Thousands of trans people are turning to crowdfunding websites to help pay for treatment. Claudia Williams investigates a kind – if complicated – digital community
A few months ago, a notification popped up on Nathan Williams’s phone. He glanced at it absent-mindedly, mid-conversation, and did a double-take. Someone had donated £100 to a crowdfunding page that Nathan, who is trans, was using to raise money to pay for his transition. It was the biggest donation he’d ever received.
The money came from a woman he hadn’t spoken to since they were in school 12 years ago – and even then they were only vaguely friends. He couldn’t stop checking his phone to make sure it was real. He sent an emotional thank you, but heard nothing back.
A few months later, it happened a second time: the same woman, the same amount. He sat down and sobbed for 20 minutes.
Nathan, who is 28 years old and a graphic designer based in the south west of England, is one of an increasing number of trans and gender nonconforming people in the UK using crowdfunding sites like GoFundMe or JustGiving to raise money in order to transition, a social and medical process some trans people go through to live in the gender they identify as.
According to GoFundMe, one of the world’s largest crowdfunding websites, UK fundraisers using keywords associated with trans-related issues have risen by 36 per cent this year, compared to the same period in 2019. The coronavirus pandemic has made a noticeable difference: there was an almost 32 per cent rise in crowdfunders using the same key terms between April and June compared to the three months prior. There are currently thousands of trans crowdfunders live on GoFundMe’s site alone, covering a whole range of subjects: from access to private doctors and gender-affirming surgeries, to specialist therapies and funds to escape abusive environments.
This rise in digital fundraising reflects complex problems in the delivery of care and support for trans people more broadly – a problem clearly made worse in a pandemic. In the UK, long delays in NHS healthcare in particular means many trans people are filling the widening gaps themselves, creating an alternative ecosystem of financial and community networks that include mutual aid groups, digital forums, and communal fundraising pots.
Many of the practical reasons that make trans crowdfunders necessary – marginalisation, difficulty accessing medical services, a high risk of financial vulnerability and homelessness – have fuelled the creation of online communities that play a vital role. The sense of solidarity that they engender, as well as their offline impact, can be powerful for people who feel they have nowhere else to turn. And at a time in the UK when the conversation around trans rights has become increasingly toxic, and hate crimes against trans people have risen by 16 per cent, this kind of digital community is important.
But crowdfunding is a means of taking control that is still entirely reliant on the actions of others, with its own dangers and disappointments. It is also the clear result of structural problems that won’t be eliminated without a change in the delivery of trans healthcare in the UK.
Nathan set up his crowdfunder in 2018 after finding out that the waiting list for an appointment at his nearest Gender Dysphoria Clinic was 18 months long. That appointment, usually the result of a GP referral, is the first rung on a long ladder – and a series of waiting lists – for trans people who want to transition via the NHS. A gender dysphoria diagnosis, which can take several appointments, is required before starting hormone therapy, and a trans person must have socially transitioned for at least a year before a GDC will refer them to the waiting list for gender surgery. According to NHS England guidelines the wait between first referral and first definitive treatment should be 18 weeks.
Currently, without a gender dysphoria diagnosis trans people cannot apply for a Gender Recognition Certificate and legally change their gender, which some people argue adds to the strain on the healthcare system. The proposed reform of the 2004 Gender Recognition Act, in September ruled out by the government, could have de-medicalised this process.
Gender identity services in the UK were overwhelmed long before the pandemic. According to BBC research published in January 2020, there has been a 40 per cent increase in referrals to NHS England over the past four years, and there are more than 13,500 trans and non-binary adults on waiting lists in England alone. At the Northern Region Gender Dysphoria Service, run by the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, the current waiting time for a first appointment is in excess of 32 months. The overall waiting time from first referral to actually starting treatment, last updated in August 2020, is 62 months.
