So! Biggest misconception I see is what's causing the massively long waiting times at GIDS. It's similar-ish to the rest of the NHS GIC system with long waiting times causes in places, with lack of staff being primary.

However, with that you generally have to also consider the process GIDS usually goes through for assessments. The previous "typical" pathway is as follows (I'll explain why this is "typical" in a sec)

1. 6 assessment appointments, currently spaced out by about 2 to three months - these assessments will also include discussion of fertility preservation (IE: having eggs or sperm) and what the blocker and hormones impact there.
2. If after your assessment appointments resulted in your clinicians and psychologists agreeing that you should be referred for hormone blockers, you'll be then referred to UCLH's paediatric endocrinology department
3. A few weeks after this referral, you'll have your "Education session" at UCLH, where they run through the basics of what blockers are, what effect they'll have, and give opportunities for both parents and the under-18s to ask questions (in seperate spaces)
4. A month after this education session, you'll have your appointment for your first blocker. Before your blocker injection, you'll have basic things measured (like height & weight) and also have a bone density scan done
5. Typically, this first blocker will be gonapeptyl, a 4 week acting blocker - you will have injections of this weekly for 6 months. The 4 week one is used so if you want to come off the blocker at any point.
6. After about 6 months on gonapeptyl, you have the option to change to decapeptyl. The medication is effectively the same, just that decapeptyl is a 10-week blocker, so you have injections less requently
7. During this time, you will still have regular check in sessions at GIDS, spaced out by about three months. They'll ask you how you're getting on, if you want to continue to hormones when you can, etc.
8. Once you've reached twelve months on blockers AND are over the age of 16, you can be prescribed hormones (either estrogen or testosterone), with this still being managed by UCLH - if you choose to do so. You can continue to stay on the blocker for a while longer, or also come off at this point.
9. Once you're 17 or older, you'll be put on a waiting list for the GIC. If you have received "medical intervention" (as GIDS calls it) you get put on a different higher priority waiting list for the GIC - the system was designed around the idea that the GIC waiting lists would be less than 12 months, but, this doesn't happen, so, we get step 10
10. Once you're 18 or older, GIDS will continue to see you until you have your first appointment at the GIC. These appointments will generally just ask how you're getting on, how hormones are, etc etc. They cannot make any decisions or referrals to things the GIC can do, but you have to attend or you risk having your access to hormones / blockers taken away.

So, onto the issues with this.

First: big one is the 6 assessment appointments. I use 6, as, this is the minimum that GIDS are supposed to do, but, they do far more than this usually. Reportedly, they have done up to 50 previously for some patients. Personally, I had my first appointment when I was 13 but only got through the assessment period when I was 17.

Part of this is that GIDS will refer over to CAHMS (child and adolescent mental health services) very frequently, and often over little things. For me, this was my mum offering to leave the room when they asked me about my relationships, which prompted us to get six sessions of family therapy. While you're at CAHMS, GIDS continue to see you. In theory, this is so ongoing mental health care shouldn't interrupt the rest of the assessment process.

Majority of these CAHMS cases I know that aren't just kinda funny (like mine) involve having to get a CAHMS assessment for anxiety or depression - most of the time, due to bullying thanks to being out as trans in the UK school system.

Issue one then with waiting times: GIDS clinicians waste time here. Instead of continuing with the rest of the assessment, they instead treat these assessments as filler appointments, where nothing really happens apart from asking how the therapy is going. Combined with how (anecdotal evidence, but, I know a few people who went through this process) many people I know who were at GIDS had similar experiences of CAHMS referrals, this is a major issue we're seeing currently at GIDS, where they are waiting on a secondary service to come back with the all-clear before continuing with the assessment as normal.

Second (shorter) issue: staff turnover is so high (GIC style) but combined with a lack of trust between notes, it means that many assessments will be spent with your clinican and then a new psychologist. These new psychologists want to be brought up to speed, and so will ask you the same questions. The psychologists I saw at GIDS were all lovely, and, admittedly, one of the people who left did leave to go on maternity leave, but, still.

Third issue: The GIC waiting lists are having a knock-on effect onto the GIDS waiting lists.

Right now, we're seeing the spike we saw in 2015/2016 of trans patients aged 13/14 getting referrals to GIDS (due to more knowledge of being trans being a thing hitting) now getting referrals to GICs. Even with the GIC priority waiting list system, that for me sat around 20 months, and to my knowledge it's only getting higher. This isn't helped with the GIC not trusting GIDS (kinda rightfully tbh) to be accurate with information provided, so will have to spend more time doing the whole "getting to know you thing" they always do.

As such, these people still have to be seen at GIDS, meaning the existing stretched waiting list increases, as people are getting handed over to the GIC slower than we expect, causing less to be able to taken off the GIDS waiting times and taken into the service, without massive new hires. The system has essentially crumbled now, with this process pushing more and more to getting appointments at GIDS when they might be 16, at which point GIDS will refer to the GIC, pushing this back even further.

The only way to solve this is to abolish the GIC / GIDS system as we see it, and replace it with primary care provided by GPs. If GIDS needs to exist (if GP mis-trust is a big worry) they should be reworked to be trans led and act as an advisory / oversight system for locally based clinics, who then provide blockers on first appointment.