Statement on Labour's Motion Re: Trans Health

Trans Healthcare Action fully supports the motion put forth today by Labour re: Trans Healthcare. The motion notes the ongoing struggle that trans people are all too familiar with: a ballooning waiting list of 13+ years, invasive and distressing assessments, and how we have been let down by hollow government promises. Our healthcare still follows an outdated, dehumanizing psychiatric model of care, far out of line with international standards.

Our Current System Fails Us

Our current system fails us in many ways. Not only is there a lack of clinics willing to treat us, but those that will are gatekept by time-consuming and unnecessary assessments. Our waiting list is long not due to the requirements of our health, nor due to a lack of funding, but due to the fact that we must appease doctors for us to be allowed to transition. We are denied the freedom and bodily autonomy to determine our own gender, on arbitrary grounds determined solely by those without firsthand experience of being trans. Furthermore, there is no way for trans youth to access timely care in Ireland. The public system requires a person to be 17 years old before being referred to the immensely long waiting list, leaving youth helpless and distressed as they experience unwanted, preventable, physical changes.

A Better Way is Possible

But a better way is possible, and it is what Labour is calling for. Ireland must begin to follow international standards, and implement an informed consent model of care: a system where the choice lies with the patient over what to do with their body, and not in the hands of a pathologizing psychiatrist. A system where doctors work with their trans patients, not against them. A system where trans people are armed with the knowledge of benefits and risks, and choose their own path forward. A system where care can be accessed locally, without having to travel across the country to a single clinic.

This is not a new solution, but a tried and tested system. The informed consent model, outlined by WPATH, has been successfully used across the world for years and years. It is a model that grants the individual bodily autonomy, increases patient satisfaction, and delivers great patient outcomes in a cost-effective manner. For an example of its efficiency, we can look to Iceland, where the Trans Team at Landspítali University Hospital adopted this model and swiftly eliminated a year-long waiting list despite having a lean staff.

There is no reason why the majority of our care needs cannot be met by GPs. Monitoring blood levels and titrating dosages is basic medical practice, which any doctor is capable of, yet these common services are repeatedly refused for trans people. To ensure that care is accessible to everyone who needs it, we must create a model of care that recognises the crucial role of GPs, as called for in Labour’s motion. For an example of decentralized, GP-led care we can take inspiration from Trànsit, Catalonia. Trànsit runs 8 clinics across the province, and not only care for trans people, but act as training hubs for medical professionals. Trànsit understands the importance of primary healthcare providers, and ensures they have the confidence to treat their patients appropriately.

We must have a voice in our care. Trans people have been left out of discussions about our own health for far too long. Any new model of care created must be done so in direct collaboration with our community. We are the ones with the lived experience that lets us understand our struggles and our needs. Labour’s motion calls for the new National Clinical Programme to be developed in collaboration with transgender people, which is absolutely essential for building appropriate care. We want our healthcare to be in co-production with trans people. The benefit of including us in our healthcare is so great that clinics such as Orygen, Australia, include dedicated Peer Navigator roles in their centers, to ensure that people are being looked after and supported by people they can trust. There must be nothing about us, without us.

Beyond Our Healthcare

Our issues extend beyond just healthcare, and into legislation. The Gender Recognition Act 2015 was progressive at the time, but in the decade since has failed to modernize. We still have no official recognition of non-binary identities. Gender recognition for under-18s remains heavily restricted and medicalized, leaving many unable to access it. Labour is correct in saying this legislation is in dire need of reform.

To ensure that our needs are being met and to prevent abuse, the government must implement a conversion therapy ban that is inclusive of transgender identities and healthcare. This is something that has long been discussed, but never acted on. We agree with Labour’s call to enact a ban, for if these harmful practices are allowed to operate they will hinder trans people from accessing much needed care.

Lastly, we stand in solidarity with our intersex siblings in our shared struggle for bodily autonomy. This is a core principle that applies to all people, and we cannot argue for autonomy for some, without autonomy for all. Labour also recognizes this, and rightly calls intersex people to receive the same respect. We must put an end to unnecessary surgeries on non-consenting intersex children.

We strongly urge the government to listen closely to Labour’s motion, and implement it in full. The motion reflects the abysmal state of trans healthcare in Ireland, but offers effective, workable, and practical solutions. We cannot let the current status quo continue, when there are proven alternatives that would change the lives of people around the country.

Ireland must do better for its trans, non-binary, and intersex citizens.