Transitioning Teens: Charlie Craggs on the NHS Crisis in Gender-Affirming Surgery for Trans Youth

New BBC documentary centres the voices of the trans youth impacted by the trans healthcare crisis in England and injects a much-needed factual narrative into the ongoing ‘debate’ around the rights and lives of trans people.

ILLUSTRATION Bee Illustrates

“People should be more focussed on what happens if young trans people don’t get medical intervention. We’re talking about the ‘long-term side effects of being on hormones or hormone blockers’. Why are we not talking about the long-term side effects of not being on them? Because guess what? There is no long-term without them”, says Charlie Craggs in her new documentary, Transitioning Teens.

Released on the BBC in August 2021, this 40-minute feature sees trans activist and author, Charlie Craggs, speaking directly with trans youth across England who are waiting to be seen by the NHS gender clinics. With research indicating that more than one in four (27 per cent) trans young people have attempted to commit suicide and nine in ten (89 per cent) have thought about it, access to gender-affirming healthcare is a matter of life and death for many. Yet, trans youth are often – at best – ignored by the mainstream UK media or – at worst – presented as the brainwashed victims of a manufactured ‘trans lobby’. 

Trampled upon by ill-informed individuals and caught up in a ‘debate’ they never agreed to be a part of, it’s rare that the voices of trans youth are centred and amplified. But it’s their experiences that we must listen to in order to know how best to support the next generation of marginalised individuals – how the future of LGBTQ+ advocacy and institutional change must look.

As the documentary lays out, according to The Care Quality Commission 2021, there are over 4,500 under-17s on waiting lists for NHS Gender Identity Clinics just in England – there are only two Tavistock clinics for under-17s in London and Leeds. And the current waiting times for a first appointment are three to five years, despite the NHS website stating that the maximum wait should be expected to be 18 weeks from referral. Within the context of this damning failure by the very systems put in place to protect the public, trans youth are being driven to desperate measures simply to feel safe and happy in their own bodies.

The stories of these young people, including 19-year-olds Jess – who has been buying unregulated hormones with her student loan after waiting 24 months for a first appointment – and Felix – who is crowdfunding for private surgery in Poland after spending four years on the NHS waiting list – as well as the thoughts of an anonymous young person who de-transitioned and those of several healthcare professionals, shape the narrative of this powerful documentary that cuts through the noise, opting instead to simply lay out the facts surrounding this muddied issue.

In order to explore the topics covered by Transitioning Teens deeper, I spoke with Charlie Craggs about her intentions, opinions, and experiences.

Charlie Craggs in BBC ‘Transitioning Teens’

Prishita: Why did you decide to make this documentary? What’s the importance of putting this out there in the world for you?

Charlie: I’ve been campaigning for eight years now, but I’ve seen the conversation shift in bizarre ways especially over the last five years. When I was commissioned to make this documentary, the new stick that they [transphobes] were beating our community with was around trans young people and trans teenagers. I was seeing this ‘debate’ where trans youth were being constantly talked about, but never talked to. So, I wanted to travel around the country and meet the teenagers who are at the heart of this ‘debate’ to get the truth. 

Not only was I a trans teenager once, but I also know just how different the lived experience of these young people is from what the media are saying. The media makes it out like they go to the GP on Monday and by the weekend they’ve had surgery. They use the word ‘rush’ all the time, and also use words like kids and children. It has created a moral panic. I just wanted to show the public the truth, and I feel like this documentary has done exactly that.

Prishita: Yes, definitely – it’s so important to centre the voices of those that are being talked about, and you’ve done that here. Aside from the differences in the speed at which the process happens, are there any other things that you hope people will take away from this documentary?

Charlie: The first piece of press that was done around the documentary was by The Daily Mail – which was basically a smear campaign – and the headline was ‘New BBC Three documentary ‘DIY Trans Teens’ reveals how children can buy sex-change drugs’. The use of the word ‘children’ is imperative here because it implies that they’re too young and too naive to know what they’re doing. It implies that they shouldn’t be given autonomy because they can’t consent. But, in the UK, you have to be 18 to have any surgery, and 16 to access hormones – and this is only if you’re lucky enough to have supportive parents who take you to the GP, and if you’ve already been waiting in the system for four or five years. 

It’s bizarre because if you look at the other conversations society or the media are having – around mental health, for example – they use words like ‘young people’ and ‘youth’, not ‘children’. At the same time, you can join the army and get married at 16 in this country, and you can drink, smoke, and gamble at 18 – you can make all these potentially life-changing decisions at the same age. But god forbid you go on a hormone that’s going to make you grow breasts!

This documentary had to be very impartial because it’s for the BBC – I had to include both sides and even topics that I wouldn’t necessarily want to talk about, like detransitioning. So I hope it offers a respite from the hearsay and just communicates the facts to those people who don’t hate trans people – they probably don’t even know any – but are open to learning more.

