My first-hand experience with transgender healthcare in Ireland

A trans student discusses what it is like to access gender-affirming medication through the HSE today

There are many issues with the Irish healthcare system which each contend for public attention, such as the need for secular free healthcare or the exploitation of junior hospital staff or nurses. Of course, these issues are of utmost importance and must be resolved. However, there is an area of our healthcare system that is often excluded from popular discussion, a system that specifically caters to some of the most vulnerable people in Irish society: transgender people. The treatment of transgender people in an already limited service is something that must be met head-on, with urgent change needed drastically.

“For transgender youth, healthcare in Ireland does not exist”

For transgender youth, healthcare in Ireland does not exist. According to Gay Community News, the Crumlin Hospital-based gender identity service closed its referrals in 2020, having waiting lists of over three years prior to this. No replacement clinic has been put in place, with transgender youth being placed on a waiting list that simply does not exist. However, it is when the child turns seventeen that they are put on the adult waiting list automatically, at the very end of the queue. This queue is reportedly ten years long when applying today; however, as a transgender girl who is a patient of the service, I wish to provide an account of my own personal experience with it – from waiting lists to dehumanisation to psychological evaluations – to support a necessary conversation that needs to be had about transgender healthcare in Ireland today.

I’ve always known I was trans. When I first discovered the term as an early teen, I finally felt a sense of self. This was somehow a shock to my parents, despite my Christmas lists consisting primarily of Hannah Montana merchandise and a Blu-ray copy of The Little Mermaid. Although there were some initial stresses, my family eventually came around to support me in my transition and brought me to the GP at age sixteen. This process was relatively easy thanks to a supportive doctor who had experience with transgender patients before. I was put on the waiting list – one I didn’t actually join until my seventeenth birthday. I very much want this account to speak to the tireless and compassionate work of so many doctors and nurses all around the country, as my issue is not with them, but with the stagnant bureaucracy of trans healthcare in Ireland which makes it so difficult to access trans-specific healthcare professionals.

The years went past with little to no communication from the National Gender Service. Every letter I received with my name on it sent my adrenaline pumping with excitement in case it was them, followed shortly by utter disappointment when it wasn’t. Eventually, three years later, I received a letter from them confirming my first appointment. I was overjoyed and so relieved, and began planning my outfit in my head (a Lady Gaga t-shirt and nice jeans, naturally). Being trans hadn’t been sunshine and roses – especially having attended an all boys school – but for the first time, I felt as though I was moving forward to finally being me. I had spent my teenage years watching transition update videos on YouTube, desperate for that to be me, and for the first time it finally felt within reach.

I had known going into it what to expect. I had read the horror stories online from trans people that had gone through the system, but nonetheless I kept a brave face. I had heard of the refusal of care and the invasive questions. When the time finally came to go, I hopped out of bed, threw on a face of makeup and the aforementioned outfit, and I was on the M50 to Loughlinstown. In the waiting room there were a myriad of other transgender patients, all sat quietly, not speaking to each other. I was then met with what appeared to be an entirely cisgender staff at every level – from receptionists to nurses. I was incredibly anxious and felt completely at the mercy of staff members in this new medical situation. I met nurses who lacked sensitivity for my situation, providing condescending comments about how I must have tried hard to make my hair look pretty. These comments actualised my worries, with the thought of being publicly perceived as someone just trying to assimilate womanhood coming to fruition. I then brushed it off and presumed it was just in my head; however, the worst was yet to come. 

“I was asked about how I performed specific sexual acts…all these questions made me feel completely dehumanised”

For over three and a half hours, my psychological evaluation took place. In order to receive life-saving hormones, I needed to be diagnosed with Gender Incongruence. The medicalisation of my gender opened up every fold and crevice of my life to evaluation and scrutiny. I was asked about masturbation. I was asked about my parents’ divorce. I was asked  how I performed specific sexual acts. All of these questions made me feel completely dehumanised, and felt as though little care was being given to my wellbeing at that moment, besides a quick ten-minute break where I sat on a bench alone outside the clinic. Assumptions were made openly about me when I felt too uncomfortable to answer questions, including whether I had “night emissions”. It’s distressing to recall, and there are blanks in my memory around it. 

I count myself lucky however, as many trans people have publicly said they were denied or delayed treatment because they were autistic, had ADHD or answered sexual questions unsatisfactorily. Although, it is important to note that I was not really there for just a check-up – I was being examined. The authenticity of my gender was under interrogation and if I did not willingly offer up satisfactory answers, I could be faced with the reality that my three year wait could have been for nothing. I knew I was trans before I thought about medication, and I knew it before, during, and after my assessment. I was told I would hear back from them in a couple of weeks after the team (including the mental health nurse, the endocrinologist, etc.) could review the notes taken from the evaluation. 

It took me a while to realise the distress this appointment had caused me. In a therapy session a year later, a counsellor expressed shock when I informed them of the system, and for the first time, felt a real understanding of how horrific it is. I eventually received a kind of call-back for being trans in the form of an appointment with the psychiatrist that lasted for an hour and a half (I wore a gorge blue skirt, I’ll lend it to you if you want) where I was pronounced trans enough. I then received an appointment with the endocrinologist, where I left with a prescription of Fematab (a very fierce name for an oestrogen tablet, that is given to cis women with a single GP appointment), and didn’t hear from them again for six months until a check-up appointment. This was the moment I had waited for and I could hardly believe it. 

“We force transgender people through a humiliating system that holds them at their mercy for life-saving medication”

I have trouble writing this story in the past-tense, for fear that you’ll think that these experiences are behind me – they aren’t, and that’s the crux of this article. Every time I return for an appointment, I must re-enter a learned behaviour of self-reflexivity. A chronic anxiety haunts the life of every trans person who has gone through this system. We each know, though don’t talk about, the lurching knots that collect in our stomach every time we must return to that sterile room, under that fluorescent lighting, and try to convince somebody that we can be categorised in a neat and tidy way, in order to be granted our necessary healthcare. The WHO no longer recommends a medical diagnosis for gender affirming healthcare for transgender people, and yet we still require one here in Ireland. We force transgender people through a humiliating system that holds them at their mercy for life-saving medication. It seeks to only treat the “right” kind of transgender person, with some of the most vulnerable members of our community being completely left behind. We deserve better as a community and yet nothing is being done. This was only my experience, and it is not to say I haven’t had good experiences in some ways with the NGS, specifically with help changing my name. We must be treated with respect and dignity. We must give trans youth the healthcare they need. We must be given an informed consent model for trans healthcare in this country.