Background

In recent years, the United Kingdom (UK) has witnessed an alarming surge in transphobic policy and discourse. As clinician-researchers, public health practitioners, and grassroots activists, we felt compelled to respond to what we increasingly recognised as a real-time public health crisis. Our article, “Transphobia in the United Kingdom: a public health crisis,” is a call to action informed by a synthesis of the mounting evidence that trans, non-binary, and gender diverse (TGD) people in the UK are experiencing increasing disparities in healthcare access and health outcomes related to their marginalisation.

Transphobia as a multi-level threat

We approached the issue through a socio-ecological lens, identifying three nested systems of transphobic hostility:

• Macrosystem: National policies and legal decisions that restrict TGD rights, such as the UK Government’s unprecedented action to block Scotland’s Gender Recognition Reform Bill, and the 2025 Supreme Court ruling which mischaracterises “sex” as a binary and immutable characteristic
• Mesosystem: Press and social media environments amplify misinformation and dehumanising narratives about TGD individuals
• Microsystem: Interpersonal discrimination and violence, including a 200% rise in police-reported transphobic hate crimes since 2018.

These layers interact to create a hostile environment that marginalises TGD people, compromising their physical and mental health.

The Health Consequences of Transphobia

Our review of the literature and national data highlights stark and persistent health inequalities. TGD people in the UK face significant barriers to both general and gender-affirming healthcare, alongside increased rates of morbidity across a range of conditions and elevated mortality. They are also more likely to engage in health-related behaviours that carry risk, such as substance use. These disparities are not random—they are the foreseeable outcomes of structural inequities across the wider determinants of health, compounded by exposure to stigma. Minority stress frameworks help explain these patterns, linking stigma to poorer health via chronic psychological and physiological stress responses to discrimination.

One of the most alarming findings we highlight is the inadequacy of access to gender-affirming care. Waiting times for adult gender identity clinics now exceed four years, with a system that lacks the capacity for the UK TGD population. Recent policy changes have prohibited access to puberty blockers and restricted access to hormone therapy for young people. Coroner reports have linked lack of access to gender-affirming care with suicides among young TGD people.

Moreover, TGD people are often erased from health research and routine clinical data collection, making it difficult to fully understand or address the scope of these disparities. This erasure is both a symptom and a driver of systemic neglect.

What needs to change

We argue that addressing this crisis requires a coordinated, multi-sectoral response. Our recommendations include:

• Advocacy: Public health professionals must speak out against transphobic policies and support inclusive legislation
• Workplace Protections: Employers, especially in the public sector, should implement policies that affirm and protect TGD staff
• Research Reform: Funders and institutions must prioritise TGD health research and ensure inclusive data practices
• Community Investment: Public health teams should partner with LGBTQ+ organisations to co-produce services and interventions
• Education: Anti-trans stigma must be addressed through evidence-based educational initiatives, including in healthcare training
• Policy Change: The Equality Act should be amended to better protect TGD people, and the Gender Recognition Act should be demedicalised and expanded to include non-binary identities.

Looking Ahead

We hope this paper will serve as a resource for policymakers, clinicians, researchers, and advocates who are committed to health equity. Most importantly, we hope it affirms the experiences of TGD people and underscores the urgency of action.

The health and human rights of TGD people and all minoritised communities are a collective responsibility. We must act now.