NHS probes Welsh Gender Service following concerns about high number of referrals

Martin Shipton

NHS Wales is investigating the Welsh Gender Service following the recent revelation that it refers between three and four times the number of people for irreversible gender-related surgery than the UK average.

A report to be considered by NHS Wales’ Quality, Safety and Outcomes Sub-Committee on Monday August 24 states that the service “is currently under consideration as a potential Service of Concern, reflecting issues identified through ongoing review and assurance processes. These include higher rates of surgical referral than seen in comparable services.

“Given the significance of the emerging concerns, enhanced governance and oversight arrangements are being considered ahead of completion of the independent review of adult gender services in Wales.

“The independent review of the adult Welsh gender service comprises both quality and clinical governance elements. The review will focus primarily on assessment, referral and non-surgical aspects of the pathway, while considering relevant pathway interfaces and engaging key stakeholders, including health boards, partner organisations, patients and carers.

“In parallel, NHS England is undertaking a review of gender surgery services, expected to report in 2027.”

In June Nation.Cymru reported how the Welsh Conservatives had called for a full independent review into the Welsh Gender Service following concerns about the high incidence of people being referred for irreversible gender surgery.

Clinicians working for the WGS, based in Cardiff’s St Davids Hospital, also decide whether or not it is appropriate to put people claiming a trans identity on potentially life-changing hormones.

Freedom of Information requests

Freelance journalist Neil Wallis wrote an article on his Gender Blog after making a series of requests under the Freedom of Information Act.

He stated: “Over the last three years the WGS has seen around 800 patients a year. The average age of those patients is 26. The crucial question is how many of those patients are recommended for cross-sex hormones after one or more appointments.

“Astonishingly, Cardiff and Vale University Health Board tells me ‘this information is not centrally recorded or collated’. The WGS doesn’t know what percentage of its intake it sends to the NHS’ Local Gender Teams (run by individual health boards) around Wales for endocrine assessment and hormone prescription.

“Cardiff and Vale University Health Board, which appears to be responsible for WGS, did give me some figures from March 2023 to Dec 2024, which suggested that throughout that period the monthly conversion rate from initial appointment to hormone plan varied between 51% and 88% of patients, though it did also say the data ‘was manually tracked and entered and so cannot be assumed to be 100% reliable’.

“More concerning, perhaps, is the rate at which WGS refers its patients for irreversible gender surgeries. In 2025 the WGS said under FOI it referred 207 patients for what the NHS calls “Masculinising Chest Surgery” – an umbrella term for the various methods of breast removal and plastic surgery techniques aimed at achieving a facsimile of a male-looking chest.

“The minimum confirmed number of referrals for the whole of the UK in 2025 was 1275. Working off the minimum number, Wales accounted for 16.2% of all UK MCS NHS referrals (or 16% working off the maximum number), despite only having 4.6% of the UK population. Put another way, in 2025 while the WGS was sending 207 women for Masculinising Chest Surgery, across the whole of Scotland in 2025 the confirmed minimum number was 120, yet the population of Wales is 3.19m and the population of Scotland is 5.6m.

“The average percentages for what is euphemistically known as ‘bottom surgery’ are broadly similar. WGS referred an average of 156 men a year for Feminising Genital Surgery in 2024 and 2025 against a minimum average of 837 [across the UK]. That’s 18.6% of all NHS referrals with just 4.6% of the population. Over the same two years WGS referred an average of 51 women a year for Masculinising Genital Surgery against a UK minimum average of 398 people per year, bringing it in at 12.8%.

“Across all three types of surgery in 2024 and 2025, the WGS referred between three and four times the number of people per head of population than the UK as a whole.”

Concern

Natasha Asghar, the Welsh Conservatives’ health spokesperson at the Senedd, wrote to Mabon ap Gwynfor, the Cabinet Secretary for Health and Social Care expressing concern about the revelations.

She stated: “I am writing to you today following an extremely concerning news article about the Welsh Gender Service.

“The main areas of concern are: 1. Information relating to the number of patients being recommended for cross-sex hormones is seemingly not collected. 2. Figures suggest the clinic is referring between three and four times the number of people for irreversible gender surgeries than the UK average. 3. The service was referred for an independent review in 2024, yet it appears as though this has yet to begin.

“These revelations are incredibly concerning and, in my view, warrant a closer inspection. To that end, will you commit to launching a full independent review into the service’s practices and leadership as a matter of urgency?”

Aligned

A spokesperson for Cardiff and Vale University Health Board, told Nation.Cymru: “The NHS Wales Joint Commissioning Committee (NWJCC) is currently reviewing the Welsh Gender Service to ensure it remains aligned with the latest evidence, national guidance and service provision across the UK. As part of this process, independent experts are being commissioned to assess the service against recommendations from the NHS England review of adult gender services and identify any areas for improvement. The review is expected to conclude by the end of 2026, with recommendations to follow in 2027.

“Concerns have been identified through the NWJCC’s routine review and assurance processes, and it is actively considering these matters through established governance arrangements, including the next Quality, Safety and Outcomes Committee meeting on 24 August 2026. The Health Board is committed to working with the NWJCC and partners to ensure we continue to provide safe, effective, and high quality care for the population through the Welsh Gender Service.”

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