Trans Healthcare Now

Let’s talk about the reality on the ground for trans people in Ireland. There is no feasible pathway to transition right now, either privately or publicly. Best estimates place the National Gender Service waiting list at over eleven years, after which you will be subject to an invasive psychiatric assessment, inadequate care, rampant discrimination, and a need to ‘prove it’ at every turn. This piece will present a systematic takedown of everything the National Gender Service (NGS) represents & call for a radical transformation of Ireland’s gender-affirming healthcare system.

Firstly, let’s examine the NGS itself. Professor Donal O’Shea and Dr. Paul Moran have set up the service in such a way as to make transition effectively impossible. They employ numerous gatekeeping mechanisms to create prolonged waiting periods & increase anxiety, depression, and suicidal ideation. If you want to get some idea of just how gas these two lads are, they instruct GPs against monitoring sex hormones. Isn’t that just utterly ridiculous? So basically, if you want to keep an eye on how your transition is going, you need to hope your GP is sound and ignores the NGS. Cis people can get these blood tests no questions asked of course.

The use of psychiatric assessments by the NGS is frankly abhorrent, reinforcing harmful stereotypes that being trans is inherently problematic & must be ‘treated’, rather than recognising gender diversity as a natural variation of human experience. They ask you all sorts of weird dehumanising questions about masturbation, what kind of porn you watch and the like. They ask these questions because a lot of people think being trans is a fetish. They’ve zero emotional intelligence and operate on the assumption that you’re wrong in your decision. It’s up to you to change their mind and maybe if you fit in their box, you’ll get life-saving medication in a decade or so. God forbid you try access healthcare somewhere else. If these clinicians find out, they will shame & gaslight you and write to your GP to try get you taken off it. I’d say they’re delighted the private options have all collapsed now.

Of course, O’Shea and Moran love the Cass Review, an outlier that ignores more than three decades of clinical experience on the benefits of hormonal interventions. A review set up by the Tory government, so they have an excuse to enact policies they already decided they wanted. We’re stuck with Cass now for the next decade at least. People will use the document to hold us back at every stage because it confirms their pre-existing biases and looks vaguely scientific. It’s been completely debunked by the medical community at large.

What’s the alternative to the NGS? It’s super easy. You would just let GPs prescribe hormones. This immediately eliminates waiting lists, respects individuals’ autonomy, and empowers people to make informed decisions about themselves. The approach works well in countries such as the USA, Canada, France, Spain, Portugal, New Zealand, and many more. Look at how informed consent works in these countries & notice how the sky didn’t fall in. Timely access to gender-affirming care is crucial for psychological and emotional wellbeing, and there is no sane argument against letting GPs handle it.

You will see in the media that calls for trans healthcare come solely from an ‘activist agenda’. What a load of rubbish. I didn’t realise the World Health Organisation is run by activists now. If this ‘activist agenda’ has really become so rampant, then you might see us included on RTÉ Prime Time next time they do an episode about us, or maybe the HSE will talk to a trans person before appointing Karl Neff as clinical lead. Karl Neff is yet another NGS clinician whose mission is to contravene as many best practice models of care as possible, and of course appointed with no consultation of the TGD community.

Many Irish politicians wax lyrical about how much they love the LGBTQ+ community, waving their flags about the place for Pride month. Few are willing to take a principled stance against the barbaric system we have in place right now. They’re frightened to touch off it as it’s become politically toxic. We are mired in debates and distractions from right-wing commentators, when a few simple steps are all that’s needed to immeasurably improve the lives of trans people across the country.

I will close out with a personal anecdote. Starting estrogen changed my life in every way. I spent years in countless sessions of therapy & trying every anti-depressant under the sun; never getting anywhere until the day I started estrogen. I feel so full of life now, and I will never go back. The NGS would take me off hormones and make me struggle in silence for another 11-14 years and for what? It’s not just medical malpractice; it’s morally and ethically indefensible to continue forward with such an unjust system. Ireland must do better.