"Grasping on a spider web of hope": Psychological challenges and impact of waiting to access UK gender dysphoria Clinics on young adults.

Background: Young transgender adults report higher levels of mental health difficulties compared to the general population. These difficulties reportedly improve following gender-affirming care and transition. However, gender-dysphoric people wait up to 5+ years in the UK to access gender-affirming treatment. Aims: The study aimed to qualitatively explore the psychological challenges and impact of waiting to access UK Gender Dysphoria Clinics (GDCs) for young trans adults. Methods: Recruitment via two GDCs resulted in a sample of 10 participants (aged 17-26) who had been waiting at least 12 months for assessment. Qualitative semi-structured interviews were conducted online or by phone with four men, four women, and two gender nonconforming people. Data were analyzed through Interpretive Phenomenological Analysis (IPA). Results: Challenges and impact of waiting were represented within eight themes. Five psychosocial challenges included "Grasping on a spider web of hope that's about to snap," "People are uneducated and they don't understand," "Society or whatever made me second guess myself," "I'm too autistic for that shit', and "It sounded like the phone was just being left all day every day." Mental health impacts of waiting were captured in the themes "(Gender) Dysphoria attacks" and "If it doesn't go well by 30, I'm gonna kill myself." A final theme, "I'm going to just go on with me life," focused on healthy and less-adaptive coping strategies. Conclusion: Waiting to access GDCs is a fragile and vulnerable time; experiences of discrimination, stigma, transphobia, and uncertainty during the waiting period appear to increase feelings of hopelessness and diminish mental health. Focusing on social transitioning was reported by most participants as a coping strategy for waiting. Findings highlight the importance of reducing waiting times for GDCs and offering psychosocial support during the wait.