Trans healthcare is healthcare. This should make us all angry.

Trans healthcare is healthcare. This should make us all angry. | by Heather Paterson | Sep, 2026 | Medium I am angry about what is happening to trans people in Wales.

On 28 August, the NHS Wales Joint Commissioning Committee told Cardiff and Vale University Health Board to pause the surgical pathway through the Welsh Gender Service. That means no new referrals for gender-affirming surgery, no surgical assessments and no scheduled operations while an independent clinical review takes place.

This is adult healthcare.

People who have waited years. People who have done everything asked of them. People who have attended appointments, been assessed, met the criteria, been referred, arranged time off work, travel and accommodation. People who finally thought they were getting the care they needed.

Then it was stopped.

Call it a pause if you like. For somebody with a surgery date in the diary, it is a cancellation.

For somebody already travelling across the country, or already at hospital, it is the rug being pulled out from underneath them. Reports from affected patients and Welsh trans organisations include surgeries being cancelled at the last minute, including after people had travelled or been admitted to hospital.

That is cruel. There is no softer word for it.

The Welsh Gender Service still provides other support, including hormone therapy, endocrine care, psychological support and speech and language therapy. That matters. But it is no comfort to someone whose surgery has been stopped after years of waiting. The fact that other care continues does not make the withdrawal of this care any less devastating.

The NHS says this is a pause, not a permanent change. It says the decision followed a Level 3 escalation after concerns about referral rates, assessment processes and clinical governance. Its later update said the Welsh service had made significantly more surgical referrals than English services, that fewer Welsh patients were progressing to some forms of surgery, and that there were questions about whether some people had met surgical requirements such as BMI, surgical fitness or wider health needs.

Those concerns should be looked at properly. Nobody is asking the NHS to ignore genuine clinical concerns. Healthcare services should be safe. They should be accountable. Patients deserve thorough assessment and high-quality care.

But there is a massive difference between reviewing a service and stopping an entire surgical pathway.

The Welsh Gender Service’s own FAQs say that no immediate patient-safety concerns have been identified, and that no patient has been identified as having undergone surgery inappropriately.

So what exactly was the emergency?

If there are concerns about an individual referral, look at that referral. If there are concerns about a particular process, fix that process. If extra support is needed, provide it. You do not stop every referral, every surgical assessment and every booked operation, then tell people that a review is underway and offer no clear public timetable for when their care will resume.

Cardiff and Vale has said it does not want to give a timescale before the assurance work has progressed. I understand why that might sound reasonable in a communications meeting. But to somebody whose life has just been put on hold, it is not reassurance. It is being told that the healthcare they need could be gone for an unknown length of time.

There is a petition on the Senedd Cymru Welsh Parliament petition site calling to “Immediately unfreeze gender-affirming surgeries and protect NHS Welsh Gender Service patients.” The petition rightly calls for scheduled and approved surgeries to be unfrozen, for any review to happen alongside established patient care, and for clear terms of reference and a strict timeline. That should be the absolute minimum.

The response from Welsh LGBT+ and trans organisations has made something else painfully clear: people affected by this were not properly involved.

Llais said it first learned about the change when it was publicly announced, and that people affected deserve clear information about why it happened, how long it will last, what support is available and what is being done to minimise disruption. TransActual described the impact as cruel. Trans Aid Cymru and Trans Partnership Cymru said they were alarmed by the emotional and financial impact on patients, and raised serious concerns about the absence of stakeholder involvement or an apparent plan for the hundreds of people affected.

Different organisations. Different roles. The same obvious point.

You cannot make a decision with this level of impact on trans people without involving trans people.

And the wider context matters.

It would be inaccurate to say that one blog alone caused this decision. The NHS says its concerns came from routine checks in July and August, clinical information, correspondence and referral data. That needs to be tested openly and properly.

But it would also be deeply naive to pretend that this has happened in a political vacuum.

