Trans Safety Network

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Some thoughts on the Levy Review

On 18 December, NHS England quietly published the report of Dr David Levy’s review of adult gender clinics. The report’s official title is the massively dry Operational and delivery review of NHS adult gender dysphoria clinics in England, but it’s commonly referred to the “Levy Review” within community spaces.

Prior to its publication, there were some concerns about the Levy Review being a sort of Cass Review for adults, leading to further massive restrictions in trans people’s access to healthcare. I witnessed active catastrophising in some quarters, with social media posts calling medication stockpiling. I don’t think this kind of rollback was ever on the cards with Levy, but I do understand why people were concerned. Trans people’s trust in the NHS and political processes is – justifiably – at rock bottom.

There were also a minority who hoped that the Levy Review might result in significant improvements to how trans people are treated by the NHS in England. I don’t think that was ever realistic either.

In reality, Levy does acknowledge some of the problems with English gender clinics, focusing especially on capacity issues, inefficiencies, and long waiting times. It offers a series of recommendations relating largely to the practical operation and delivery of gender services (the hint is in the title!) QueerAF asked me what I thought about it for their coverage of the Levy Review, and I told them this:

“Faced with the sinking Titanic of trans healthcare in England, the Levy Review suggests we rearrange the deckchairs,” Dr Ruth Pearce, a transgender health expert and Senior Lecturer in Community Development at the University of Glasgow, tells QueerAF. Levy's report offers a limited, technocratic response to the ongoing crisis, recommending a range of bureaucratic measures to improve the efficiency of the current system.


These measures may still result in a few improvements. NHS England hope Levy’s recommendations will contribute to “clinical effectiveness, safety, and experience”. I am not entirely convinced. But perhaps the waiting lists can be a bit shorter and fairer, especially with the opening of new clinics and introduction of a national waiting list.

Why is the Levy Review like this?

Levy did not truly seek to understand, let alone confront, the real scope of the problem in trans healthcare services, sticking instead to the very narrow scope of the brief provided by NHS England. Deeper issues he ignored include open discrimination from healthcare practitioners, as well as gatekeeping, pathologisation, and dehumanisation baked into the design of the gender clinics. These all harm patients, while also wasting clinical time and resources.

When I started my PhD on trans healthcare in 2010, such issues were not widely understood outside of certain trans community settings. That is no longer the case.

There have been multiple reviews and consultations undertaken by NHS England over the past 15 years, including in 2012, 2014-2015, and 2017-2019. There was also a review undertaken by the House of Commons Women and Equalities Committee in 2015.

Then there’s the research I undertook for that PhD, later published in my book Understanding Trans Health. Here, I argued that long waiting lists for gender clinics are not simply a result of underfunding or bureaucratic inefficiencies, but also an inevitable outcome of the gatekeeping system. By positioning trans healthcare as a specialist matter, and forcing patients to prove over and over again in psychiatric evaluations that they are “really” trans, you create unnecessary roadblocks and bottlenecks for care.

There have been a lot of other studies undertaken since. The most notable might be the massive, rigorous, and extremely detailed final report of the Integrating Care for Trans Adults (ICTA) project, published in 2024. This was funded by the UK government through the National Institute for Health Research, and has been roundly ignored by NHS England.

There are also a growing number of popular analyses: blog posts, news stories, podcasts, and video essays. One prominent example is I Emailed My Doctor 133 Times: The Crisis In the British Healthcare System, by Philosophy Tube, which has been seen by over 2.5 million people to date.


All this research and commentary highlights those same problems ignored by Levy: discrimination, gatekeeping, pathologisation, and dehumanisation.

My feeling is that neither NHS England nor Levy were interested in these issues. In fact, they are not really interested in understanding trans people at all.

It is therefore no surprise that Levy not only ignores widely-documented problems, but also repeats factually inaccurate claims, such as that the growth in patient demand for gender clinics is “not well understood”. Quite aside from what we have learned from all of the research and commentary noted above, this growth was forecast back in the 2000s by the education and advocacy organisation GIRES, in a study funded by none other than the Home Office.


The really bad stuff (and how to protect your data)

For all the limits of the Levy Review, I feel most of the recommendations are somewhat positive and may help people a bit. On balance, it’s mostly okay.

However, there are a few real points for concern.

Firstly, Levy argues that a first assessment for medical interventions should always be undertake by a psychiatrist or clinical psychologist. As all the research on trans healthcare services has shown time and time again, this is both unnecessary and unhelpful. It compounds the pathologisation of trans people, wrongly positions trans healthcare as a “specialist” matter, and creates expensive bottlenecks for treatment.

Secondly, Levy insists that gender clinic patients should be referred by GPs, and should not be able to self-refer. This is intended to help with the problem of patients ending up on a waiting list with no information for clinical staff on who they are, what they are looking for, and what their healthcare needs might be. However, the recommendation ignores the widespread issue of transphobic GPs refusing to provide referrals, as well as the fact that not everyone will have a GP (see, for example, the fact that trans people disproportionately experience homelessness, or that we are more likely to avoid healthcare providers due to justified fears of abuse). The problem Levy is trying to address could have been tackled in a more sensitive way, for example through NHS England providing a short referral form that prospective patients can fill in when seeking an appointment at a gender clinic.

Finally, there is the issue of future research. Citing Alice Sullivan’s transphobic report on sex and gender, Levy calls for more data collection on patient outcomes. Here Levy fails to acknowledge the urgent need to build trust before trans patients can be confident the NHS will not misuse our data. Moreover, as Trans Safety Network have noted, NHS England have committed to addressing this through expanding the role of the National Research Oversight Board for Children and Young People’s Gender Services. Trans Safety Network report that the board includes members associated with anti-trans medical groups, including the Society for Evidence-Based Medicine (SEGM), who are listed as a hate group by the Southern Poverty Law Center, and CAN-SG. It’s little surprise therefore that the National Research Oversight Board has recommended that clinicians working with young trans people attend SEGM and CAN-SG conferences, ensuring the further spread of transphobic disinformation, pseudoscience, and hate.

Trans Safety Network therefore recommend that trans patients in England opt out of their healthcare data being used for research. They provide the following advice on opting out:

This can be done via the following links, the first to stop GP records being shared and the second to stop secondary care records being shared.

We also suggest you email your GIC the following to ensure your opt-out is clear and ask to have a note of this added to your care record. I do not give my permission for any aspect of my patient data to be submitted to, or collected for, the purpose of any research or non local audit without my express permission in writing being obtained in advance.

Emails should include your name, DOB and NHS Number to assist your GIC admin in finding your record. If you have been referred but not been seen by a GIC, you can still contact the GIC you were referred to.


Could it be better?

The failings of the Levy Review are not inevitable. There are numerous international models of better practice. For a strong example, see the Professional Association for Transgender Health Aotearoa’s 2025 Guidelines for Gender Affirming Care in Aotearoa New Zealand. This recommends treatment under an “informed consent” model. Here is some of their guidance on this for adult patients:

Being transgender is not a mental illness, and it does not impair capacity to consent to treatment. If a doctor or nurse practitioner has sufficient knowledge, skill and professional scope to initiate GAHT [gender-affirming hormone therapy] in an adult patient:

– There is no requirement for all people to be assessed by a mental health professional prior to starting GAHT

– For many transgender adults, GAHT can be initiated in primary care, without the involvement of secondary or tertiary care.

But we need not even look overseas for better. The Welsh Gender Service has seen a growing shift towards the provision of hormone therapy for trans people in primary care settings, supported through close collaboration with community organisations and GP practices. This has proven to provide a better experience for trans patients and has improved the efficiency of the service from an NHS perspective. The ICTA reportdescribes what this looks like in practice.

Case Study 4 in Chapter 4 reports on the establishment and initial development of regional primary care clinics, spread across Wales, which take responsibility for prescribing and monitoring HRT for trans adults following assessment at the specialist gender clinic. This is the most significant initiative we studied to address lack of integration between an assessing gender service and arrangements for prescribing and monitoring HRT. The key features are as follows. Their effectiveness and efficiency would appear to be of wider relevance to other gender services and NHS primary care commissioners.

The regional clinics were largely staffed by GPs, located within established GP practices and funded by the local NHS. They took responsibility for prescribing hormones, monitoring blood tests and titrating doses immediately following assessment, aiming to pass service users on to their usual practice after around 12 months, on the basis that their doses and prescriptions would by then be stable. This arrangement avoids the costly and damaging difficulties in communication between GICs and primary care practices over blood tests and dosage changes, experienced by many people attending other GICs. It also frees up gender specialists to devote more time to assessments, rather than review appointments for people already on hormones. Local clinicians, however, worked in an integrated way with their specialist colleagues, attending joint training on trans health care, and holding regular joint clinical consultations.

Further advantages emerging from this arrangement include the regional clinics rapidly becoming established as having GPs confident in prescribing under shared care with a GIC, whether based on a full GIC assessment or on the basis of a ‘harm reduction’ bridging prescription. These more knowledgeable GPs can then advise and educate colleagues in their own and neighbouring practices. Above all, both service users and GPs involved in these regional clinics were enthusiastic about how they brought HRT for trans people into the mainstream of primary care. Doctors in the regional clinics helped service users deal with a range of health issues, and hormone therapy came to be experienced as part of primary care, rather than something specialised, difficult, or in any way stigmatised.

The Welsh model is still far from perfect. However, it proves that there is no need for NHS England to keep asking the same tired questions and presenting the same tired answers. Yes, we deserve better than the Levy Review: but more importantly, positive change is both realistic and possible.

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Conference report: International Trans Studies Conference, Day 1

REPENT.

The messages greeted me as soon as I left the ancient, rattling commuter train from central Chicago, chalked onto the sidewalk all along Church Street on the walk to my hotel. They seemed oddly out of place in Evanston, a leafy college suburb with an extremely chill vibe; a strange contrast to the low-key cool of the bars and restaurants, and turquoise blue calm of the inconceivably vast Lake Michigan.

At first I misread the final word of every message as “repeat”, as in (for example): “Praise the Lord – repeat”. I thought someone was simply very enthusiastic about sharing their values. “Repent”, however, feels a lot more aggressive and also quite pessimistic, assuming the reader’s guilt and their urgent need to make amends.

I am here for the 2nd International Trans Studies Conference, held at Evanston’s Northwestern University, in the original homelands of the Council of Three Fires (the Ojibwe, Potawatomi, and Odawa peoples). In the opening plenary of the conference, the political scientist Paisley Currah argued that we are living in a crisis moment for trans politics: not because we are necessarily facing more discrimination than ever before, but because more people are paying attention to our existence. Many of these people hope we might repent our trans identities, our gender deviance, our very existence. And yet, here we are, gathering from around the world to discuss trans knowledge and trans ideas, and to imagine trans futures.

Over the course of the conference I am attending numerous talks and meetings across a dizzying array of topics and themes, taking in both theory and evidence from researchers based in the humanities, social studies, and physical sciences. I plan to blog regularly, sharing information I have learned as well as critical reflections on the event. There are literally hundreds of talks taking place over up to 11 simultaneous sessions at any one time, so please do not expect an exhaustive account! Still, I hope these posts will be of interest to people unable to attend the conference, as well as fellow attendees.


The opening plenary: ‘The State of the Post-Discipline’

The conference began on the evening of Wednesday 4th September, with a two-hour opening plenary titled ‘State of the Post-Discipline’, reflecting the official theme of the event. Across four talks, this session aimed to set the tone for the conference and introduce a series of key ideas for consideration in the coming days.

I felt the plenary very much reflected the ambition, the importance, and the limitations of this conference. Each of the speakers emphasised the importance of a materialist approach to trans studies, in which our research can speak helpfully to the reality of people’s lives. This necessarily involves grounding our work in practical examples of trans realities, and understanding our histories in order to better tackle the challenges of the present and future. The speakers were perfectly blunt about the enormous harms that trans people have faced across time and in many places, while maintaining an optimism for how we might productively learn together.

At the same time, it felt strange that together, these four opening commentaries reflected a very limited geographic perspective, with three of the speakers being based in the United States. Similarly, it was disappointing to see just one trans woman on the stage, the Mexican biologist and philosopher Siobhan Guerrero Mc Manus.

This unfortunately reflected the wider dynamics at play within trans studies. As conference organiser TJ Billard noted in their opening comments, trans studies has historically been dominated by US and (to a lesser extent) European voices. Moreover, all four of the field’s major journals are effectively based in the United States. The 2nd “International” Trans Studies Conference is inevitably dominated by US scholars and perspectives, even as there are an impressive range of people present from the rest of the world. I’ve also frequently observed the minoritisation of trans women with trans-oriented conferences and research projects, even given the enormous influence of key figures such as Susan Stryker (who will be speaking in a later plenary) and Sandy Stone.

Nevertheless, the conference couldn’t have found a better opening speaker than queer Indigenous historian and literary scholar Kai Pyle. I have long admired Kai’s written work, so it was exciting to finally see them speak.

North American conferences frequently open with a land acknowledgement, in which organisers and/or invited elders of local Indigenous communities recognise the role of Indigenous peoples as the original stewards of lands taken by settler colonists. However, land acknowledgements rarely offer deeper understanding, let alone any form of reparation for the enormous damage wrought by colonialism.

Pyle themself rightly noted that a single talk could not possible begin to account for the violences and erasures of the past and present, and they observed also relative absence of Indigenous academics from the conference space. They further comments that “although I’m speaking on a panel titled ‘The state of the post-discipline’, I’m barely concerned with the discipline at all”: instead Pyle is concerned with a future where indigenous trans people can live.

Nevetheless, it was powerful to begin the event with a talk specifically about the oppression and resistance of Indigenous peoples in the Great Lake region. Pyle also argued that this history is necessary for properly understanding the history of trans studies itself.

Pyle explained that the lands of the Illinois or Inoka people were first invaded by the French in the 17th Century. Subsequent European accounts and travelogues widely reported the presence of gender roles in Inoka society that did not align with European norms: examples included the leadership of women in agriculture, and genders that could not be easily categorised as female or male. The subsequent projection of European understandings and desires onto Indigenous North American peoples informed early pathological accounts of gender ‘deviance’ as physical and mental sickness, which in turn would inform inform diagnostic categories from the 19th century to the present day. Indigenous people themselves, meanwhile, were subject to immense colonial violence, including coercive conversion to Christianity, removal from their homelands through forced marches such as the Trail of Death, and cultural destruction through the Indian residential school system.

Turning to the early 20th century, Pyle told the story of Ralph Kerwineo, an individual of Potawatomi and Black heritage who successfully ‘passed’ as a man and married two women while living in his ancestral homelands. While Kerwineo might today be understood as a trans man, there is no evidence of any engagement with the traditional gender roles of his people. Pyle noted that this stands as evidence of both enormous alienation but also resistance: Kerwineo successfully lived a gender ‘deviant’ life in the Chicago are a hundred years of attempted elimination of his people.

Finally, Pyle reflected on the emergence of the two spirit movement in the early 1990s, in parallel with the emergence of the contemporary US trans movement, as well as trans studies.

The second talk was by Paisley Currah, who argued for theorising “trans rights without a theory of gender”. He posited that trans studies has been increasingly “stepping aside from just doing theory” over the last decade, as seen for example in the creation of the journal Bulletin of Applied Transgender Studies. In this context we can potentially separate questions of social justice from questions of what sex and gender might actually be.

Currah illustrated this argument with the example of campaigns around sex classification policies in New York City. Attempts to introduce a system of self-declaration in the 2000s and early 2010s were complicated the fact that some city bureaucrats supported the proposed changes, and others opposed them. This was summarised by a legal argument made by the city government: “the existence of difference approaches to similar problems does not render an agency’s rule irrational”.

In this context, Currah argued that sex/gender is in practice a “decision informed by law”, and by the needs and interests of lawmakers. For example, in many jurisdictions it is fairly easy to change a sex/gender marker on a driving license. This is because in practice driving licenses are used by the state primarily for tracking and surveillance, and it is therefore in the state’s interest for the license to reflect what people look like and how they live. By contrast, it has historically often been more difficult to change sex/gender for the purpose of marriage: that is because this would entail a disruption of the heteronormative biological logic for property transfer across generations.

Currah concluded by arguing that when we argue for changes to these policies, the existence and diversity of trans people “is enough”. We exist no matter what your theoretical position on sex or gender, and “a world without us cannot be willed into being”. The focus of policy advocacy should therefore be on what we need to flourish, rather than abstract theorisation.

I found Currah’s arguments extremely helpful and well-framed. However, I was surprised to his insights framed as novel, as the approaches he described feel well-established in the UK. Unlike in the US, materialist approaches have been central to trans studies since the 1980s, in the work of key scholars such as Dave King, Stephen Whittle, and Zowie Davy. Meanwhile, the focus on trans people’s practical needs is embodied in the work of organisations such as Trans Safety Network and Trans Kids Deserve Better, who very intentionally centre questions of harm rather than any theorisation around gender. My own PhD thesis (published in 2016!) and later book Understanding Trans Health deliberately set aside the question of sex/gender to focus on how trans healthcare services operate and are experiences in practice. The feminist philosopher Katharine Jenkins has done important work on how what is important about gender varies according to context, and the legal scholar Chris Dietz has extensively considered questions of governmentality in terms of how and why differing aspects of trans people’s lives are managed by different agencies of on the behalf of healthcare systems and the state.

I make this point not to try and undermine Currah or big up UK trans academia specifically. Rather, I want to note how this kind of awareness of what is already being done in different parts of the world highlights why a truly international approach to trans studies is so vital.     

The next talk was by Siobhan Guerrero Mc Manus. Unfortunately I – and many other attendees – missed much of her talk due to an apparent failure by the translation company hired to support the conference. This was an enormous pity given what I did catch felt extremely important, and built on the critiques of Currah that were bubbling away in my brain during his talk.

Guerro Mc Manus emphasised the importance of organising across borders, with the example of taking successful trans liberation strategies from Mexico, adapting these in a Colombian context, and then again in Peru. Conversely, she described the example of how work on reforming the criminal code in Colombia informed trans activism in Mexico. In this kind of organising and exchange of ideas, reflections from the Global South might be combined with insights from the North, without simply reproducing Global North theory in a way that is not necessarily applicable to countries such as Mexico.

I wish I had heard more of these presentation! I feel the International Trans Conference’s investment in both live translators and translation through transcription software is an incredibly important move, and should set the tone for future events in the field (or “post-discipline”, if you prefer). At the same time, it is important to get this right lest non-Anglophone perspectives are further marginalised through technical error. While I just missed large parts of this one talk, attendees who were not fluent in English may have missed much more from the other speakers. I definitely felt for the organisers, speakers, and fellow attendees, and hope these problems will spur future work to further improve our communication across languages and borders.

The plenary closed with a short address from TJ Billard. Billard explained how the choice of conference theme was informed by the “first” International Trans Studies Conference, which took place in Arizona in 2016, “riding the high of the transgender tipping point” just months before the election of Donald Trump. An enormous amount has changed in the last eight years, and the time is ripe for a re-appraisal.

Billard’s use of the term “post-discipline” draws on the work of John David Brewer. Brewer describes post-discipline thinking as knowledge about a phenomena that is detached from disciplinary allegiances, instead emphasising theoretical and methodological pluralism, political investments, and ethical values.

The emphasis is therefore less on academic siloing, and more on real problems facing contemporary society.  This couldn’t be more appropriate for trans studies, especially in the context of the insights shared by the other speakers.


Some final thoughts

The first “day” of the conference was really just an evening: the opening plenary, plus a reception where the in-person attendees got to spend time meeting and catching up with one another (some of the most important academic work!) I am finishing this monster post at the end of the second day of the conference, a true marathon which ran from 8:30am (when registration opened) to 9pm (when a reception and 10th anniversary celebration hosted by the journal Transgender Studies Quarterly theoretically wrapped up). It’s difficult to capture the sheer scope of this event: indeed, this series of posts can only possibly touch upon the vast amount of knowledge and information we are discussing at the conference.

For all that I (and others) have shared several critiques, I am hugely grateful this event is happening, and feel very privileged to attend in person. I couldn’t be happier to be a gender deviant, and hope to repeat the value-based work of resistance over and over.

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RCGP host conversion therapy conference in London – protest 23 March

On Saturday 23 March the Clinical Advisory Network on Sex and Gender (CAN-SG) are hosting at conference at 30 Euston Square, the headquarters of the Royal College of General Practitioners. CAN-SG are described by Trans Safety Network as “an organisation composed mainly of activists involved in the pseudoscience network SEGM, and the anti-trans conversion therapy campaigning body Genspect“.

A noise demonstration will be held outside the conference venue from 10am on 23 March, hosted by Transgender Action Block, Lesbians and Gays Support The Migrants, and The Dyke Project.

Protest poster, which reads as follows. Noise demo against Royal College of GPs conversion therapy conference. 30 Euston Square, March 23rd, 10am, 2024. Get loud, get angry against institutionalised abuse. No parasan. Full youth autonomy now. No cops, no SWP, no Tories.



According to the Memorandum of Understanding on Conversion Therapy, an agreement signed by 40 leading professional bodies and healthcare providers, conversion therapy “is an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis”. Conversion therapy has been described as a form of torture in academic work and by UN experts.

The CAN-SG event speaker lineup is a who’s who of conversion therapy proponents and anti-trans activists, including:

  • Stelley O’Malley, founder and director of Genspect, who has described seeking to suppress the gender identity of teenagers in her therapeutic work, adding: “I don’t think you should have empathy or sympathy” for young trans girls.
  • Michael Biggs, an anti-trans campaigner linked to a prolific troll account on Twitter.
  • Richard Byng, a member of anti-trans pseudoscience network SEGM.
  • Rachel Cashman, a campaigner against trans inclusion in schools, and supporter of Women’s Declaration International (WDI). Under their former name of Women’s Human Rights Campaign, WDI have openly called for the “elimination […] of the practice of transgenderism”.
  • Az Hakeem, a member of Genspect and an active opponent of a proposed legal ban on conversion therapy. Hakeem was reported for conversion therapy to the GMC by a former patient.
  • Anne Hutchinson, who has promoted materials by Genspect in training for South London and Maudsley NHS Mental Health Trust.
  • Riittakerttu Kaltiala, a Finnish clinician and opponent of affirmative care who contributed evidence for Florida’s ban on medical transition for young trans people. I have not found any evidence that Kaltiala opposed Finland’s policy of forced sterilisation as a condition of legal recognition for trans people, which was repealed only last year, but am willing to be corrected on this. According to a recent academic biography, Kaltiala sits on the advisor board of the Cass Review.

The Royal College of General Practitioners (RCGP) are signatories of the Memorandum of Understanding on Conversion Therapy. Signatories agree that conversion therapy is “unethical and potentially harmful”, and commit to ending this practice in the UK.

Following complaints from LGBTIQ+ groups and their own members, the Royal College of General Practitioners (RCGP) released a statement saying that the conversion therapy conference would go ahead. In the statement, they argue that their headquarters building, 30 Euston Square, is “an event space run by an independent events company”. However, the statement opens by saying that the RCGP has “reached the decision that the Clinical Advisory Network on Sex and Gender (CAN-SG) conference can go ahead”, and later adds that “the College would be at risk of being faced with a claim for breaching the Equality Act if we acted otherwise”. This implies that the RCGP do, in fact, have control over their own building, and have taken the active decision not to oppose the conference.

Legal threats are increasingly common from anti-trans campaigners, who argue that cancelling contracts or events constitutes an attack on their “gender critical” views as “protected beliefs”. The CAN-SG conference has been widely reported as a gender critical event, and indeed several of the speakers appear to describe themselves as “gender critical”. However, the issue with the event is not the beliefs of the speakers or organisers in and of themselves. It is that they are actively promoting disinformation and harmful practices.

The RCGP’s position is therefore one of gross cowardice, and demonstrates that they are not actually committed to preventing harm against trans people in healthcare settings. It costs the RCGP very little to sign a document claiming that they oppose conversion therapy, or condemn the UK government for failing to introduce a legal ban. However, now that the fight against conversion therapy has come to their door, they are not prepared to act.

It is within the power the RCGP to ensure that the CAN-SG conversion therapy is cancelled. They have chosen not to do this. It is within the power of the RCGP to oppose CAN-SG in court, if it came to that. They have chosen not to.

This reflects the same failures we have seen from bodies including NHS England and the Cass Review. I am often asked why trans people do not trust doctors. This is why. We are failed by medical professions over and over again.

Change happens not because powerful organisations allow it, but because ordinary people fight for it. A true commitment to ending conversion therapy can be seen not in the actions of RCGP, but in the work of groups like Transgender Action Block, Lesbians and Gays Support The Migrants, and The Dyke Project. I am also hugely grateful to grassroots organisations such as Trans Safety Network, Health Liberation Now, and Gender Analysis for gathering a lot of the information I collated in this post.

That power also potentially lies with you. Trans support groups and harm reduction networks for people self-medicating can be found across the UK, and will always benefit from your support. And you can complain to the RCGP here.