Average wait times from referral to initial appointment currently reported on the websites of NHS England Gender Dysphoria Clinic
Over two-and-a-half years after being told that his initial appointment would take 18 months, Nathan, who struggles with depression and self harm, is still on the same NHS waiting list. It’s only thanks to the £950 he has raised through his crowdfunder that he has been able to see a private specialist and have the assessments that have allowed him to begin taking testosterone. It doesn’t “solve the entire issue”, he says, “but it definitely alleviates” his gender dysphoria.
Nathan is not alone. “I would be surprised if I went a day without seeing a handful of new crowdsourcing funds being shared to my feed, both from friends and from people who I’ve never met before,” says Emma Underwood, the Trans Programme Officer for the LGBT Foundation, a national charity based in Manchester. She is concerned about the implications of young trans people turning to the internet to get medical support. “It’s really worrying that’s where people are having to turn to get the healthcare treatment that they need.”
She is keen to counter the narrative that hormones or surgeries are simply cosmetic luxuries. They are “life saving” and necessary forms of healthcare, she says, “that have an enormous impact on people’s health, both mental and physical. […] These crowdfunders are not fun. Nobody wants to prostrate themselves in front of an audience to get sympathy.”
Amy, who is in her 20s and is based in England, recently set up a crowdfund to help pay for her private doctors appointments and testosterone blocker injections, which cost £90 each month. Despite working full time, she is struggling to keep up financially. She emphasises that for most people, crowdfunding is a last resort. “I feel as if I owe everyone who’s donated the world, but I don’t for a second feel good about any of it,” she says. “I honestly feel a lot of shame about asking for money like this.”
There’s also a level of skepticism that comes with the territory: the assumption that people asking for money on the internet are scammers. Amy would ideally like to share updates about her situation with her funders for the sake of transparency but the shame weighs on her heavily and she doesn’t know if she will feel comfortable doing so. Her worry hints at the uneasy and unspoken contract many crowdfunders find themselves troubling over: what, if anything, do you owe people who have given you money?
Some feel compelled to upload personal details like receipts, regular life updates or medical information, raising questions about privacy and safety for a community that already faces disproportionate abuse and violence. Trans people in England and Wales are more than twice as likely to be victims of crime when compared to cisgender people (whose gender identity matches the sex they were assigned at birth). Last year a report into the scale of transphobic abuse online found that 12 per cent of Twitter posts relating to trans people were abusive. It was worse on news websites, at 19 per cent; on YouTube a staggering 78 per cent. Trans people of colour are even more at risk: in the UK, politics and race were the main drivers of transphobic abuse.
And there are other more urgent health concerns, too. “A lot of people take their hormone [therapy] into their own hands: they buy them off the internet and they read their bloods themselves – or they don’t,” Underwood explains. Regular blood testing is an important part of safe hormone intake and skipping it is dangerous. She believes that current barriers to NHS healthcare services are “putting people’s health at risk”. Crowdfunding for money to pay for consultations and early procedures may sit at one end of a spectrum in which trans people must look online for all medical resources, and may not always choose the safest options. “It concerns me that people are having to resort to that,” Underwood says.
Phoenix Andrews, a writer and researcher who specialises in internet culture, gets direct messages on Twitter containing trans crowdfunders most days. “If you’re a trans person or trans ally who has a [social media] post that does well, you will get a shit tonne of DMs and/or replies from small follower accounts with their crowdfunding details,” Andrews, who uses they/them pronouns, says.
The idea is that even if you don’t donate directly, you can “signal boost” the crowdfunder and increase its chances of reaching a wide audience of people who might. Signal boosting is increasingly a part of the digital toolkit: a few years ago when a post went viral on Twitter, budding rappers would link their soundcloud music page below in an attempt to capitalise on this moment of fame. Now you’re as likely to see a string of links to crowdfunders (for any number of causes) as you are a personal promotion: from cards detailing donation options for movements like Black Lives Matter to specific, individual funds for hospital bills in the US or animal rights charities.
