Welsh Tories call for inquiry into Welsh Gender Service

Martin Shipton

The Welsh Conservatives have called for a full independent review into the Welsh Gender Service following concerns about the fact that it refers between three and four times the number of people for irreversible gender surgery than the UK average.

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

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

He states: “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.

“2025 was not an exceptional year. In 2024, WGS referred 234 women for MCS. The minimum confirmed number of UK referrals was 1158. In 2024 Wales therefore accounted for 20.2% of all UK NHS surgery referrals. According to population size against the total number of UK referrals that year, the number referred in Wales should have been around 53.

“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.

“Some would say the WGS is leading the way in helping trans people assuage their dysphoria on the NHS by removing women’s breasts and attaching tubes of skin and fat to their genitals while fashioning men’s facsimile vaginas. Others might be concerned that the NHS in Wales is referring too many vulnerable people for unnecessary irreversible surgeries on healthy body tissue without taking steps to properly consider the alternatives.

“Which is it then? We don’t know. No one knows. According to documents I have seen, in July 2024, the NHS Wales Joint Commissioning Committee decided to undertake an independent review of WGS. In September 2024 the Director of Mental Health and Vulnerable Groups within NHS Wales was appointed Executive Lead for the WGS review. It was confirmed the WGS review would be overseen by a ‘Clinical Expert Group’.

“In February 2025, the Director of Mental Health and Vulnerable Groups resigned his post. NHS Wales committed to setting up the WGS review by the end of the year.

“In September 2025 NHS Wales said it had got as far as making ‘initial enquiries with potential members’ for its review panel. In November 2025 it confirmed it was in the process of ‘developing a scope’ for the WGS review panel. By January 2026 the scope had not been finalised as NHS Wales were ‘incorporating’ the outcome of the Levy review into adult gender services, which was published in Dec 2025.

“By March of this year NHS Wales had still not produced a scope for the WGS review and did not have a date for when the review would commence.”

‘Extremely concerning’

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

She states: “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?”

The Cabinet Secretary’s response is awaited.