For those looking to explore their gender identity and medically transition, the wait time for an initial appointment at an NHS gender clinic has now reached close to five years.

The largest gender identity clinic in London is only just offering appointments to those who were initially referred in December 2017, and according to a trans-activist from Medway this is "unviable" and is amplifying existing mental health issues for young transgender people.

Campaigner Hilary Cooke

At the beginning of this year there were 10,981 people on the waiting list for the Gender Identity Clinic in South Hampstead, the oldest and largest gender clinic in the country commissioned by the NHS.

It received a total of 293 referrals this January, but was only able to offer 38 people a first appointment and those offered an initial appointment would've been on the waiting list for close to five years.

The Gender Clinic Identity website addresses the "high demand" and "very long" waiting times which is attributed to a rise in referrals in recent years.

It says: "We are collectively working with the other clinics and our commissioner, NHS England, to find meaningful solutions to address waiting times.

"We are doing all we can to see patients as quickly as possible and are currently actively recruiting more staff to our clinic."

Hilary Cooke, from the Medway Pride Community Organisation believes this long wait could be particularly damaging for young transgender people and those looking to explore their gender identity.

She said: "The main issue for the community is access to health care.

"The problem with the access is that it has been compounded over the decades with lack of funding and lack of training for medical staff who have found themselves in positions where they don't feel they've got the necessary skills to be sure that they're doing the right things.

"It's had a very pathologizing care pathway, where you have to navigate through psychologists and psychiatrists to be able to access the care you require."

In recent decades, medical and social terminology surrounding gender has changed - with gender dysphoria being officially recognised for the first time in the 2013 Diagnostic Manual which is used by mental health practitioners in the United States.

However, in the UK, the current diagnosis is Gender Incongruence which is a sexual health condition recognised by the World Health Organisation in ICD11.

Hilary would like to see a gender-affirmative model of delivery, including social, psychological, behavioural and medical interventions delivered by multi-disciplinary teams via GPs - she believes this would cut down the demand on specialist clinics and reduce waiting lists to access treatment.

In 1967, homosexuality was legalised in the UK and Hilary remembers a lot of people feeling safe to express who they truly were.

She explained: "Younger people, especially the under 25s, are feeling more aware of themselves, more aware of the spectrum of identity and how they fit in.

"And they have their language, which is constantly developing."

That was until the Section 28 amendment came into force in 1988 which stated that a local authority shall not "promote the teaching in any maintained school of the acceptability of homosexuality as a pretended family relationship" - this wasn't removed in England until 2003, and since then more young people have once again been able to feel safe to reveal their true identities.

However, with rising demand creating a backlog in the system and lengthy waiting times, Hilary fears this will have an impact on the mental health of young people preparing to transition, especially during puberty.

She said: "Within the trans community, there's a greater level of mental health issues.

"The mental health problems can be caused by societal family rejection, and discrimination and fear, which leads to anxiety in going out and clinical depression.

"And if that's not treated, you can end up with people who self harm or then have suicidal thoughts.

"But all those conditions can be avoided if the individual is given the support they need at the beginning, and feel comfortable that they can talk about how they feel in a more affirmative rather than pathologizing regime of treatment and care, and then those associated mental health issues would generally go away."

She is also concerned that by having treatment delayed by up to five years, for those who already feel uncomfortable in their own body, it can create a dangerous culture of seeking other ways to transition without proper advice and medical care.

Ms Cooke added: "This has forced people to look for other ways to access healthcare.

"Those people in a position where they can afford to go private, are trying to find private routes to see the gender care specialists and there's very few of them in the UK, so some people travel abroad.

"For people who also can't afford those routes, they unfortunately seek self-medication and try and just buy the drugs, the hormones, the testosterone they need, all over the internet.

"Then you risk problems when you don't know what you're buying."

Hilary believes that the best way to avoid people going to such drastic measures is by offering early intervention through further funding of NHS gender clinics.

She said: "Breast development or facial hair development, voice breaking, all of those changes that make them even more uncomfortable with their bodies, could be prevented with early access to treatments such as puberty blockers.

"And that process then means your development is in line with how your gender identity is, and you don't suffer from the problems of going through the wrong puberty.

"You don't need to have lots of hair removal, you don't have to have as much surgery.

"So as well as it being good for the individual, it's saving money, both for mental health and in physical procedures - early intervention is needed."

NHS England have been approached for a comment.