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.
All my life I have felt female, and suppressed it. But now our time is running out with age, and I want to spend whatever time I've got left as what I am: female. I have grave worries about what will happen if I don't. Three times in my life I've considered suicide.
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.
The long waiting times are such a problem because young people are suffering now - not in two years time - and they really need support now. It makes so much more sense to spend money here in a stitch-in-time prevention model, so these young people can grow up happy and healthy and actually be constructive adults that are contributing to society.
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.
They're taking dangerous drugs without often knowing what they're doing. Theres an awful lot of misinformation around: a lot of people think if you double the dose, you go twice as fast. At least two of my friends died from too high a level of oestrogen, which can cause heart problems.
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.
Greater Manchester’s local trans community have expressed many frustrations with the current system, including dissatisfaction with waiting and traveling times, poor communication, lack of consistency and support resulting in little trust or confidence in the system and that’s why it’s important that we work to find a better solution. We’re still at the beginning of this project but we’ll be feeding back to NHS England what we find out and we’re hopeful that in the future there will be a dedicated service based here and designed for, and with, Greater Manchester residents.”
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: