“The Levy Review proves that the UK trans+ community has been right all along” by Munroe Bergdorf

“Finally, an official report that’s saying what we’ve been shouting into the void for years. Six-year waiting times? Check. Over 40,000 people stuck on waiting lists? We’ve been saying this. Complete absence of safety data? We’ve been pointing that out forever. System in crisis? We know!

The Levy Review’s 143 pages confirm every testimony, every social media thread, every advocacy report, every parliamentary submission that UK trans+ communities have produced over the past decade.

As a community, we have documented the problems with extensive precision. We explained the failings and the harms. We even proposed the solutions. And yet it took an external clinician with institutional authority to say the exact same things before anyone with power to change things started listening.

This isn’t just frustrating. It reveals something fundamental about why trans+ healthcare fails the community so catastrophically.

The UK trans+ community has been documenting this crisis for years, decades even. We’ve shared our referral dates and still-pending appointments. We’ve tracked which clinics have the longest waits and the worst cultures. We’ve compiled data on GP refusals to prescribe hormones. We’ve explained how people turn to DIY through unregulated online pharmacies out of desperation. We’ve counted the friends, partners, children and loved ones we’ve lost while they were left unassisted on ever-growing waiting lists.

We weren’t merely complaining. This was consistent testimony corroborated across thousands of individual experiences. When Levy’s review found that long waiting times led patients to seek private diagnosis and hormone treatment, we could have pointed to years upon years of advocacy saying exactly that. When it noted demographic shifts toward younger patients with additional conditions, we’d been discussing these changes and demanding that services adapt accordingly since at least 2018.

But our testimony has always been treated as “patient experience” or “opinion”, rather than valued as actual evidence. As advocacy with an agenda rather than expertise born of lived experiences. Individual truths, no matter how many thousands of them there are, could be dismissed as biases or exceptions. We lacked access to the institutional data that would have proved our case, data that the clinics themselves haven’t been collecting because they didn’t think they needed to listen to us anyway.

Here’s the question we need every healthcare provider, every politician, every clinic administrator to sit with… How can you expect trans+ people not to be failed by the system providing our care, when far too often you don’t believe us about who we know we are?

Much of trans+ healthcare on the NHS is built on scepticism about our knowledge of self. We are expected to “prove it” more often than not to people who have no first-hand experience of how it feels to be a trans+ person themselves. That foundation of disbelief doesn’t stay contained to questions about gender.

If you don’t believe me when I tell you I’m a woman, why would you believe me when I tell you that the reality of six-year wait is causing me serious harm?

If my understanding of my own gender requires years upon years of professional verification, why would my description of systemic failures in my healthcare be taken at face value?

You can see this disbelief in the Levy Review itself, even while validating many patient concerns. It describes our testimony about feeling dismissed as “accusations”, while clinicians’ claims about “adhering to professional standards” are presented as explanations. Trans+ patient testimony requires investigation, while professional judgment gets presumed legitimacy. We are not seen as reliable narrators of our own shared reality.

Every year that NHS England failed to act on our warnings has added thousands more people to the ever-growing waiting lists. Every month without the standardised assessments and outcomes data we demanded was a month of postcode lottery and untracked care quality. Every week that GPs refused to prescribe hormones was a week someone either went without necessary medication, or sourced it from unregulated online pharmacies, or spiralled into distress.

While the Levy Review uses careful clinical language to speak about “patient safety risks” and “distressing” waits. What we’re actually talking about is depression, anxiety, relationship breakdowns, job losses, public harassment, self, and suicidal ideation.

We’re talking about highly vulnerable people such as Alice Litman, who have died waiting. We’re talking about people who cannot afford to go private, turning to DIY, administering their own hormones unsupported and unmonitored. This continues to happen because nobody believed us when we said it was happening.

So where do we go from here? What needs to change on a foundational level to move things forward? It’s time that trans+ people are not only believed, but seen as the authority on trans+ issues and how to improve our lives and wellbeing. Not consultants to be brought in for token feedback. Not subjects requiring management and validation. Not patients whose testimony needs corroboration from “objective” or “impartial” professionals.

It’s high time to reevaluate and reimagine gender-affirming care on the NHS. The people whose knowledge matters most are the ones living these realities. The authority is us. Just as the authority on women’s health is women, the authority on disability rights is disabled people, the authority on anti-racism is people of colour.

We need to invest in access by training more clinicians in gender-affirming care and addressing GP refusals of routine care directly. If cisgender patients are able to access HRT through their GP, trans+ patients should be able to experience the same standard and level of access to the care we need. End the postcode lottery with consistent, nationwide standards that prioritise access over roadblocks.

It’s time to stop gatekeeping our identities and move forwards toward informed consent models where we make our own decisions about interventions once we understand the risks and benefits. Trust our self-knowledge as the starting point, not something requiring years of professional verification.

Real legal protections need to be provided. Ban LGBT+ conversion practices in ways that protect trans+ people and gender-affirming care, rather than weaponising the law against us. Gender recognition certificates need to be more accessible, not an undignifying obstacle course.

Involve the trans+ community in systemic decision making. Give us actual power in service design and governance. Not honorary advisory roles you can ignore, but voting authority on commissioning decisions, quality standards, and oversight. Put trans+ people on the proposed National Oversight Board with real decision-making power.

Fund trans-led research and resource us to conduct our own research, collect our own data, and evaluate services according to criteria we define as important. Stop treating professional research as inherently more valid than community-generated knowledge.

The Levy Review proves that trans+ people were right all along. We knew what was wrong and we knew what would help. We were the experts the whole time. The only people who didn’t know this were the institutions with the power to change things. They didn’t know it because they chose not to believe us. The question now is whether anything will actually change.

Will the NHS and healthcare systems learn that they should have been listening to us from the start? Will they build systems that centre our expertise rather than requiring external validation of our testimony?

It’s time to recognise that we are the authorities on trans+ lives, and to build the reimagined systems that reflect that very reality.”

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