Trans men ‘let down’ and in ‘extreme distress’ as NHS quietly stops life-changing penis surgery
Stock photo: Depressed man sitting alone on a couch. (Envato/Rawpixel)
Finlay Games is a trans man who, as part of his transition, had a series of operations to construct a penis, which is known as phalloplasty.
“I am a functioning man precisely because of this surgery,” Finlay says. “I’ve got my own business. I’ve graduated, I’ve written a book, and all of these things are because of transition.”
“Nobody in their right mind would choose this, we have to – because the opposite is pain and not wanting to be here.
“I didn’t want to live before, I had no hope. And that’s what this surgery does.”
Finlay had phalloplasty – also known as bottom or lower surgery – several years ago now on the NHS. It was available via surgeons at a London clinic called St Peters Andrology. Finlay’s phalloplasty took six surgeries over three years, which he thinks would have increased to a seven- or eight-year timeframe today, based on the current waiting lists.
St Peters Andrology has been the sole UK provider of phalloplasty since 2014. In April 2021, the clinic stopped carrying out the surgeries.
After the situation slowly came to light in the first five months of 2021, PinkNews spoke to trans men who described feeling left in limbo, let down by the NHS and ignored by the wider LGBT+ community.
Only two were prepared to be quoted in this article, under pseudonyms – explaining that “people are scared to speak out publicly on this issue” because “names go missing off waiting lists”.
NHS phalloplasty: What’s the situation?
Those who’ve been referred for phalloplasty by an NHS gender clinic have already been through an arduous period of waiting. In some parts of the country, trans people referred by their GP to a gender clinic wait five or more years for that crucial first appointment – with no support or treatment in the meantime.
Then it takes multiple appointments, spaced over several years, before an NHS gender clinic will refer a trans person for gender-affirming surgery. The surgery waiting lists are also measured in years, not months.
Phalloplasty is an “elective surgery” – one that is planned ahead of time, rather than done as an emergency – so it was put on hold during the pandemic. But as other elective surgeries resumed in April, trans people waiting for masculinising lower surgery were left hanging.
This was because the NHS had quietly paused the surgeries – which construct a penis – after a contractual issue with St Peters Andrology.
St Peters Andrology, which won a £32.9 million NHS England contract for “Genital Surgery (Trans Masculine)” in 2019 that should have seen it deliver the surgeries for the NHS until 2027, had not secured a contract with a hospital that would enable it to carry out the operations. After months of speculation and no communication to patients, both St Peters and the NHS confirmed in May that the surgeries are currently on hold.
The NHS contract to provide the surgeries in England, Scotland and Wales is being retendered – but while the NHS is working to secure a new provider, trans men and trans masculine people have no idea how much longer they will have to wait. Some have had the first or second phase of phalloplasty and are awaiting the next, while others are waiting for vital repairs to their erectile implants.
PinkNews understands that some patients had been told that surgeries will resume in July, while others have been told that this is not the case. Neither St Peters nor NHS England could provide any further information due to the tendering process that is underway.
I feel let down by St Peters but I also feel let down by NHS England.
All the trans men PinkNews spoke to, who are waiting for phalloplasty, described poor communication from both the NHS and St Peters that had made their experience of the situation worse.
“I think the thing that’s difficult is the lack of communication,” said James, not his real name, who had the first stage of phalloplasty in October 2019 and has no idea when the next stage will be carried out. “And the lack of certainty. The lack of understanding about how much this affects someone’s life.”
He describes being “trapped” by the situation: “I’ve had stage one… so, I’ve got my penis, and I’ve also got everything else. I’ve not got testicles. It’s quite a lot to be going on down there.”
James says he’s in a relatively fortunate position – a job, supportive family – but “it’s still s**t for me”.
“Half of the distress has been caused by the lack of information,” James says. “This has always been an issue when it comes to complaining about poor communication generally from St Peters. As a patient you can’t do it because they’ve got so much power over your life.”
A lot of people have been extremely distressed.
When PinkNews spoke to Miles, not his real name, a trans man who was referred to St Peters for phalloplasty and had his surgical consultation just before the pandemic hit, he also emphasised the absence of any communication about the situation.
Miles had “absolutely none whatsoever” from NHS England or St Peters, and then, confusingly, had an appointment at an NHS gender clinic where the clinician allegedly denied that phalloplasty provision was on hold and went on a “wild rant” at Miles, telling him he was “stupid” for getting information about the situation from social media. The same week, NHS England finally confirmed that the surgeries had stopped months earlier.
“I do healthcare advocacy work for trans people and also people with any kind of complex disability or health condition that the NHS doesn’t want to look after,” Miles says, “and although malpractice and neglect is not unique to trans patients, the level of active malice at all levels certainly is something that I’ve really not seen in other places.”
Miles says he was “extremely angry” about the situation and that, in his opinion, the way it’s been handled has inflicted “a bunch of medical abuse on vulnerable people”.
In addition to that, “the trans masculine community has one of the worst healthcare communication issues I’ve ever seen,” he says.
“That’s in part due to clinicians who will insult phalloplasty, and pressure patients not to try and have them. They will s**t talk them all the time and say how awful they are.”
“Pre-2014 there was no domestic phalloplasty provision,” Miles says – NHS patients were sent to Belgium for the operations. “There was provision for less than a decade [in the UK], and now our provision has gone again. But you wouldn’t know, because there are multiple provisions for feminising lower surgeries and trans masculine top surgeries, and so fundraising and access efforts for gender-affirming surgeries only raise awareness of those.”
Alongside his anger at the current situation regarding phalloplasty, Miles wishes that there was more solidarity within the wider trans community for trans men’s healthcare.
The in-between stages are so difficult to cope with.
Finlay says he was worried to speak out about the situation because “[St Peters] are the only providers” and he feared “messing it up for other trans people” – but he wants more people to understand the terrible limbo so many trans men have been forced into.
“The in-between stages are so difficult to cope with, when you’re neither one or the other. You’ve got this penis that you can’t use, you can’t pee out of,” he says.
Finlay stresses that the current mess with NHS phalloplasty provision is part of a wider issue with trans healthcare in the UK. “We definitely need more surgeons, we need more accountability, we need better joined up care, we need better provision,” he says.
“Having a dedicated hospital would solve a lot of the problems.”
TransActual are running peer-to-peer support group meetings for those on the phalloplasty waiting list. Find out more here.
