that told us we needed more evidence, and a trial to generate the evidence that the review said was missing, while the people who needed care continued to wait.
The guidelines are there. Follow them.
For anyone who says we do not know enough to provide this care, here are the guidelines that are already available, already peer-reviewed, and already in use around the world:
WPATH Standards of Care (Version 8) – the international gold standard, published in the International Journal of Transgender Health.
Endocrine Society Clinical Practice Guidelines – comprehensive guidance on hormonal treatment, published in the Journal of Clinical Endocrinology & Metabolism.
UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Diverse People – a practical resource designed specifically for primary care clinicians.
American Academy of Pediatrics – policy statement affirming the importance of gender-affirming care for young people.
Australian Standards of Care and Treatment Guidelines – from the Royal Children’s Hospital Melbourne.
New Zealand Guidelines for Gender Affirming Healthcare – from the University of Waikato.
Boston Children’s Hospital – comprehensive guidance on care for transgender young people.
The evidence is there. The guidelines are there. The medications are already in the formulary. What we need now is not another review. What we need is the courage to follow the evidence, train our primary care workforce, and start providing the care that people are waiting years to receive.
Dr Helen Webberley
Gender specialist and medical educator
A reader rightly pointed out that the Melbourne research shows the government's rebate on surgery, not the full cost, is recouped within three years. I have updated the article to reflect this. The core finding still stands: the public investment in gender-affirming care pays for itself rapidly through reduced mental health spending. Thank you for the correction.