Actor and writer Tabby Lamb examines the history of gender affirming surgery and calls for a more accessible future
IMAGE PROVIDED
If I hadn’t done any research at all, I might wonder what Roberta Cowell and Michael Dillon would make of gender affirming healthcare today. Roberta, racing driver and WWII pilot, was (probably) the first British trans woman to undergo surgery in 1951. Michael, physician, author, and almost-monk, is known to be the first trans man to medically transition in the 1940s. These pioneers lived in a world far less forgiving than ours. And yet, in some ways, their access seems enviable compared to the labyrinth my generation faces.
Back then, the surgeries were experimental, the risks huge — but they happened. Sympathetic doctors pushed medical boundaries, sometimes for their own egos, but still. Today, we have decades of research confirming the necessity and benefits of gender affirming care. And yet, for most trans people in the UK, the journey feels endless. We are, somehow, moving backwards.
My own transition has been unusual. At first, I was lucky enough to qualify for TransPlus — the NHS’s first integrated Gender, Sexual Health and HIV service. I had a peer mentor, a social prescriber who paid for Trans Sauna, and my hormone prescription took just 45 minutes. I’d been living as trans for nearly 10 years, didn’t start my medical transition until my 30s, and even then, surgery was offered within a year. I wasn’t ready — autism makes change hard, and my body had already shifted so much on hormones that I wanted to pause. But the care was never rushed, never cruel. No degrading questions about childhood wanking habits, no cross-dressing interrogations — just safe, human conversations.
Later I realised how rare this was. While my friends fought over basic access, denied and forced to pay privately, I had a safe space where my hormones were dispensed and monitored. For three years. Then I was moved to shared care with my GP — a faceless online service that, at first, seemed fine. But where TransPlus had checked my blood every three months, my GP requested one test in two years. Prescriptions started getting challenged. Zoom cross-examinations determined whether I “still deserved” them. Somehow, I’ve survived their system longer than anyone else I know.
Roberta and Michael had their own disagreements. Roberta claimed most trans people were “freaks,” and would, I’m sure, have made a fortune on the right-wing grift circuit if born later. Michael, meanwhile, argued for self-determination and saw medicalisation as an option, not a prerequisite. My own views are closer to his — but lately, his nuance has been weaponised. People twist “not everyone needs medicalisation” into “those of us who do are wasting the NHS’ money.” And as always, it’s women and femmes who are hit first, hardest, and the most.
Michael found Dr Harold Gilles, a plastic surgeon who had rebuilt soldiers’ genitals after WW2. Over three years, Gilles performed thirteen surgeries to give Michael a functional penis. No gatekeeping, no endless waiting lists. Just medicine. Roberta’s journey was rougher, but still, community support carried her through. Then it meant breaking the law; now it means crowdfunding. I’ve had to turn to one myself.
As of writing, I’m two weeks from opening The Law Of Mayhem and three weeks from my own bottom surgery — though the date has already been cancelled and reinstated twice. Three years with a personal trainer to meet arbitrary BMI goals. Five years on hormones. Fifteen years out as trans. My passport says female, my driving licence says female, my bloodwork says female. Still, every unknown number on my phone fills me with dread: another cancellation? Another hoop?
And yet, I am still one of the lucky ones. White, middle-class, with family NHS ties, dating a nurse at the right time. Doors opened for me that stay bolted for others. Roberta may have wanted to exclude, but I want the opposite: call me a freak if you must, just open the gates.
When people claim gender affirming care is “new,” I want to shake them. It’s not new. Our legacy is long and rich — what’s new is that it’s now recorded, legislated, and rationed by people who don’t want it. Roberta and Michael’s paths weren’t easy, but they didn’t spend half their lives waiting. They got on with living.
Finally being approved for surgery feels bittersweet. Sweet, because I can at last imagine a future without dysphoria gnawing at me. Bitter, because I know so many others are still waiting, years of their lives wasted. The system is collapsing under its own prejudice, and real people are being crushed with it.
So where does that leave us? Angry, yes. Exhausted, always. But also determined. Every time we tell our stories, we remind the world: gender affirming care isn’t a luxury. It’s survival.
The Law Of Mayhem runs at The Haymarket in Basingstoke for four nights only in 2025 – from 18 – 20 September 2025 at 7:30pm – with tickets starting at £12. The play is suitable for ages 14+ and tickets can be found here: anvilarts.org.uk/events/the-law-of-mayhem.
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Thank you for sharing your story. It really shows how important and life changing proper healthcare access is, and how frustrating the system can be for so many. I’ve sometimes looked at blogs on sites like SheMed when I needed clear info around health options, and it’s been helpful in its own way. Reading this reminds me how much more still needs to change.