Exclusive | TL;DR: Questions are being raised over the evidence behind NHS Wales's decision to cancel surgeries for Welsh Gender Service patients, who tell QueerAF of their 'absolute devastation' on having surgeries cancelled at the last minute. One patient was in a hospital bed ready for top surgery when the decision to ban surgeries was implemented.
"We were 20 miles out and had travelled a very long way, paid thousands in travel costs and accommodation to make sure I'd be free and available, and I'd arranged time away from work.
"As we were driving, I received a phone call from the clinic where I was meant to get the surgery. My appointment had been cancelled."
Chloe* is one of up to 800 trans patients of the Welsh Gender Service who, as QueerAF revealed last week, received news that a long-awaited procedure – in her case, bottom surgery – was being cancelled.
Many of the cancellations were last minute, and all came out of the blue. Chloe was on her way to have surgery when she got the call, while others were already in hospital when their surgeries were cancelled. In some cases, Trans+ patients had already been through pre-operative checks with their surgeon and anaesthetist when the surgery was put on hold.
"The nurse [who called] was very lovely, and very apologetic, but there was nothing she could do," Chloe recalls. "I feel absolutely devastated by all this. My whole life has been on pause as I work on getting this sorted and at the last possible moment it feels like it's been wrenched away without warning, or appeal."
All gender-affirming surgeries for Welsh Gender Service (WGS) patients were cancelled on 28 August, after concerns were raised – first by a gender-critical blogger, then by a Welsh Tory, and finally by NHS Wales's Joint Commissioning Committee (NWJCC) – over claims that the gender clinic is allegedly referring patients for surgery faster than gender clinics in England and Scotland - QueerAF
Surgeries and pre-operative assessments for patients at Wales' only trans clinic are to remain on hold while the WGS is reviewed. The Welsh First Minister, Rhun ap Iorwerth, said this week that this must happen swiftly.
"What I want is that we get a resolution quickly," he told a BBC Radio Wales phone-in on September 3. "We have to take a step back from that as the clinicians look for those answers."
Ap Iorwerth also set out to affirm that Plaid Cymru "is very supportive of the LGBTQ+ community" - BBC News
This follows a statement by Plaid MS Matthew Jones, who said: "So what if Welsh gender affirming care referrals are higher than the rest of the UK? All this says to me is that Wales has been the last bastion of dignity and compassion against the snowballing transphobic rhetoric from the right wing media and unqualified commentators." - Instagram
More than half of Plaid Cymru members of the Senedd signed a letter this week, led by Jones, to Ian Green, chair of the NWJCC, expressing "profound disappointment at the abrupt pausing of planned operations".
"What evidence informs this decision?" the MSs ask. "Was any risk assessment carried out regarding the impact of cancelling treatment at such short notice? If not, why?" - Cwiar Cymru
Another WGS patient, Rey, was scheduled to have top surgery last week. They had travelled to the hospital in Wales, and on the morning of the surgery all the pre-operative checks were carried out and the surgical plan discussed with the anaesthetist.
But at the scheduled time, the surgery did not take place. After hours of waiting, Rey was told by their surgeon that their procedure wouldn’t go ahead due to the WGS investigation.
Rey – who had prepared extensively for the surgery by fasting, stopping prescribed medications, organising accommodation, travel, and time off work for their partner – was discharged.
They spent the next few days trying to process the information they had been given. They described being “wired, frantic, and unable to sleep”.
Rey's experience was contained in a briefing sent this week to members of the Senedd by TransActual, seen exclusively by QueerAF.
TransActual describe the cancellations as "irresponsible interference" that fit into "a long pattern of construing transition-related care as inherently harmful, and attacking services that are successful at addressing the trans healthcare crisis with unsubstantiated allegations of ‘rushing’ patients into surgery."
Members of the Senedd were urged to call on NHS Wales to reinstate surgeries immediately, and to demand clarity from chief executive Jacqueline Totterdell and the Welsh Cabinet Minister for health and social care, Mabon ap Gwynfor MS, over what sources of information led to the decision to cancel surgeries.
"It’s rare that much needed medical care is stopped completely during an investigation, particularly if no specific safety issues have been raised," Chay Brown, director of healthcare at TransActual, told QueerAF.
"I’ve seen no evidence so far that any risk assessment has taken place in relation to this decision and have seen nothing to suggest that any patients have been harmed by their referral for surgery by the Welsh Gender Service – and certainly there has been no harm of the nature that would justify stopping surgeries for all Welsh patients," he said.
What we know about referral rates
Another patient, Robyn, was first referred to an NHS gender clinic in September 2022. She had her first appointment in January 2024, her first surgical referral appointment in August 2024, the second in October 2024, and finally had her initial consultation in April 2026. She was due to have lower surgery this month.
All in, this means that Robyn went through four years of appointments, waits, referrals and diagnoses before she was able to get the surgery she needed. In terms of waiting times for NHS trans healthcare, Robyn was one of the lucky ones.