But signal boosting can be deceptive. It’s easy to find trans crowdfunders that have been shared or liked hundreds of times, often by large accounts, yet their cash totals remain low. Some platforms are better than others. Instagram is widely seen as the most difficult to source donations, whereas a recent Wired article highlighted the number of teenagers opting to crowdfund on TikTok because of its effective use of hashtagging.
“It’s a platform that is less reliant on you having a following than other platforms,” Andrews explains. But in their experience reaching lots of people on TikTok “doesn’t seem to translate, for the most part, into any actual extra donations”. Nathan’s crowdfund was shared by a friend with a large Tumblr following: despite lots of attention, it only brought in one payment. The £955 he has raised since 2018 is a long way off the target he set of £15,000.
Of the thousands of these funds doing the rounds online, few “have the narrative that breaks through,” Andrews says. In their experience, “a long [written] piece and a photo generally does better,” and it helps to include “traumatic” details. Crowdfunding does not exist in a world separate from society’s biases: “I’m not going to lie, if somebody is ‘hot’, they definitely do better.”
And as with so much on the internet, it’s the success stories that are the most widely seen: like Vitoria Mario, whose university fees were paid by pop star Taylor Swift, or Noah Adams, a 20-year-old trans YouTuber who crowdfunded his top surgery. These stories can make the whole thing seem more hopeful than it really is. In fact, Andrews contends that most of the crowdfunding efforts that have received tens of thousands of pounds are by people who have pre-existing online connections or proximity to people with cash and clout.
Most crowdfunders receive much smaller amounts. “There’s a common line that in the trans community we are always just passing around the same tenner,” says Andrews. A study of trans crowdfunding efforts in the US published in 2019 found that on average, campaigns received about 25 per cent of their target amount. The disappointment can be crushing.
Luca Jimenez de Laiglesia, a 27 year-old currently living in London, found the crowdfunding process incredibly stressful. He set up the page in December 2018 to help pay for private top surgery, scheduled for February 2019. Although it gained traction at the start, by the time the operation came around he had raised less than half of his £6,000 goal.
He found it emotionally exhausting to be so public about something he had spent his whole life feeling ashamed of. He felt exposed, and not reaching his target felt like a rejection. People he was previously close to questioned the morality of using crowdfunding to pay for his treatment, which was painful to hear, and played into fears he already had of asking other people for money. “I felt embarrassed,” he explains, “or like I didn’t have the confidence to do it.”
He was eventually able to fund the surgery by using a small amount of money left to him after his dad died, and borrowing the rest from family. Nearly two years since he set up his crowdfunder, he is overwhelmingly grateful for the generosity of the people who did donate. “For all those years you’ve kept that secret and it’s been so heavy. And then all these people are just telling you that they see you, that they accept you. It’s a pretty amazing experience.”
The majority of donors were people he had some form of connection to already, which is the reality of many trans crowdfunding efforts: for those who have them, donations often flow from supportive friends and family and work colleagues – more so than strangers.
In this sense, crowdfunds can be joyful, life-affirming and life-changing. “I received so much love through that experience of putting myself out there,” Luca says. But it’s clear that the vulnerability required to take part in a process that can feel part lottery, part popularity contest came at a personal and emotional cost.
And it’s even more evident that an individualised and random process like crowdfunding is no replacement for adequate healthcare. Structural change is badly needed. So far this year, NHS England has announced three pilot gender dysphoria services for adults in Greater Manchester, London and Merseyside, and in September confirmed an independent review into gender identity services for children and young people.
When asked for comment, an NHS spokesperson said: “Demand for gender identity services continues to rise as more people feel able to come forward for support and treatment, which is why the NHS has increased investment to respond to rising demand, while the independent review of these services will recommend improvements to care.”
But in the financial and medical context of the pandemic, it seems likely that the burden that crowdfunders are set up to support will undoubtedly continue to grow, and the number of people feeling pushed to access healthcare by lucky dip – to put their mental and physical health in the hands of others – will only increase.
All photographs Getty Images