Transgender campaigners are warning that lives are being put at risk, as people are being left waiting months or even years for the earliest stages of treatment to help them undergo gender reassignment on the NHS.
In most cases, people seeking hormone treatments or surgery must be seen by one of the country's seven Gender Identity Clinics.
In 2018, people are facing waits of up to two years at the most in-demand clinics.
One of the people waiting is Isobel.
At the age of 74, she visited a dressing service for the first time, and finally saw herself as a transgender woman:
She fully came out as a transgender woman in 2016, and now wants hormone treatment and surgery to complete her transformation.
Isobel says she's expecting an 18 month wait, and that time is not on her side.
Are long waiting times a problem?
The Proud Trust, a charity for young LGBT+ people, have raised concerns that long waiting times are exacerbating mental health issues or even suicidal thoughts.
Sam Cresswell is a transgender youth worker based in Manchester, and says he's seen a steady increase in young people who develop eating disorders or who are self-harming, as they try to cope with going through the puberty of a gender which feels discordant to them.
There are also concerns that people may be unknowingly risking their health by turning to unprescribed hormones bought over the internet, in a bid to speed up their transition while they wait for NHS treatment.
What's being done?
A public consultation on shaping the future of Gender Identity Services in England has looked at ways of smoothing treatment pathways and reducing waiting times.
It explored suggestions of overseeing treatments more locally - and now there are hopes that Greater Manchester will get its own GIC.
If successful, the Greater Manchester model could be adopted in other parts of the country to increase the capacity of the NHS.
An NHS England spokesperson said: “Demand for gender identity services continues to rise as more people feel able to come forward for support and treatment.
“NHS England has provided important funding for these services and staff are working hard to reduce waiting times for patients.”
You catch watch Lise McNally's report in full below:
What help is available?
If you or someone you know needs advice on gender transition, the following links or support groups may be able to help: