What Trans Youth Asked For vs What They Got
Trans young people told us exactly what they needed from gender services. Here's what happened next.
A Tale of Two Services
When trans and non-binary young people were asked what they wanted from NHS gender services, they came back with a pretty reasonable list. Rima Hawkins1 compiled their voices2 through Mermaids UK focus groups, capturing the hopes and dreams of young people who just wanted to be heard, understood and helped.
So what did they ask for? And what did they actually get when the old GIDS3 at the Tavistock closed its doors and the new services opened?
Let me walk you through it, did they get what they wanted and needed, were their voices heard?
They Asked: Include Us in Decisions
The young people were clear: they wanted trans voices and expertise actively included in service design, policy-making and complaints boards. They wanted youth panels and multiple representatives with diverse identities sitting at the table when decisions were being made about their lives.
What they got: The new service specifications were developed through “stakeholder engagement” where NHS England acknowledged there “remains a divergence of views amongst stakeholders.” The August 2025 consultation document4 notes that decisions have been made based on the Cass Review recommendations, with the final service specification aiming to reflect “a fundamentally different approach” to the one young people had previously experienced. Whether trans young people feel genuinely included in shaping these services is a question that lingers.
They Asked: Affirmative and Respectful Care
Young people wanted care teams that were accepting, supportive and respectful. They wanted clinicians to use correct names and pronouns, avoid condescension, and not judge them based on weight, sexuality, disability or trauma history. They specifically asked for trans staff to be recruited and visible in clinical teams.
What they got: The new services operate under an interim specification that emphasises “holistic assessment” including screening for neurodevelopmental conditions and mental health assessment before any discussion of gender-related support. The service specification states that “social transition should be recognised as a significant decision” and becomes “a significant and valid subject” for clinical discussion, rather than something affirmed at the outset.
They Asked: Multiple Ways to Access Care
This one really stings. Young people wanted multiple referral pathways, including self-referral, referrals from schools, youth groups, doctors, social workers and family. Crucially, they wanted unsupportive parents not to prevent their access to care.
What they got: From 1 September 2024, all referrals to NHS Children and Young People’s Gender Services must be made through NHS secondary care services, specifically mental health or paediatric services5. Self-referrals cannot be accepted under any circumstances. GPs can no longer refer directly. Young people must first be seen by CAMHS or paediatric services before they can even join the waiting list.
The NHS states this is “to ensure that every child or young person has a thorough assessment of need, and that those who need it receive appropriate support from local NHS services while they remain on the waiting list.”6
They Asked: Support While Waiting
Young people requested that waiting lists be triaged into different streams, with regular check-ins using a traffic light system to monitor risk and wellbeing. They wanted peer support groups supervised and facilitated to provide interim support.
What they got: Current waiting times are around three years for the new children’s services. Young people who are unlikely to be seen before their 18th birthday will be removed from the waiting list and advised to consult their GP about referral to adult services. The Leeds adult gender service currently has nearly 7,000 people7 on its standard waiting list, booking appointments for people referred in approximately August 2019, a wait of over six years.
NHS England has commissioned “an additional support offer for young people who are waiting to be seen by the new gender services, through an assessment with their local Children and Young People Mental Health services.” Whether this constitutes the kind of triaged, regular check-in support young people asked for is debatable.
They Asked: Regional Services Closer to Home
Young people wanted regional service hubs established to reduce travel barriers and improve local access to care.
What they got: This one is actually happening. NHS England has opened new regional services in London, the North West and the South West (Bristol), with plans for up to six specialist regional centres by 2026. The East of England service was planned for spring 2025. This represents genuine progress from the old single-site Tavistock model.
They Asked: Puberty Blockers as an Option
Although not explicitly stated in Hawkins’ summary, the context of the consultations was clear: young people wanted access to puberty blockers as part of their care pathway, giving them time and space to make decisions about their futures.
What they got: Puberty blockers for gender dysphoria in under-18s are now indefinitely banned8 in the UK outside of clinical trials. The ban came into force on 1 January 2025. NHS England stopped routine prescriptions in March 2024 following the Cass Review. The Commission on Human Medicines advised that “there is currently an unacceptable safety risk in the continued prescription of puberty blockers to children.”
The only route to access puberty blockers is now through a clinical research trial being established by NHS England. Young people who were already receiving these medications before 3 June 2024 can continue.
They Asked: Welcoming, Non-Clinical Environments
Young people wanted spaces that were welcoming and gender-diverse friendly, with houseplants, comfortable seating, soft furnishings, sensory accommodations and visible LGBTQI+ symbols like rainbow flags.
What they got: The new services are hosted by children’s hospitals, specifically Great Ormond Street, Evelina London, Alder Hey and Royal Manchester Children’s Hospital. These are specialist paediatric settings. Whether they feel welcoming and non-clinical to gender-questioning young people is something only those young people can answer.
They Asked: Autonomy and Informed Consent
Young people wanted genuine choice and autonomy, including the ability to delay decisions or decline interventions without fear of losing access. They wanted robust informed consent that recognised power imbalances.
What they got: The new service model describes “an individualised pathway” determined by clinicians based on “the clarity, persistence and consistency of gender incongruence, the presence and impact of other clinical needs, and family and social context.” The service specification notes that “not all children and young people will need an in-depth assessment and will get what they need from other forms of local support.” The framing has shifted from “what does this young person want and how can we help them achieve it safely?” to “does this young person meet the criteria for our service and what are their wider needs?”
The Bottom Line
Trans young people asked for services that listened to them, believed them, included them in decisions and gave them options. They asked for care closer to home, support while waiting, multiple ways to access help and environments that felt safe.
Some of this is happening. Regional services are being rolled out. Support offers while waiting are being developed.
But the pathway to care is now longer and narrower. No more self-referral. No more GP referrals. Mandatory mental health or paediatric assessment before even joining the waiting list. Puberty blockers banned. Waiting times measured in years.
The young people who spoke to Rima Hawkins wanted to be heard. Whether they feel heard now is another question entirely.
Rima Hawkins is a senior accredited National Counselling and Psychotherapy Society (NCPS) Psychotherapist, College of Sexual and Relationship Therapy (COSRT) accredited and UK Council for Psychotherapy (UKCP) registered Sex and Relationship Therapist, Clinical Supervisor, accredited Eye Movement Desensitisation & Reprocessing (EMDR) Therapist, Clinical Associate with Pink Therapy and Group Facilitator.