Prishita: I completely agree! And it’s amazing that you did include the perspective of someone who had detransitioned, and it seemed like the conversation was rather a positive one. It was so important that you concluded the documentary by talking about how the focus should be on the fact that all young people – who are experiencing body dysmorphia or are gender diverse – need appropriate mental health support, regardless of what the next steps that they take might be. How do you think that we bring this conversation into the mainstream? And how do you think that we overcome this pervasive idea that deransitioners can be pitted against trans people and be used as an example for why young trans people shouldn’t get the support they need?

Charlie: Watching the documentary is a good start! I wasn’t expecting it, but it has presented an argument that I’ve never seen anywhere else: that trans people and detransitioners essentially want the same thing – more intervention. As you mentioned, it’s not about saying: “People might change their mind, so let’s just stop it for everyone.” No, instead we should be saying: “We need to increase intervention to catch the 1% who might change their mind, but also for the 99% who are suicidal while they’re waiting.”

It’s a similar conversation as with abortions. It’s ridiculous to suggest that nobody should have access to abortions because a tiny percent of people regret it, so why would you apply this idea to trans healthcare? This perspective changes the game because it gives transphobes no leg to stand on. The stick that has been used to beat trans people is no longer valid – detransitioners agree with us that we need more intervention. This is really important.

The stick that has been used to beat trans people is no longer valid – detransitioners agree with us that we need more intervention. This is really important.

Charlie Craggs

Prishita: Yeah, I completely agree. And similar to abortions, whether or not that healthcare is accessible, people are going to seek it out regardless, and they might do so in more dangerous ways. For example, Jess, whom you spoke with in the documentary, has been buying and using unregulated hormones. That’s definitely stuck with me. Could you please talk a little bit about the circumstances and experiences that lead young trans people to go down this route?

Charlie: I definitely considered it myself when I started transitioning aged 20. You’re so desperate in every single way – your body is not right, and now you’re at the last stage where you have a grasp on changing it. Time is ticking. You feel physically sick – you don’t want to live anymore if you have to look in the mirror and hate yourself. And then, when you finally come out, you go to a GP and you’re told you have to wait five years. You have no other choice but to try and source other ways of accessing healthcare – whether it’s private or unregulated. I heard horror stories so never went down the unregulated route myself – I had the privilege of only having a two-and-a-half-years wait for my first appointment at the gender clinic. But now trans youth are having to wait for double that – I don’t think I could have waited five years.

If no one is helping you, you just have to help yourself. The fact that there are these communities in online forums made up of hundreds of people shows just how bad the situation is. There’s an underground railroad of people who are having to be their own endocrinologists aged 18. They have to understand and monitor their own hormone levels, blood levels, when they should just be focusing on their A levels or degree. Jess, for example, is spending her student loan for textbooks on hormones, and it’s just so sad. I’m actually going to be selling some prints through my Instagram, and all proceeds will be going to the young people in my documentary.

Prishita: That’s a lovely idea. And what would you say to people who claim that these forums are causing more harm than good because they’re “enabling young people to use unregulated hormones”?

Charlie: I would say to put yourself into the situation – let’s take trans out of it – and maybe apply it to something like abortion, for example. As you said, even if it wasn’t legal, people would still try to access it. Making abortion legal just means that people can access it in a safer way, and we don’t lose lives needlessly because of unsafe abortions. We see it in so many different arguments – whether it’s to do with abortion or sex work, or even drugs. It’s the same premise. Making it illegal or inaccessible doesn’t stop it from happening. It only makes it more dangerous for those who are forced into shady transactions.

Making it illegal or inaccessible doesn’t stop it from happening. It only makes it more dangerous for those who are forced into shady transactions.

Charlie Craggs

Prishita: 100% – more information is never a bad thing, especially if it’s helping people be safe. If you’re not receiving the systemic support you need, then it’s obviously better that you have access to an informed community rather than being completely alone. 

Charlie: While I was doing the documentary, I also found out that doctors are legally prohibited from helping a young person who is self-medicating. They’re not allowed to give guidance on safe suppliers or drugs, or healthy blood levels. It’s also reminiscent of Section 28, where teachers were banned from talking about homosexuality. So, even good doctors who want to help cannot do so in the UK. And that’s just so wrong. It makes you question the moral fibre of this country that they’re willingly encouraging doctors to turn their backs on young people who need help.

Prishita: It’s really terrible – it goes against everything that good care practice is supposed to stand for. There’s also a section in a documentary where you talk about how trans and gender non-conforming people seek surgery because they want to blend in and be safe. There is a common argument from transphobes that by seeking surgery, trans people, especially trans women, are perpetuating patriarchal beauty standards and binary gender roles. What are your thoughts on this, and how do we combat it by actually talking about the fact that it’s about safety more than anything else, and that trans people should be able to express themselves however they feel is most authentic?

Charlie: I was going to add to your point and say that I’ve spent tens of thousands of pounds on surgery as a way to feel safe and also more like myself.  But, you know what, even after this surgery, I’m still clocked and I still get laughed at constantly. I haven’t experienced violence in a long time, but at the start of my transition that was very much my life. Every time I left the house, I would say a prayer. It’s so unkind and privileged of these people to say that it’s all about being sexy. It must be nice if that’s how you can think, but it couldn’t be further from the truth.

