Our Vision
We envision an Ireland where trans and gender diverse people can access gender-affirming healthcare within our local communities through an informed consent model. This vision calls for an end to the current outdated gatekeeping model practiced in Ireland. Our framework for this model is detailed below.
Informed Consent Model
The informed consent model involves a clinician providing accurate and appropriate education regarding transition—including risks, benefits, and limitations of any intervention—so that the patient can make free and informed decisions about their own body and treatment. Providers will typically document the patient's consent after a discussion outlining the patient's expectations, understanding of the treatment, support structures, and overall health.
The informed consent model is not aimed at assessing a patient and therefore does not involve an evaluation of a patient's gender or whether they are truly "trans." Rather, the goal is to facilitate thoughtful decision-making in a way that centres the patient's experience, expertise, needs, and autonomy. Patient-centred (or person-centred) informed consent encourages relationships wherein patients are the primary decision-makers about their care and clinicians serve as partners who utilise their expertise to enable effective and safe treatment. Under this framework, clinicians provide individualised care where patients lead in decision-making about their transition, rather than relegating them to the sidelines as passive recipients of decisions made by doctors.
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Informed consent stands as a well-established model, having been practiced by community health centres like Callen-Lorde in the US for decades. Implementing a patient-centred informed consent model in Ireland would depathologise access to care, drastically reduce the years-long waiting lists, improve patient experiences, and reaffirm the self-determination of trans and gender diverse people.
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Resources
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The Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 by the World Professional Association recommends an informed consent model.
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TransHub provides detailed information to trans patients and guidance for clinicians about the informed consent model.
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The Australian Informed Consent Standards of Care for Gender-Affirming Hormone Therapy assist and enable clinicians to better meet the medical needs of their trans patients, centring the trans person seeking hormonal intervention and empowering the clinician to facilitate this access.
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The Path to Patient-Centred Care is a living resource for offering better patient-centred care using the informed consent model to transgender adults seeking gender-affirming medicine in Canada.
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The Guidelines for Informed Consent in Primary Healthcare by Gender Minorities Aotearoa detail what informed consent means and provide practical examples.
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This research article describes how more widespread uptake of an informed consent model of care to initiate hormone therapy by primary care physicians has the potential for high patient satisfaction and may be a practical solution to reduce waiting lists in gender clinics.
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This research article explains the informed consent model and how it shows promise for the treatment and understanding of the transgender experience outside of the lens of medical pathologisation.
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This research article describes how clinicians’ use of the informed consent model would enable them both to attain a richer understanding of trans patients and to deliver better patient care.
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This article shares recommendations for moving beyond psychiatric gatekeeping to take an informed consent approach to gender-affirming surgery.
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This research article illuminates that there is no evidence that gender assessments can reliably predict or prevent regret better than self-reported gender identity and embodiment goals and provides additional support for informed consent models of care.
Community-Based Approach in Primary Care Settings
The provision of gender affirming care is not a specialty service and therefore should be accessible through primary care providers in our communities. Community-based care enables patients to access gender-affirming medical services locally, delivered by their primary care general practitioners (GPs) and nurse practitioners (NPs), as well as within sexual health clinics. This model offers greater accessibility compared to the centralised gender clinic model, as patients are able receive services within their local community, which particularly supports access for those living in remote or underserved areas.
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Primary care providers are uniquely positioned to support trans patients, as they are usually already familiar with their patients and thus can provide continuity of care and apply a holistic approach to gender-affirming health services built on trust. GPs and NPs also have knowledge around prescribing and monitoring hormone therapy in other populations, such as post-menopausal cis women and hypogonadal cis men, which they can apply in providing gender-affirming care to trans patients.
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To ensure effective implementation of this approach, community health providers need proper education and empowerment to offer essential gender-affirming health services, including prescribing and monitoring hormone therapy. Implementing a community-based approach to care facilitated by primary care providers would significantly reduce barriers and increase access for trans patients seeking gender-affirming health services in Ireland.
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Resources
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The World Professional Association for Transgender Health Standards of Care Version 8 supports the provision of gender-affirming hormone therapy by primary care GPs.
