The Experience of Waiting for Gender Affirming Care in England: emotions, temporality and coping.

Waiting times for initial appointment for gender-affirming healthcare services in England can be seven years (NHS, 2023a). Months pass between follow-up appointments and subsequent care, falling well outside NHS standards. This thesis examines the emotional and temporal consequences of this protracted waiting, and coping mechanisms used by patients to approach and manage this time. In order to investigate these issues, the study adopted a mixed qualitative methodology of semi-structured interviews, diaries, and ethnography with 26 trans identified people living in England. The analysis of the data revealed that waiting for gender-affirming care is a depressing, anxious time for many who experience distortions of time perception that are detrimental to their emotional and social wellbeing. The many coping strategies showed some well-thought-out methods of managing lengthy waiting experiences. Active strategies to progress through transition, or at least give the illusion of it, appear in the form of supplementary gender-affirming clothes, obtained hormones, or social affirmation. More private and solitary strategies of emotional release also offer relief from the difficult waiting experience. The majority of participants also use trans social media as an information source and found comfort from others in knowing that their experience is shared. The findings of thesis contribute to studies of waiting time in healthcare, queer temporality literature, minority coping theory, and community social media use. Also importantly, this study sheds light on how trans people function - together and alone – in the context of the difficulties of waiting for gender-affirming care. It shows community is an invaluable source of care in the absence of timely medically sanctioned treatment. This thesis recommends an informed consent approach to trans healthcare be implemented in England and further afield, with hormone replacement therapy available from primary care, removing the burden of waiting from the trans community.