the law


A U.K. teen caught up in the battle over trans health care.

Luke, 18, is one of thousands of young trans people in the U.K. whose care has been delayed. Photo: Olivia Arthur/MAGNUM PHOTOS
Luke, 18, is one of thousands of young trans people in the U.K. whose care has been delayed. Photo: Olivia Arthur/MAGNUM PHOTOS
Luke, 18, is one of thousands of young trans people in the U.K. whose care has been delayed. Photo: Olivia Arthur/MAGNUM PHOTOS

This article was featured in One Great Story, New York’s reading recommendation newsletter. Sign up here to get it nightly.

Luke was a teenager, but sometimes he suffered from hot flashes so intense he felt faint. His bones ached. Sitting on the edge of his bed, he twisted repeatedly to relieve the pain in his back, which “feels like it could snap in two.” The discomfort was like having an illness, he says, except he was not sick. Instead, he was suffering from the side effects of puberty blockers — a drug that suppresses the estrogen his body would otherwise naturally produce. Luke was supposed to be on the blockers for a year, part of a mandatory thinking period for minors before they can be prescribed gender-affirming hormones through the United Kingdom’s National Health Service. That deadline, like others before it, had passed. When I first met him, he was 17, and he had been waiting six years for care.

Luke is one of thousands of young people in the U.K. living in limbo, casualties of a battle being waged in the media and the court system over the Gender Identity Development Service, a division of the NHS that performs psychological assessments for gender-diverse youth. The fight has divided British mental-health professionals: On one side are clinicians who believe if a child says they’re trans, they’re trans — and they have the right to puberty blockers and hormones.

A small group, however, has sued to force GIDS to adopt a more conservative approach and withhold medical interventions. Their aim, they say, is to prevent young people from making decisions they might regret. The case they brought, Bell v. Tavistock, continues to play out in the British courts, but the repercussions are already being felt. For almost a year, GIDS was brought to a near standstill. After an early court decision, no GIDS patients were referred for gender-affirming hormones, and today, roughly 5,300 young people are on the waiting list for a first appointment, with an expected wait time of 23 months.

“I was in an absolutely terrible place because I couldn’t cope with waking up and things being the same every single day,” Luke says. He socially transitioned at age 12, the same year he was diagnosed with gender dysphoria. He has been binding his chest for so long that he barely thinks about it anymore. To boost his five-foot-four frame, he often walks in black lace-up boots with a chunky heel. (They also look cool.)

He is now in his final months of secondary school. When the academic year started, his hope was that he could go on testosterone before university. “To see the treatment there and be running toward it, and it moves at the same pace as you away from you — coming to terms with that is the hardest thing,” he says.

In places with a more progressive approach, such as the Netherlands or some parts of the U.S., Luke could have gone on blockers as early as age 12, preventing breast growth and menstruation. If he had continued on to hormones, he would have experienced a male puberty alongside his peers. But in the U.K., that path was closed to him.

There are signs that the debate in the British courts has found an audience in the U.S. Last month, Texas governor Greg Abbott ordered state agencies to investigate parents of children who medically transition for child abuse. In his written opinion supporting the order, Texas’s attorney general cited arguments from Bell v. Tavistock. Nationwide, right-leaning lawmakers proposed 43 bills last year aimed at preventing minors from accessing gender-affirming care.

As the lawyers and legislators fight, countless gender-diverse young people are caught in the middle. Without access to blockers, some of them are forced to go forward with a puberty that doesn’t align with their gender, producing irreversible changes that can only be corrected with painful and expensive surgeries later on. In the meantime, governments and health authorities seem further than ever from reaching a consensus on the best kind of care for trans kids. So Luke and his peers wait, month after anguishing month.

Photo: Olivia Arthur/MAGNUM PHOTOS

Until he turned 10, Luke (who asked to be identified by first name only) never thought much about his gender. He was, by his own telling, “a very, very girlie girl.” His mother, a caretaker in a residential-care home, and his father, an engineer, never suspected that he might be grappling with his gender identity — and for the first decade of his life, he wasn’t. “I had quite a balanced upbringing,” says Luke, who now lives about two hours outside London with his mother and 14-year-old brother. (His parents separated when he was 7.)

With the onset of puberty, however, Luke began to feel disoriented in his body. He was particularly bothered by his hips. When he looked in the mirror, it was almost like staring at someone who’d had botched plastic surgery, he says. Instead of seeing minor curves, the reflection was like looking at “a badly done caricature, like Betty Boop.” Luke discovered that dressing in masculine clothes made him feel a little bit better, so he started wearing tracksuits.

At age 11, he discovered videos about gender dysphoria on YouTube, made by people whose experiences matched his own. After watching videos by Jamie Raines, a British man assigned female at birth who documented his medical transition online, “I eventually settled on what I was,” says Luke. He had his long brown hair cut off and told his mother that he was, in fact, a boy. A few weeks later, he told his father, too.

He eventually decided he wanted to be called Luke and use male pronouns. His father covered up a tattoo on his hand of the name they’d given Luke at birth, which Luke saw as an act of love. “He’s not superemotional, but that was his physical action, like, showing a lot of acceptance,” he says.

Luke’s mother took him to see a general practitioner to discuss starting a medical transition; that doctor referred Luke to a specialist who, over the course of several appointments, diagnosed him with gender dysphoria, which meant he was feeling distress over his gender identity and body not aligning. (To be transgender is not necessarily to have gender dysphoria: the latter is a medical diagnosis; the former is not.)

In the early aughts, a protocol developed at the Amsterdam Center of Expertise on Gender Dysphoria to help dysphoric children began to gain traction. Researchers found that they could alleviate their depression by halting puberty at a relatively early stage (often around age 12, but earlier in some kids) using drugs that had, for decades, been prescribed to children with precocious puberty (when puberty starts too early, sometimes as soon as age 8). These puberty blockers prevented sex changes driven by adolescent hormones: Transfeminine kids could avoid developing an Adam’s apple and a deep voice, for instance; transmasculine kids could stunt breast growth. At age 16 (though sometimes younger), according to the protocol, those patients could choose to start on estrogen or testosterone. At 18, they could consider surgery.

Shortly after his appointment with the specialist, Luke learned that in order to access blockers and perhaps eventually hormones, he would still need to be separately evaluated by GIDS clinicians. In September 2016, two months before his 13th birthday, Luke received his referral. He was told it would be roughly ten months until his first appointment. Then the letters began arriving. “I’d probably get a letter every four months telling me that the waiting list has been extended. Basically, you move forward a month and then you move back a month,” he says. During this time, “there were no checkups, nothing like that” to help Luke with his gender dysphoria.

To cope, Luke tried to alter his body on his own. He began binding his chest, first using “really rubbish” binders he’d ordered on Amazon before finding one that didn’t hurt quite as bad. He Googled ways to deepen his voice, none of which worked, and lifted weights in the hopes of broadening his shoulders. He began menstruating, and his depression worsened. “I was getting really desperate,” he says.

As his male peers began to physically mature around him, Luke felt stuck in place. “I was basically paused sounding like a teen girl,” he says. “Mentally, it created a conflict because my personality got forced to develop in order to cope with the circumstance, but I still had to inhabit a body that made me feel really immature and disconnected from myself.” Even though he’d once loved performing, he gave up theater when his classmates’ voices changed and his didn’t; he stopped doing gymnastics when he became hyperaware of the differences between his body and those around him.

Luke considered using GenderGP, a telehealth service registered in Hong Kong that could potentially prescribe him blockers and hormones. The service has become popular with transgender people in the U.K. frustrated with the slow pace of the NHS. “It’s what everyone goes on,” says Luke. But the fees were expensive, and his family couldn’t afford it.

Meanwhile, his first appointment with GIDS kept getting pushed back. The initial ten-month period became 18 months, then 22 months. Finally, he received a letter with a firm date. By then, he was almost 16 years old — the age at which young people in the U.K. are eligible for gender-affirming hormones. “I thought, Okay, I’ll go and get interviewed. They’ll see that I’ve been living as male for about four years, and they will put me on hormones because I’ve wanted it for a long time,” says Luke. At first, the letter felt like a winning lottery ticket.

Photo: Olivia Arthur / Magnum Photos

While Luke waited years to be seen by GIDS, a rift was developing within the organization. In 2014, the service’s leadership adopted the protocol developed in Amsterdam, but some clinicians objected that GIDS was pushing patients toward blockers and hormones too quickly. They began voicing their concerns internally, arguing for a greater commitment to therapy for patients with gender dysphoria.

They were calling, in a sense, for a return to the organization’s roots. GIDS was founded in 1989 by Domenico Di Ceglie, a psychiatrist at St. George’s Hospital in London who wanted to create a place for young patients to explore their gender identities. It was one of the first clinics in the world dedicated to helping children with gender dysphoria. In 1994, GIDS was moved under the umbrella of the Tavistock, the talk-therapy arm of the NHS. It had “three or four staff in a tiny office” and saw as few as 50 patients a year, says Bernadette Wren, a retired consultant clinical psychologist and family therapist who started at GIDS around that time.

Almost 20 years later, GIDS was still seeing only 300 or so patients a year. But then, in 2016, the organization made it easier for doctors to refer patients to them, and by 2018 — the year Luke received notice of his first appointment — that number had jumped to 2,500. (Most patients are seen at the Tavistock clinic in London, although GIDS operates a smaller clinic in Leeds and has outreach sites in Bristol and Birmingham.)

As the numbers grew, patients and their parents began arriving at GIDS already aware of blockers and hormone therapy, says Wren. GIDS director Polly Carmichael and some of the senior members of her team supported the gender-affirming model, but other clinicians were startled by the number of patients demanding medical interventions right away. They had trained as psychoanalysts and family therapists and came to the service expecting to do long-term therapeutic work. (GIDS’ most recent data shows that patients averaged ten appointments before moving on to hormone therapy.  Carmichael did not respond to interview requests.)

Anastassis Spiliadis, a psychotherapist and psychoanalyst who worked at GIDS from 2015 to 2019, says that at times, he felt like “the only thing that the service was offering was a medical approach.” Spiliadis was alarmed when, he says, Carmichael told clinicians not to bring their concerns to the service’s child-safeguarding lead. (A spokesperson for GIDS denied this, but evidence presented before a tribunal investigating the matter backs up Spiliadis’s account.)

When the GIDS clinicians in favor of a less medicine-focused approach felt their objections weren’t addressed by management, ten of them (from a staff of around 70) shared their worries with David Bell, a high-ranking psychiatrist and former president of the British Psychoanalytic Society who had been at the Tavistock for more than 25 years. Bell worked with adults and was not affiliated with GIDS, but he was a staff representative on the Tavistock Council of Governors, which meant he was elected by employees to make sure they have a voice in how things are run.

He was also not a neutral sounding board. He says that GIDS always made him “uncomfortable,” and that while he supports an adult’s right to medically transition, in his view, minors “can’t make that kind of decision.” He was skeptical of the idea that someone could be born trans. “Over time, you develop a gender identity, which is probably quite early on in life, but it’s not assigned at birth,” he says. “There isn’t a gendered soul.”

Bell, who is 71, suspects clinicians came to him because “I had a reputation, I think, of being the kind of person who wasn’t scared to say what he thought.” In his conversations with clinicians, “the most important thing was that they felt, or they believed, that the children referred to the service were not adequately cared for and were in danger of being motored on an inappropriate pathway, which would have irreversible consequences, without sufficient thought,” he says.

In the summer of 2018, Bell wrote a report on the clinicians’ concerns and submitted it to the Tavistock Council of Governors. “Dr. Bell kind of ran away with it and wrote a report that was full of his own criticisms,” says Wren. He used “very, very extreme language, implying senior staff were harming children.”

The 55-page report, which includes lengthy, anonymous testimonies from GIDS clinicians, was damning for GIDS management, going so far as to assert that the service is “not fit for purpose” and that “children’s needs are being met in a woeful inadequate manner.” Bell pointed to unmanageable caseloads, “an excessively affirmative attitude” that he attributed to external political pressures, ethical questions around consent, systemic homophobia among staff and parents (one clinician said some parents would rather their child be trans than gay), and inexperienced clinicians tasked with complex cases.