A week after her surgery was cancelled, Robyn says she is still in shock. "I can't quite believe that this is real," she tells QueerAF. "I have to keep my mind off of it by staying busy, thankfully I've had so many friends and family reach out and my partner has been very supportive.
"I had friends who had booked time off work to come see me in hospital, I'm now making plans with them to keep busy over the time I would have been in hospital."
Despite the four years it took for Robyn to nearly access gender-affirming surgery, the reason given so far for it being cancelled is "concerns" that the Welsh Gender Service has "higher rates of surgical referral" than NHS gender clinics in the rest of the UK.
Yet no additional detail of these concerns, or why they led to the cancellation of all surgeries, has been provided to date.
At a meeting of NHS Wales's Joint Commissioning Committee (NWJCC) on 24 August, the WGS was described as being “under consideration as a potential Service of Concern” due to “higher rates of surgical referral than seen in comparable services in England and concerns regarding referral appropriateness”.
That day, the WGS was placed into "Level 3 Escalation".
"Level 3 escalation is a formal NHS improvement and assurance process," the Cardiff and Vale University Health Board, which runs the WGS, said in a statement on 3 September. "It means that concerns have been identified which require increased oversight, monitoring and improvement action." - NHS Wales
Claire Prosho, a Trans+ healthcare researcher who worked on the Gender Clinic Files investigative series with QueerAF and What The Trans?!, raised question marks about the claim of higher rates of surgical referral in Wales in a letter she sent on August 29 to Mabon ap Gwynfor, the Welsh minister for health and social care.
"I highlighted how, using accurate data gathered for the UK Gender Services Monitor, coupled with other data gathered by Freedom of Information Act requests, the surgical referral rate for the Welsh Gender Service was actually lower than that in England," Prosho tells QueerAF. "And far below the '3x - 4x national referral rate' claimed by Nick Wallis and the right-wing media."
"Almost a week later I have received no reply from the Welsh Government, and I don’t believe they are taking this issue with the seriousness it requires," she said.
After TransActual's briefing, QueerAF understands that Senedd members and the Welsh Health Minister wrote to the NWJCC with their concerns, highlighting the significant impact the decision to pause surgery has made.
In the meantime, some patients have been contacted by their surgical team advising them to apply to the Cardiff and the Vale University Health Board for financial reimbursement to cover the costs of the cancellations.
So far, there have been no signs that the decision will be reversed. And, as Chloe says, "even if they reverse this and I can get my surgery, I feel my trust in the NHS is irreversibly shaken."
Like many other trans patients, Chloe had been waiting years for her lower surgery. In that time she's "done everything asked of me by the NHS", she says. "Every hoop I've needed to jump through I've done it. I'm an adult who is making an informed decision."
"I'm very upset and hurt right now. I've been angry and sad and I've not slept very well. I'm just very tired, I thought I was at the end of this process and now it feels like I'm trapped in limbo," Chloe adds.
"I've been on the waiting list for gender care for so long that there wasn't even a Welsh Gender Clinic when I started."
*Name changed to protect the privacy of this trans individual.
Analysis: Questions without answers on why this has happened
Pressing questions remain about how the decision to cancel these surgeries was made and, crucially, the evidence it was based on. The decision was – and I don't say this lightly, having been reporting on Trans+ healthcare in the UK since 2018 – unprecedented in its ruthlessness.
The ban on gender-affirming surgeries for Trans+ patients in Wales led me to recall the legal victory, 30 years ago, which forced NHS health boards to properly and consistently fund Trans+ surgeries - QueerAF
The final verdict came in 1998. Three women (known only as A, D and G) had brought legal action against the North West Lancashire Health Authority for refusing to pay for their gender reassignment surgeries. They won, and NHS health boards in England and Wales were obliged to fund Trans+ healthcare in a way that they hadn’t been before - Press for Change
It's a historical glimmer of hope that reminds us that even as healthcare institutions fail us, there are those who are already jumping in to fight back. This week, we’ve seen a monumental response with activists, organisations and people who care jumping into action to see that this pause is just that, and overturned quickly. This story is far from over.
This bears repeating.
Our investigation into the UK's gender clinic system was backed by dozens of FOIs, excruciatingly fact-checked, published while abiding by our strict independent press regulation rules about accuracy and seen by more than a million of you - and that's before we count the reach of the many outlets that carried the story.
The investigation provided a far more accurate picture of the system than the then health secretary, Wes Streeting, had.
It was referenced in Parliament, in the Scottish election campaign and by international figures.
No change was made, and neither the Government nor the NHS responded.
One blog, self-published by a gender-critical freelance journalist - cited by one Tory member of the Senedd in Wales - last week led to the withdrawal of care for potentially hundreds of Trans+ adults.
It speaks volumes of how much the systems are stacked against our community. That's why we need a long term plan to change the media, and the country.
We are here every week while that work continues, filling the gap left by the mainstream media - reporting on LGBTQIA+ news with justice. But we're more than just a publisher.
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