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The Primary Care Gender Affirming Hormone Therapy Initiation Guidelines from the University of Otago in Aotearoa New Zealand facilitate a primary care-based approach to gender-affirming hormone therapy through an informed consent model, providing tools for GPs and NPs.
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This clinical article provides practical guidance for prescribing hormone therapy to trans and gender diverse patients in the general practice setting in Australia.
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The Primary Care Toolkit from Trans Care BC provides informed consent-based guidelines to assist primary care clinicians offering gender-affirming care for their patients.
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The Medical Care of Trans and Gender Diverse Adults guidelines from Fenway Health in the US describe the provision of informed consent-based gender-affirming care within primary care.
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The Trans Primary Care Guide from Sherbourne Health and Rainbow Health Ontario offers guidelines for gender-affirming primary care, including hormone therapy and blood work monitoring for primary care GPs in Canada.
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This article highlights the importance of primary care GPs providing hormone therapy to trans patients.
Human Rights-Based Approach
A human rights-based approach to gender-affirming care involves developing policies and practices that adhere to human rights principles. This approach acknowledges that transgender and gender diverse (TGD) people have the right to the highest attainable standard of healthcare without discrimination on the basis of gender identity. This framework centres patients' rights to access healthcare that respects their individual bodily and mental integrity, autonomy, and self-determination as well as their free and informed consent when making decisions about their medical treatment.
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Resources​
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The Guidelines to Human Rights-Based Trans-Specific Healthcare from Transgender Europe addresses how the specific services trans people access in the healthcare system relate to human rights principles and supports the creation of healthcare legislation and protocols that are compliant with human rights.
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This article explores the shared human rights focus and relationship between trans depathologisation and the human rights protocol considerations framework.
Harm Reduction Framework
A harm reduction framework for gender-affirming care means implementing practical approaches to reduce the risks and negative impacts associated with self-medication, including the provision of safe access to blood tests. This approach is facilitative rather than coercive, centring the patient’s bodily autonomy in making decisions about their health and their lives.
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Resources​
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Trans Harm Reduction provides resources and support for trans people who are self-medicating.
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The WPATH Standards of Care 8 supports the value of harm reduction approaches.
Co-Production
Co-production involves the the active engagement and participation of the trans and gender diverse community in the planning, design, delivery, and evaluation of their own gender-affirming healthcare services. Co-production recognises that trans people are best positioned to advise on and oversee decisions that impact their healthcare outcomes and should be meaningfully involved in shaping care at every stage.
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This collaborative approach values the lived experiences, perspectives, and expertise of trans and gender diverse people, ultimately leading to the design of more inclusive, effective, and patient-centred care.
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Resources​
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This video from the Coalition for Personalised Care defines co-production and describes how to develop a culture of co-production.
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The Co-Production Collective provides a library of resources on co-production, including case examples.
Affirming Youth Care
An affirming approach to care for trans and gender diverse youth upholds their right to access quality care that centres their needs and wellbeing in a safe and inclusive space. This means ensuring that trans youth are active in decision-making around their healthcare, positioning the clinician's medical knowledge as complementary, rather than coercive. This approach promotes the bodily autonomy and self-determination of trans youth through facilitated self-reflection as they navigate the path that aligns with their gender needs.
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In an affirmative model, health care providers work with the patient and their caregivers to create a supportive environment for free and open exploration of their gender needs, recognising that these may evolve over time. Treatment may include offering support for social transition, providing reversible puberty blockers to delay the effects of puberty, and, for those above the age of medical consent or who demonstrate Gillick competence, prescribing hormone therapy. As with all gender-affirming care, informed consent is a central principle throughout every stage of transition for trans youth.
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Employing an affirming approach to trans youth care in Ireland would have a significant positive impact on their health and wellbeing.
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Resources​
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The WPATH Standards of Care 8 shares guidance on the provision of gender-affirming care for trans adolescents.
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The Trans Youth Matter toolkit from Fenway Health shares resources and information around healthcare for trans youth and the harm caused by policies that block access to care.
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The Reaffirming Autonomy of Trans and Gender Diverse Children and Adolescents paper from GATE aligns the international human rights framework with the decision-making autonomy and bodily integrity of trans and gender diverse children and adolescents.
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This essay provides a comprehensive timeline and compilation of studies around gender-affirming care for trans youth.