A gender-critical journalist’s Freedom of Information analysis raised concerns about Welsh referral rates. A Conservative MS then called for an urgent review after reading that reporting. The issue was amplified in hostile national media coverage. The Welsh Gender Service was escalated on 24 August, and four days later patients were being told their surgeries were off.

That is the public timeline. And it should worry us.

The review itself was not new. An independent review of the adult Welsh Gender Service had been promised earlier and was reportedly expected to conclude by the end of 2026. If there were governance questions to answer, there was time to answer them properly.

Instead, the response was a blanket stop to adult care before the review had reported.

That is not how you build trust.

The other thing that needs saying is this: a higher referral rate than England does not automatically mean poorer care.

Trans healthcare in England is broken. It is defined by years-long waiting lists, fragmentation, gatekeeping and people being left in limbo. The Welsh Gender Service was hard won by trans people in Wales who wanted care closer to home, rather than being forced to travel to England for every stage of their transition. It works differently, with a national service and local gender teams across Wales.

Even before this pause, people were waiting years for a first appointment with the Welsh Gender Service. That is not a model of speedy, easy healthcare. It is simply less broken than parts of the system elsewhere.

So when Wales refers more people for surgery than English services, we should be asking questions. But one of those questions should be whether the Welsh service is actually getting people through a system that England leaves them stuck in. A functioning pathway should not be treated as suspicious simply because other pathways are failing.

I care about this because I give a shit about trans people. It really is that simple.

If you do not believe in equality for all of us, you do not believe in equality.

Healthcare is a human right. Trans people are people. Trans healthcare is healthcare.

We have watched attack after attack on trans rights in recent years, much of it aimed at young people and dressed up as concern about whether they are too young to know who they are or make decisions about their bodies. I disagree with that framing too.

But this goes beyond that.

This is about adults.

Adults who have been assessed.

Adults who have consented.

Adults who have waited years.

Adults who are now being told that their healthcare can simply be taken away.

As a feminist, bodily autonomy matters to me deeply. The only person who should have the final say over my body is me.

I have covered my body in tattoos. I have had permanent make-up. I have used weight-loss medication, hair treatments and supplements. Some people may not like those choices. They may not understand them. Good for them. They do not have to.

They are my choices.

Some are medical choices and some are aesthetic choices. I am not pretending they are clinically identical to gender-affirming surgery. Obviously they are not. But the principle is the same. I get to make informed decisions about my body, what I put into it, what I do to it and how I want to look and feel in it.

Cis people make gender-affirming choices every day. We just call it beauty, confidence, treatment, self-care or getting on with our lives.

Don’t like tattoos? Don’t get one.

Don’t agree with abortion? Don’t have one.

Don’t support gender-affirming surgery? Don’t have it.

Nobody is forcing you to do any of those things. But you do not get to take that choice away from somebody else.

And even if you do not care about trans people, even if you do not care about feminism or bodily autonomy, you should care about this out of pure self-interest.

Because this is a dangerous precedent.

You do not want to live in a country where healthcare can be stopped because somebody with a platform decides they do not like it, a newspaper turns it into a culture-war story and politicians demand action. You do not want to be lying in a hospital bed, fully informed, fully consenting and ready for a procedure you have waited years for, only to be told it has been cancelled because your healthcare has become politically contentious.

What happens when it is your treatment?

Your surgery?

Your medication?

Your reproductive rights?

Your disability support?

When one group’s healthcare can be withdrawn this easily, nobody’s healthcare is entirely safe. If trans people’s bodily autonomy is negotiable, bodily autonomy itself is negotiable.

That should scare all of us.

Please sign and share the Senedd petition to immediately unfreeze gender-affirming surgeries and protect NHS Welsh Gender Service patients. It has already passed the 10,000-signature threshold for consideration for debate, but it needs continued pressure.

Sign it because trans people deserve their healthcare back. Sign it because bodily autonomy means nothing if it only belongs to people whose bodies you approve of. Sign it because healthcare for all means healthcare for trans people too.