A transgender student who spent two years waiting for her first NHS gender identity clinic appointment has revealed she now takes unregulated hormone drugs sourced from an online black market.
Jess, 18, from Brighton, said she refuses to 'put her life on hold' but can't afford to go private - where waiting lists are shorter - to seek the treatment she wants.
Some patients spend as long as three years on a waiting list before they finally see a specialist at a gender identity clinic, according to a BBC investigation last year.
Jess admitted she would 'rather disappear off the Earth' than not transition, and has spent hundreds of pounds on the unlicensed hormone tablets for the past 10 months.
Jess, 18, from Brighton, said she refuses to 'put her life on hold' but can't afford to go private - where waiting lists are shorter - to seek the treatment she wants
Speaking to trans activist and author Charlie Craggs in a new BBC Three documentary Transitioning Teens, she said all she wants to be able to do is to 'look in the mirror and see reflected back what I see inside'.
'I was originally planning to wait until I got into a clinic to start hormones, but then I kept seeing the waiting list go up and up and up and I just thought, it's never going to end,' she explained.
'When I was first referred it was a one year waiting list, now it's gone up to a three year waiting list. You can't just put your life on hold for three years.
'If I can't transition then I would rather just disappear off the Earth. I can't go private, I can't afford to do that, so my only option is to go online and find whatever I can.'
There are over 13,500 adults and over 4,500 under 17s on waiting lists for NHS gender identity clinics in England, according to a BBC News and Care Quality Commission report.
Speaking to trans activist and author Charlie Craggs (pictured) in a new BBC Three documentary Transitioning Teens, Jess said all she wants to be able to do is to 'look in the mirror and see reflected back what I see inside'
Desperate to start transitioning to the opposite sex, patients admitted they are turning to unregulated sources to find testosterone and oestrogen pills, meaning they may be putting their health at serious risk by taking untested drugs often from outside the UK.
Jess confessed she's often left strapped for cash after paying out for the drugs online to self-medicate.
'Some months... I've gone to buy a textbook or something like that and I've been like no, I can't actually get that because I have to save a certain amount of money for hormones,' she said.
'It just adds up and adds up, last year I spent hundreds of pounds on these medications.'
Jess claimed there are thousands of people in a similar situation to her, who have turned to the DIY approach and head to the online black market to start their transitions.
Jess confessed she's often left strapped for cash after paying out for the drugs online to self-medicate
She said she began looking at forums - where people share their experiences with different drug suppliers and hormone doses - when she was 17.
'I just started looking online, I did so much research and there are forums which have thousands of members. There are loads of people in the same position,' she explained, adding that one forum has 18,000 members.
'These kind of things that you see on here are things that you should really be bringing up with doctors - abnormal bleeding, stuff like that. You should be able to go to a specialist, you shouldn't be on here asking for advice.'
Charlie, who started her transition from male to female seven years ago, said she never considered the idea of self-medicating because it's impossible to know what you're taking and she'd heard stories of girls having strokes and heart attacks.
Asked how she goes about finding a safe supplier, Jess admitted: 'You just have to go off word of mouth, yeah of course [I worry about what's in them].'
Jess claimed there are thousands of people in a similar situation to her, who have turned to the DIY approach and head to the online black market to start their transitions
'There's no one overseeing this, it's all black market. You send the money and hope what you get is hormones. I don't know who to turn to when something goes wrong.'
NHS England, which has a target waiting time of 18 weeks for a first appointment, said demand for gender identity services is rising and there are not enough suitably qualified doctors.
Many of the websites selling the hormones are not based in the UK – meaning they may be produced away from Britain's strict regulations – and demand payment by Bitcoin or bank transfer.
It is illegal to sell testosterone drugs, but it is not illegal to buy or possess them for personal use.
And many patients may turn to oestrogen hormones which are intended for menopausal women in order to get their dose.
There are huge health risks of taking hormones without doctor supervision, experts stress.
