Jes of Trans Healthcare Action spoke at Trans&Intersex Pride Dublin 2022.
Watch or read to learn more about trans healthcare in Ireland, and how you can help to make it better.
Recording courtesy of GCN.
Adult Services
I’ll talk in a bit about Trans Healthcare Action, but first the National Gender Service at Loughlinstown and its waiting lists.
There are presently around 968 people waiting. Their website says they’re seeing people referred 2.5-3 years ago. Do the math though and someone added to the list today would have a wait of over 6 years. And that wait is going up by over a year per year.
With all the talk of waiting lists, you’d be forgiven for thinking that that was the only problem with trans healthcare in Ireland. Well, what is it that you’re waiting for? The Initial Assessment. Sounds boring, doesn’t it? Here’s one recent account in Trinity News:
“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 how I performed specific sexual acts. All of these questions made me feel completely dehumanised…It’s distressing to recall”
This is just the latest in a long line of stories of the trauma this process can bring.
This “assessment” takes 4-5 hours over 2 sessions which have to be attended in person. And a third of people are dragged back for even more!
I’ve heard of people being rejected for HRT because of all sorts of spurious reasons, such as being on disability allowance or still living with your parents. In this economy. I’ve heard of people having their HRT taken off them because they’re currently unemployed. One of the most common reasons I hear is the vague catchall of having “autistic traits”. Because apparently autistic people can only be “gender confused” they can’t possibly know their own gender or make decisions about their own body, and thus don’t deserve healthcare.
The waiting list is not the problem, the waiting list is a symptom of the problem. I know of many people who refuse to even get on the waiting list, whether for reasons of dignity or because they fully expect to be rejected.
Youth Services
All of this is adults, what about youth care?
Youth care collapsed on January 1st 2021. Nothing to do Bell-v-Tavistock or Brexit. This was expected by the HSE. And we’re still waiting for the replacement service.
That service back when it existed might take 6 years to maybe prescribe you puberty blockers. Here’s one I sniffed earlier. You know, the fully reversible way to pause puberty with numerous studies supporting their use, including of those who started them back in the 1980s. And what has happened in the intervening 6 years waiting for a chance at puberty blockers? Puberty.
Once someone hits 17 they can be referred to Loughlinstown, who don’t consider the 7 assessments you might have had so far “adequate” so you go to the very back of the 6 year waiting list. Here’s what the doctors at Crumlin have to say about all this:
“There is huge patient expectation around the prescription of cross [sex] hormones and several patients have ended up in inpatient psychiatry units with the associated distress of waiting for this medical intervention”
In case you’re having difficulty reading between the lines there, let me give a blunt hint. In a recent session with my therapist he mentioned that they had a waiting list full of suicidal children.
Real Healthcare
So the HSE cannot be relied upon to provide trans healthcare. What do people do instead?
I am one of hundreds of Irish people who access gender affirming care from doctors abroad. These are all the exact same medications I’d be prescribed here, the only difference is that I have to pay out of pocket, and that my care is following international best practice. Practices that the Programme for Government promises, and has yet to deliver.
You may notice a similarity here with the 200 people a year still travelling for abortion.
The HRT end of trans healthcare is not particularly complicated. Given the lack of other options, what is likely several hundred people - over a quarter of those of us on HRT - choose to DIY or self medicate. Groups like Trans Harm Reduction exist to help people manage risks of this.
What do the HSE think of this?
“There has been a recent resurgence in young people accessing drugs to aid gender transition on the black market, the very risk the initial [Model of care] and investment were designed to prevent”
Turns out that if you have a process which thoroughly medicalises being trans, a process that’ll take 6+ years, a process that back when it existed had a less than 40% chance to prescribe medication, that people will look for other options. And adult services are no better, refusing to engage with TENI, and decrying anything less than 5 hour in-person sessions to include in depth discussion of your porn habits “unsafe”.
I suspect that we have slightly different definitions of unsafe.
A Better Way
Let’s step outside of healthcare for a second, and talk about legal transition. If you go to the TransIreland wiki on reddit, you can see all the details of the process. It’s not perfect but if you’re over 18 and want your gender marker changed to M or F you can do so in about a week now given that the deed poll requirement is gone. Over 1000 GRCs have been issued since 2015. And it’s normal.
Why can’t we do the same for healthcare? Believe trans people. Give them the information and trust them to know which legal, social, pharmaceutical, and surgical changes they need to thrive and be happy.
By default endocrinologists don’t know anything about trans medicine and this is borne out by the stories I’ve heard from people across the world of ineffective dosages; including here in Ireland. Seriously, the 2017 Endocrine Society guidelines are only 35 pages, is it that hard to read them? You can teach this to doctors in an afternoon.
So why not teach GPs how to prescribe HRT to trans people under a human-rights based informed consent model? They already prescribe the exact same medications as HRT to cis people. The monitoring is no more complicated than they already do for diabetes.
To those who say this is unworkable, I say that this model is already successfully used in Australia.
For trans youth, why not also have GPs prescribe puberty blockers to those who request them - once puberty has started? And once they’re sure they want HRT, that too?
Trans Joy
While others wring their hands over our healthcare and very existence, we’re just trying to live and be happy. I have seen the joy of trans people when they finally realise they’re trans, that they finally know what has been gnawing on them all those decades. The joy when they start HRT, the joy when their voice drops, the joy when their skin gets softer, the joy when someone uses their name and pronouns, the joy when they have their surgeries. It’s just like a weight off their chest. And then just the joy of living. I don’t want to have to fight for simple basic healthcare that is given without a thought to cis people. I want to spend time baking, making music, and bad puns.
I’d like your help to bring that joy to trans people across the country, and to that end I and others have setup Trans Healthcare Action. We’re just getting started, our aim is to bring the informed consent model of trans healthcare to Ireland. If you want to help, sign up to our mailing list on transhealthcare.ie or follow us at transhealthie on Twitter/Instagram.
And remember just like sex workers are workers, trans rights are human rights!