Bell called for an overhaul of GIDS. If the concerns he raised weren’t acted upon, he warned, there could be long-term, damaging consequences for the service’s patients, and the reputation of the Tavistock would be “very seriously at risk.”

In the fall of 2018,  just a few months after Bell submitted his report, Luke got ready for his first GIDS appointment. It had been four years since he socially transitioned. He had partially gone through puberty by then: His hips and breasts were developing, his body taking a shape that made him uncomfortable in his own skin. But he was no longer menstruating, after his general practitioner put him on what he believes were birth-control pills. Luke says that intervention, at least, had been helpful; it ended what had become a monthly crisis. “I’d just have a nagging feeling in my head, like, You’re actually an idiot. Look, you’re clearly a woman. You’re clearly going through this. You’re not what you think you are,” he says. “It’s a very oppressive feeling because it’s your own body against you.”

Still, the pills “didn’t make everything okay,” he says. Luke got upset looking at photos of himself before puberty, when his body was “genderless,” what he describes as a blank canvas — when “it could have gone another way, but it didn’t.” He stopped going to gym class. He avoided parties. As his classmates started to look more like adults, Luke oscillated between two states of panic. Sometimes, it was like he was on a train he couldn’t jump off, barreling toward womanhood while knowing he was male. (“Seeing girls my age starting to look very curvy and like women, and knowing I was technically on the same playing field as them, that was really frightening,” he says.) Other times, he felt trapped, unable to move forward without the testosterone he needed.

His experience stands in contrast to that of transgender minors with easier access to hormones. In December, I sat down with Jason (who asked that his name be changed to protect his privacy), a 16-year-old in the U.S. who came out as transgender in the eighth grade. He started on testosterone shortly before his 14th birthday, and at 15, he underwent transmasculine top surgery. He’s now having the high-school experience he imagined. He plays on the boys’ lacrosse team and doesn’t have to worry about taking off his shirt in the locker room; in fact, most of his teammates don’t know he is transgender. Sometimes, “I’ll be at a party talking to a girl, and I’m like, Oh, this is so normal,” he says.

For Luke, the moments of normality arrived rarely, but he did his best to find his comfort zone. Over time, he grew his hair into a proper male shag and replaced the tracksuits with thrift-store finds, silk scarves, and patterned shirts (very ’70s Mick Jagger, though Luke was particularly inspired by Queen). He tried to focus on the positives of his body — that he was lean and not particularly curvy and didn’t have a high voice. It was much harder for transfeminine people stuck in the same waiting process, he suspected. His friend, who was assigned male at birth, couldn’t access blockers or hormones either. Over the span of several months, her voice broke, she shot up to five-foot-ten, and her shoulders broadened. “That is, like, a real dire thing because those few months determine the rest of your life if you are male to female,” says Luke. When he looked at himself, he simply saw a boy who was a late bloomer.

For his GIDS appointment, Luke drove with his mother to the service’s satellite office in Birmingham. It didn’t look like much, just some chairs in an otherwise empty waiting room, but Luke was elated that he was about to see the specialists who could change his life. “We were really excited to be moving forward and talked a lot about how far we had come,” says Luke.

When two GIDS clinicians came in to talk with Luke and his mother, he expected that they’d quickly go through his history and start discussing medical options. Instead, “it was a very kind of vague check,” says Luke. “They were just like, ‘How old are you? How do you feel? When do you feel it?’ ” Most of the questions focused on the past year — if he’d felt more like a girl or a boy, if people treated him like a girl or a boy, if he felt his life would be better as a boy. They ended the meeting by handing him forms to fill out and said he’d need to come in for a total of four to six appointments. Luke soon found himself back in the car, somewhat bewildered, thinking, That’s it?

Unlike the fast-paced care outlined in the Bell report, Luke’s experience with GIDS was maddeningly slow. He wasn’t yet caught up in the consequences of the court fight to come — the delays came instead from an overburdened service and the very thing the Bell report wanted more of: a staff invested in talk therapy, with no rush to prescribe blockers or hormones.