During the documentary presenter Charlie spoke to suspended doctor Helen Webberley, who in 2018 was convicted and fined for failing to register her online clinic, from which she dispensed transgender drugs
Those who take oestrogen could experience a pulmonary embolism, whereby a blood clot travels to the lungs and blocks an artery. Liver damage could also occur if patients are not being monitored.
They may also feel disheartened if the drugs do not give the desired effect, because they are actually fake.
During the documentary presenter Charlie spoke to suspended doctor Helen Webberley, who in 2018 was convicted and fined for failing to register her online clinic, from which she dispensed transgender drugs.
She is co-founder of a thriving international business called GenderGP, which sells sex hormones from its website for up to £100 a month to British children. It's the only private clinic in England and Wales that prescribes hormones to under 16s.
She was criticised for prescribing medication faster than the NHS and is currently being investigated by the GMC after complaints by other doctors were lodged against her. She hasn't worked as a doctor since April 2017.
Dr Webberley appeared to suggest part of the problem with waiting times is the lengthy assessment period doctors are required to carry out to establish whether a person is indeed transgender.
'This isn't about filling in a form and getting a prescription the next day, but what this isn't about is six months to a year worth of assessments for me to say OK I believe you now, you're trans,' she told Charlie.
Charlie, who started her transition from male to female seven years ago, said she never considered the idea of self-medicating because it's impossible to know what you're taking and she'd heard stories of girls having strokes and heart attacks
'Why do we need big long assessment periods to prove, why should I prove that anybody else is or isn't transgender? I don't think it's our job to validate anybody's gender and that's really important.
'And if ever there is an alarm bell, we need a bit more support there. We provide counselling if the person wants counselling.'
Last year an investigation by the BBC's Victoria Derbyshire programme showed the differences in wait times across the UK.
The longest wait from referral to a gender identity clinic was in Belfast, where patients waited a maximum of three years (166 weeks), treble the target time of one year (52 weeks).
Second worst was Nottinghamshire, where waits stretched up to two years and nine months (145 weeks) just for an appointment.
This was followed by Northumberland, where people could face up to two years and five months (127 weeks). The NHS in England has a target time of 18 weeks.
In Wales, where there is no waiting time target, patients may have to wait up to two years (104 weeks).
Transgender patients wait up to three years to get an appointment at a gender identity clinic after referral (Belfast). A Freedom of Information request by the Victoria Derbyshire programme shows patients in Nottinghamshire wait a maximum of two years and nine months (145 weeks). NHS Highland's gender identity clinic, in Scotland, has the shortest maximum wait of 32 weeks. Some countries have target times - NHS England's is 18 weeks
The NHS Highland gender identity clinic, in Scotland, has the shortest maximum wait of 32 weeks.
The Royal College of General Practitioners, which represents GPs, raised concerns about the consequences of rapidly increasing referrals in 2019.
It reported gender identity clinics in England have seen a 240 per cent overall increase in referrals over five years.
In a statement, the RCGP said: 'There is an urgent need to increase the capacity of gender identity specialists and clinics and expand the understanding of gender variance issues across the entire health system.'
It is understood that wait times are part due to a lack of medical professionals wanting to specialise in trans healthcare. A new Royal College of Physicians pathway had been established for this reason.
NHS England told the BBC in a statement: 'As more people feel able to seek support and treatment, the demand for gender identity services has greatly increased.
'In recent years we've increased investment to respond to the rising demand, with staff working hard to support patients to get the right care as quickly as possible.
'From the spring a new service will be piloted in London that will increase capacity in gender identity services.'
A spokesman for the Scottish government, of which NHS Health Scotland is a branch, said long waiting times for patients were 'unacceptable'.
He said: 'Gender identity clinics are a very specialised resource, and while people are waiting to be assessed they still have access to a full range of community mental health and well-being services appropriate to their situation and needs.'
Transitioning Teens is available to watch now on BBC iPlayer.