so the NHS is really fucking bad about trans healthcare for a lot of reasons. The process is unusually bureaucratic even for the NHS and hyper gate kept, like they will just deny care based on single answers to weird questions. Without a really good doctor who is willing to go to bat for you and stick it out and who understands this very specific process in the NHS, you probably will never actually be able to get care.

Partially this is due to NHS being underfunded and partially because people in positions of power have worked to make trans healthcare as difficult as possible to get in England.