Luke tried to stay positive, telling himself it was a start. Now, there was a clinician on his case and he was moving forward, at least incrementally. “First appointments are often introductory,” he figured. “I’ll come back next week, and we’ll start talking about my treatment.”

It was a couple of months until he was seen again. During the next appointment, Luke and his mother kept saying the same things over and over — that he’d been living as a boy for years and that he’d been interested in gender-affirming hormones for years as well. He already had a gender-dysphoria diagnosis and had been seen by a general practitioner and a mental-health professional. Luke had assumed that because GIDS clinicians were gender specialists, they would read his file, get consent from both Luke and his parents, and move him on to an endocrinologist who could administer the hormones.

By the third appointment, emotions were running high. One of the forms he was told to fill out asked if Luke thought of himself as a hermaphrodite, which he found offensive and outdated. He was similarly upset when a clinician challenged him on why he had never had a romantic relationship. Luke explained that he was too uncomfortable in his body to connect with another person on that level. “I can barely hug my family because it makes me so hyperaware of my body — that’s why I’m here,” Luke, who is bisexual, told her. He says that the clinician pushed back, stating that plenty of transgender teens are in relationships. In the same conversation, the clinician mentioned that Luke had said he sometimes wore eyeliner, and wasn’t that kind of experimental for someone who wanted to be perceived as male? Luke’s frustration grew. “It’s a bit of eyeliner. It’s not that deep.”

“She really had a complete lack of understanding that transgender people are different, not everyone’s the same,” Luke says. “I was saying to her, ‘For me, it’s a very biological thing. For me personally, I could dress in feminine clothes and I would be fine as long as my chest was flat and my hips were narrow.’ And she was like, ‘What? What? You can’t do that.’ ”

The appointment became a turning point for Luke and his mother. Until then, they’d been confident that they were on the path to starting his medical transition. But time was slipping away — by then, Luke had turned 16, the age he’d hoped to start his male puberty. A student in the grade above him at school, who had come out as transgender years after Luke, had paid for private care and was already on hormones. Luke’s younger brother was starting to go through puberty as well. It was as though everyone was passing him.

The real bombshell came in a later appointment, when Luke learned about the mandatory one-year thinking period, during which he’d be on blockers alone. “I was in shock. I was in disbelief. I told them, ‘That’s a whole year of my life that I’m not going to be able to feel. You don’t understand what it’s like,’ ” says Luke. “It was emotional overload.” Eventually, he calmed down. It was 12 more months. He could do this.

Bell’s report found two strong supporters in Susan Evans, who had a short tenure at GIDS in the mid-aughts, and her husband, Marcus, a member of the Tavistock Council of Governors who resigned because he didn’t think the organization was taking Bell’s recommendations seriously. They soon mounted a public campaign to sound alarms about GIDS. In their view, there was not enough evidence to support putting young people on blockers. Doing so, they argued, could push minors toward a medical pathway when they might have otherwise outgrown their dysphoria.

Susan Evans was eventually contacted by the mother of a 15-year-old with autism who was assigned female at birth and was, according to the mother, “desperate to run away from all that made her female.” The mother feared that if seen by GIDS clinicians, her child would be put on puberty blockers. Evans and the mother decided to file a lawsuit against the Tavistock. A decision in their favor had the potential to end gender-affirming medical treatment for minors in the U.K.

As they set out to find expert witnesses for the case, a woman named Keira Bell (no relation to David Bell) came forward. She was a 23-year-old former GIDS patient, assigned female at birth, who had transitioned to male after being assessed at GIDS, then gone back to identifying as female. Soon, Evans and her team asked Keira to become the main claimant named in the lawsuit. (She is the Bell in Bell v. Tavistock.)

Keira’s childhood had been difficult — her parents divorced when she was 5, and her mother, forced to go on welfare, “descended into alcoholism and mental illness,” according to an essay Keira published on the Substack Persuasion. She describes herself as a tomboy, not thinking much about gender until the onset of puberty, when “everything changed for the worse.” She no longer fit in with the boys who were her closest friends but didn’t feel she belonged with the girls, either. “By the time I was 14, I was severely depressed and had given up: I stopped going to school; I stopped going outside,” she wrote. Keira also realized she was attracted to girls.

