An ITV News investigation has found transgender people are waiting months - and sometimes years - for the earliest stages of gender reassignment.
ITV News spoke to the eight NHS gender clinics that cover England and Wales and found there are now almost 4,000 adults still waiting for their first appointment.
The average waiting time is 34 weeks and at one clinic patients are waiting 66 weeks for an initial consultation.
Ceridwen Louvaine, also known as Lou, 23, from Manchester was born male and has made the decision to live as a woman. She knew at 14 she wanted to make the transition but the first GP she approached told her she didn't know how to help.
When Lou tried again she was put on a waiting list for gender counselling but was warned an appointment could be two years away.
"They said I would have to wait two and a half years to be seen and that it would be another six months of consultations after that," Lou told me. "So it would be three years waiting for hormones and any support".
Like many others in the trans community, Lou decided to take matters into her own hands, using the internet to order testosterone inhibitors. The drugs cost her £150 every month, but the cost to her health could be far greater.
Her mother Julie doesn't like Lou using unregulated hormones, but knowing her daughter has contemplated suicide, she believes the alternative is even worse.
I know the extremes of suffering she has had to go through.
Changing sex isn't cheap.
The cost of gender reassignment is £19,236 per patient, including support as well as surgery.
The total cost to the NHS in England last year was £17.13 million and this year the budget has been increased to £22.72 million.
But it's still not enough, according to the country's leading trans support group.
"There are approximately 20% more people coming in to the system, but the system doesn't seem to be responding to the growing number of people wanting to access these services. It is sitting on a time bomb."
There are almost 2,000 patients on their waiting list alone, its chief executive Steve Shrubb says.
He told me that although he doesn't believe the NHS is consciously discriminating against the trans community, the need for more doctors trained to work on gender reassignment is critical.
He said "It is clear to me we aren't providing the equal access and equal opportunities we should be. One of the cornerstones of the NHS is the way it treats people equally, whether you have cancer of heart disease.
"If you have a need it needs to be met, so there is a moral argument here but also a pretty hard-nosed economic one. If people get the opportunity to change gender they reach their potential and make a full contribution. If they don't, they often become ill and that costs us".
NHS England told ITV News, "We have put additional funding into gender reassignment services for the last two years and will continue to do so. We recognise the urgent need to bring down waiting times,"
Until then, people like Lou Ceridwen are left in limbo - brave enough to change, but helpless to do anything more about it.
If you or someone you know needs advice on gender transition, the following support groups may be able to help: