Trans masculine bottom surgery is currently unavailable in the whole of the UK. (Envato Elements)
Trans masculine bottom surgery is currently unavailable in the UK for NHS patients.
The operation, called phalloplasty, is the surgical creation of an artificial penis that will be sought by some trans men and trans masculine people as part of their medical transition.
Gender-affirming surgeries like bottom surgery are an internationally recognised treatment for alleviating the symptoms of gender dysphoria, and are known to significantly improve quality of life and mental health of trans patients.
Phalloplasty is deemed an elective surgery, which means operations were suspended during the COVID-19 pandemic as hospital resources were diverted to coronavirus patients. If not funded by the NHS, a phalloplasty is estimated to cost between £40,000 and £70,000 in the UK.
Health secretary Matt Hancock announced on 27 April that elective surgeries could resume the following day, due to the decline in coronavirus-related hospital admissions and deaths.
But despite Hancock’s announcement, the only UK provider of phalloplasty, in London, has not resumed operations and does not have a date for when bottom surgeries will restart.
This is because St Peters, which is a Harley Street centre that does not own hospital facilities, had not secured a contract by April 2021 with a hospital site from which its surgeons could carry out procedures.
PinkNews understands that until this situation is resolved, NHS gender clinics have suspended patient referrals for trans masculine bottom surgery.
In the meantime, the £32.9 million NHS England contract for “Genital Surgery (Trans Masculine)” that St Peters won in 2019 has been re-tendered, with the NHS now seeking bids from other providers to carry out the surgery.
PinkNews understands that NHS commissioners are working urgently to secure a new provider so that trans masculine bottom surgeries can resume.
St Peters won the 2019 contract against zero competition – it was the only provider that bid to provide trans NHS patients with phalloplasty. The contract St Peters won, which covered trans NHS patients in England, Scotland and Wales, saw it promise to deliver phalloplasties until 2027.
The 2019 bid won by St Peters to provide trans masculine bottom surgery was part of a €107.1 million tender put out by the NHS for gender dysphoria surgical services. Three health clinics secured contracts to provide lower surgery for trans women and trans femmes on the NHS, five contracts were given out for masculinising chest surgery, and one for trans masculine bottom surgery.
Because of the open tendering process that is underway, St Peters Andrology Centre was unable to comment directly on the situation but shared a 13 May statement that its three surgeons – Nim Christopher, David Ralph and Philip Rubin – prepared to address concerns from worried patients.
“We understand that there is a good deal of speculation on social media about current contract negotiations and do understand the anxiety that this will be causing our patients,” the statement says.
It continues: “It had been suggested to us that we would enhance our service by centralising it on a single site and on exploring this option it was clear that it would enable us to increase our surgical capacity as well as improving the patient experience with a more joined-up service.
“This required renegotiation of existing hospital contracts but regrettably that process could not be concluded in time. NHS commissioners felt that this required them to reopen the procurement process for the provision of male genital surgery.
“Commissioners have stated that they do not anticipate that the process will cause undue delays to resumption of operating following COVID and what we have seen of the process supports that view. We share their belief that expanding the available providers of the service would be a fantastic outcome for patients.
“Even before COVID, the major problem was a shortage of operating capacity but more choice for patients would be welcome for its own sake in any case.”
The first analysis of the long-term effect of hormone therapy and gender-affirming surgery on trans people’s mental health was published in 2019 in medical journal American Journal of Psychiatry.
Researchers at Yale University used 10 years of medical data and concluded that trans people who undergo gender-affirming surgery are significantly less likely to seek mental health treatment than trans people who don’t access gender-affirming surgery.
NHS England was contacted for comment.