Keira had her first appointment with GIDS when she was 15, and she says that by the time she got there, she was “adamant that I needed to transition.” After what she describes as “a series of superficial conversations with social workers,” she was put on puberty blockers at age 16 and received her first testosterone shot a year later. Her voice deepened, she grew facial hair, and she changed her name to Quincy. At 20, she had her breasts removed.

Rather than feeling more comfortable with her body, Keira became uneasy, eventually realizing that she was not a man and the gender dysphoria she’d experienced was “a symptom of my overall misery, not its cause.” She blamed GIDS for not more thoroughly evaluating her and for putting her on a path to hormone treatments.

In court, Keira’s lawyer, Jeremy Hyam, argued that people under the age of 18 were incapable of informed consent: They lack the ability to decide if puberty blockers are right for them, and even if they could, GIDS failed to provide adequate information on the drugs and their possible effects. (Hyam did not respond to interview requests on Keira’s behalf.)

On December 1, 2020, three judges ruled in favor of Keira’s claim, agreeing that young people under 16 couldn’t consent to puberty blockers and also that the treatment was “experimental” in nature. After the ruling, the NHS updated its guidelines: Anyone 16 and under in the U.K. could not go on blockers without getting a judge’s approval first.

In their decision, the judges wrote that it was “highly unlikely” a child 13 or under could give informed consent to puberty-blocking treatment and that they were “very doubtful” children 14 or 15 could do so either. The judges seemed particularly skeptical that a child under 16 could understand the way puberty blockers might affect their fertility and sexual functioning.

The medical evidence for the conclusions in the decision, however, is thin. Joshua Safer, an endocrinologist and the director of the Mount Sinai Center for Transgender Medicine and Surgery, says that blockers are not known to affect fertility. If a kid decides to stop, “you’re going to have the same puberty you would have had anyway, just a little later. ” Juanita Hodax, a pediatric endocrinologist and co-director of the Seattle Children’s Gender Clinic, points out that blockers have been used for 40 years for precocious puberty with no effect on fertility and “there’s no reason to think it would be any different in gender-diverse kids.”

The question of sexual functioning is more complicated. Marci Bowers, the incoming president of the World Professional Association for Transgender Health and a well-known gender-affirming surgeon who is herself transgender, says she’s “squarely on the side of blockers,” particularly for transmasculine kids, because if they use them early in puberty, they can halt breast growth and avoid top surgery later. However, she does have concerns when it comes to transfeminine kids and is of the view that they should “allow a little bit of puberty to happen, if they can possibly stand it.” For starters, if a transfeminine child goes on blockers very early in puberty, it can limit the growth of the scrotum and other genital tissue, which can make vaginoplasty more complicated in the future — although certainly not impossible. Also, if those same young people go straight onto estrogen, they may experience challenges having an orgasm later in life.

Bowers’s argument for a more nuanced approach, however, squares poorly with the blanket ban imposed by the court. Susie Green, the CEO of Mermaids, a nonprofit that supports gender-diverse young people and their families, says her phone started ringing almost immediately after the decision was announced. “There was so much confusion, such a lack of clarity around what would happen next,” she says. Green heard from young people who had gotten their first GIDS appointment and thought they could finally go on puberty blockers. “They were just told, ‘That’s not happening now.’ ” Green felt that she had very little hope to offer them. “A lot of parents were talking around, ‘How am I going to keep my kid alive?’ ”

Because Luke had just turned 17, he wasn’t initially affected by the court’s decision: He had been on blockers for more than three months by the time Bell v. Tavistock was announced. He was relieved that he would be able to continue them, but he knew people who were still waiting. Most of them would likely pay for private health care, he believed.

Luke was surprised that Keira Bell’s story had had such an impact; Bell was 16, after all, when she went on blockers — old enough to give consent, according to the court. Had she been going through GIDS now, she would have been eligible for blockers and could have had the same outcome.

Luke had also never felt pushed to transition by anyone at GIDS. If anything, he thought, they were holding him back. “If that was actually happening, I would be as disgusted with it as Keira was,” he says. “You should not be encouraging children to go on hormones when they don’t need them. That’s terrible, because they are going to end up with dysphoria. That’s not what’s happening.”