I don’t even want to grace their ignorance with an answer. I don’t think I should have to defend myself – it’s just so offensive. I would love to say to them: “If being trans is all about looking sexy, then would you want to be trans? If it’s all about tricking straight men into having sex with us and being ‘pornified women’, would you want to walk down the street as a trans woman and have to live our lives? No, you would not.”

Prishita: Thank you for sharing that. It’s obviously just awful and small-minded, and, as you said, it shows the privilege of people who can boil the trans experience down to aesthetics and ignore the layers of difficulty and trauma that often accompany it. 

So, we’re talking about stereotypical gendered expectations on how we should look, and I think this also creeps into the queer community. There are mainstream expectations of what trans people or non binary people should look like, and I know I’ve personally felt as a non-binary person that I need to be more adrogynous to be valid in my identity. As a teenager, you’re only just starting to come to terms with these expectations, and this can contribute to body dysmorphia and lead to eating disorders. How do you think that we simultaneously break down these societal expectations on what people should look and still provide trans teenagers with the support they need to feel comfortable in their bodies? Because I think it’s so important to do both.

Charlie: Yeah, that’s really hard. It’s such a deep-rooted issue that you need to tackle it in a plethora of ways. One way, for example, is just increased and diversified representation of different types of bodies. Even now, we’ve got so far to go with trans representation, because I can count on one hand famous trans people in the mainstream media. If you look at any community that has fought for representation, the initial wave is going to be made up of those who are most palatable to the white cishet palette. But more diverse representation of different types of transness and non-binary bodies – like fat trans people, older trans people, etc. – would help young people see that there are so many different ways to be trans.

Linking back to your last questions, it’d be really interesting to see the effects that this might have on things like surgery. Maybe the next generation of trans people will be more comfortable in their pre-facial feminisation surgery (FFS) features. There’s a whole generation before us who weren’t lucky enough to have access to it, but my generation of trans girls have all had FFS. We’ve carved away the masculine bones in our face to make them more feminine so that we blend in. I wonder if trans people get this deeper, diverse representation in the future, whether people will start to feel more comfortable in their bodies. If you look at bottom surgery, for example, the old school trans girls all had it done without question. But my generation are asking ourselves: “Do I actually want this? Who am I doing this for?” Maybe, in the future, we’ll get to a point where people will become more comfortable with unique non-gendered beauty, and even forgo facial surgery, which is something that everyone sees.

I believe that the reason the media and the healthcare system in this country treat trans people so badly is because they know they can get away with it. We’re such a small community – we make up 1% of the population – and, until recently, we haven’t had a voice.

Charlie Craggs

Prishita: Yeah, I completely get that. Representation and education around the fact that people of any gender can look any way and still be themselves would bring wider acceptance and safety for all. Shon Faye gave an interview after her book, The Transgender Issue, was published, where she said that she doesn’t think people would have gender dysphoria if gender wasn’t a thing. It definitely ruffled some feathers, but I think it makes a lot of sense, and aligns with what you’re saying here. So, how would you personally like to see healthcare for young trans people change over the next decade?

Charlie: I personally don’t know what’s achievable – I don’t want to be depressing, but what we need is actual institutional reform and I don’t know if I see that happening. So, for now, I would just hope that we don’t have to wait half a decade for a first appointment. Now that this conversation is getting bigger and more people who aren’t trans are getting involved with it, I think things might start to change. Personally, I believe that the reason the media and the healthcare system in this country treat trans people so badly is because they know they can get away with it. We’re such a small community – we make up 1% of the population – and, until recently, we haven’t had a voice. But now allies are joining the conversation. There are even a few cases now of people taking the NHS to court because they’ve had to wait five years for an appointment.

Prishita: Yes, and you also discuss that a little in your documentary. It’s so great to see increased awareness and allyship – I really do hope that it drives change. Finally, if you could say something to you as a teenager, what would you say?

Charlie: The first thing I’d say is: “Bitch, you’re trans. You need to transition – hurry up!” For a long time, I didn’t know I was trans because I didn’t even know I could be trans – even though it was so obvious. I just didn’t have a word for it. And I’d say: “Start saving your pocket money now because you’re going to need that when you’re trying to get surgery so you don’t get beaten up for being trans. But you can do it – if anyone can, you can. You’re a strong woman who has come from a long line of strong women. And you’re also going to help other people.”

Prishita Maheshwari-Aplin
Prishita Maheshwari-Aplin

Our Politics Editor, Prishita (they/them) is a writer, editor, and LGBTQ+ community organiser. They’re currently a Trustee with Voices4 London and sit on the Advisory Board for Split Banana, a social enterprise redesigning relationship and sex-ed by bringing in the perspectives of groups traditionally excluded from the curriculum. Prishita has been published or featured in METAL, gal-dem, Hunger, and Dazed, amongst others. They also featured in ‘Soul of a Movement’, a film by British creative directors Carson McColl and Gareth Pugh that documents some of the British LGBTQ+ activists, artists and allies carrying the revolutionary fire of the Stonewall Uprising today.
Prishita‘s writing is represented by The Good Literary Agency, and they’re also a signed model and social human with CRUMB.