In August 2021, Luke finally experienced the direct effects of Bell v. Tavistock. That month, his one-year “thinking period” should have ended. But after the court decision, GIDS stopped referring its patients for hormone treatments regardless of age. Luke’s options were limited: He could stay on puberty blockers beyond the one-year mark and continue living with the side effects, or he could go off the blockers, which would cause his body to resume a female puberty.

In the end, he stayed on blockers — less a choice than a necessity. To help with the side effects, his endocrinologist suggested they try reducing the interval between doses. “I’ve been on them for so long I’ve been getting really, really bad pain in my bones, in my muscles, and getting a lot of skin pain,” says Luke. “It’s affecting my sleep.”

In September, an appeals court reversed the initial judgment, ultimately ruling that the court had no place in medical decisions made by patients, their families, and their doctors. A spokesperson for GIDS said that referrals to endocrinology resumed that same month, but patients and activists say in practice the door to medical interventions remained largely shut for months. In that time, says Green, the service was “completely stagnating as far as we can see, and NHS England seem really reluctant to do anything about all of those thousands of young people who are on that waiting list.” Only now, more than a half-year later, are patient groups beginning to see more young people move on to hormone treatments again.

Transrights advocates recently sued the NHS for GIDS’ yearslong waiting period, which is well beyond the 18-week maximum that is supposed to be allowed. Jolyon Maugham, a lawyer and the founder of Good Law Project, says he hopes that the litigation will give ammunition to those in the NHS who “do not subscribe to this view that we must pathologize gender dysphoria.” He envisions a system where many transgender young people could get puberty blockers from their GPs and only complex cases would require seeing a specialist.

Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, who is leading an independent review of GIDS commissioned by NHS, embraced a similar solution in an interim report published in March. Cass called for a new clinical model that doesn’t rely on GIDS alone, instead allowing young people to seek care through a network of regional hubs. The Cass report also criticized the slow pace of the treatment received by patients like Luke, but it has yet to come down on either side of the debate about blockers and hormones.

In the fall, Luke’s GIDS clinician told him that, with his 18th birthday approaching, his best chance for accessing hormones would be to switch to the adult service and be put on the waiting list there. In January, two months after his birthday, he and his mother drove to London for what they thought was going to be another consultation. Instead, Luke learned that he would begin a low dose of testosterone that day. It took a moment for the news to settle in. “You know, when something really good happens, you just feel a bit out of it?” he asks. “That’s kind of how I felt — like I had to have a lie-down. It felt conclusive in a really relaxed, safe, nice, ‘It’s over’ kind of way.’ ” Once home, they celebrated with Champagne.

The physical changes are, so far, subtle; Luke will eventually go on a higher dose of testosterone, which will help him grow facial hair, increase his muscle mass, and deepen his voice. The testosterone has also relieved many of the side effects of the puberty blockers, which he’s still on to suppress his estrogen levels. He has more energy and fewer aches. He’s happier, too. “I think 99 percent of my moods, feeling better, is knowing that I don’t have to go through more of this stuff,” he says.

There is relief in knowing that he will start art school in London this fall with his medical transition under way. He hopes to get top surgery in the next few years and has already started saving for the £8,000 out-of-pocket fee by selling thrift-store finds online. There’s a scenario he has imagined in which he and his new university friends go swimming and someone notices the scars on his chest and asks about them. “I will be like, ‘Oh, I had top surgery, I was born a girl,’ ” he says. “I feel like it needs to be that simple because I don’t want to hide it and I don’t want to make it a big aspect of me.”

Now that he’s on testosterone, it’s surreal to him — even infuriating — that he could have felt this way years ago. He worries about the kids who still don’t have access, the ones stuck on the waiting list for what could be years. On the rare occasion that he gets a hot flash these days, and the familiar feeling of discomfort seeps in before the testosterone recalibrates his body, he thinks of them. “There are people who don’t get through those times of it being uncomfortable,” he says. “There are people who literally don’t survive it.”

How a U.K. Court Battle Held Trans Teens Hostage