TGEU, a body which collects and distributes data for the purposes of promoting knowledge on transgender issues in the European Union, released their findings on trans-specific healthcare in the EU earlier this month. Out of a possible 12 points available across 6 metrics, Ireland received a singular point, ranking worst in the EU.
Each factor had two possible points that could be attributed to it, based on the degree to which the country met the metric. These metrics are: Type of transgender healthcare and coverage available in the country; Requirement for a psychiatric diagnosis before hormonal treatment or surgery; Waiting time for first appointment with a trans healthcare professional; Groups excluded or made to wait longer to access trans specific healthcare; Youngest age for puberty blockers, and; Youngest age for hormones. Ireland was awarded one point for providing some forms of healthcare, but did not receive the full two points due to the limited surgical options available.
At this moment in time, international best practice is considered to be an informed consent, non-diagnostic model, with puberty blockers being made available to those under 16, and full hormone replacement therapy (HRT) being made available once the teen is deemed to be able to provide informed, knowledgeable consent on the impact of this course of medication. A commitment to abide by said standards (referred to as WPATH standards) has been made in the current programme for government. At this point in time, no movement on that commitment has been made.
Ireland’s trans-specific healthcare system has been facing consistent calls for reform, with Trans and Intersex Pride Dublin and the ThisIsMe campaign (a trans healthcare focused campaign) bringing these calls once again to the national arena in 2018. Both of these movements were launched off the back of student activism.
Speaking to the University Observer, Chair of Trans and Intersex Pride Ireland Ollie Bell had this to say on the reports findings: “The National Gender Service provides a harmful and pathologising model of care that goes against international best practice and World Professional Association for Transgender Health (WPATH) guidelines. Trans people have reportedly been denied HRT due to numerous reasons such as having a diagnosis of autism, ADHD or a personality disorder, for being on social welfare or not answering those highly sexualised questions the ‘right way’.”
Aside from the quality of care, the current system also faces criticism for how it provides said healthcare. Bell went on to say “The current state of trans-specfic healthcare in Ireland is atrocious. There is only one public clinic in Ireland that deals with trans healthcare, which means this has created a bottleneck situation and has caused the waiting lists to be more than 7 years long. When you’re finally seen, you’re put through a dehumanising and humiliating assessment and asked invasive questions about your sexuality, porn habits, whether certain gendered clothing turns you on and to go into great details about any trauma/abuse you’ve gone through.”
This sentiment was echoed in the University Observer’s recently launched survey on the topic. Preliminary statements from trans students include quotes such as “[The system is] Calloused and traumatic, entirely based on stereotypes from a set of professionals who firmly believe that trans people are a problem to be contained, and not people who are forced to go through them to secure any quality of life,” and that “For practical purposes the healthcare doesn't exist.”
Students have reported waiting for close to 8 years for a preliminary appointment (a diagnosis requires three under the current Irish system), and an unreachable service. The National Gender Service also faced criticism in 2019 when it revealed that it had “misplaced” over 100 referrals, and required all those referred to contact the service directly to ensure they were still on the waiting list. There were reports of patients who had already been waiting multiple years for appointments having to rejoin as essentially new patients.
Survey respondents have also spoken about how this lack of access to needed healthcare impacted their time in education, with one respondent saying “Before I had access to hormone therapy I was too shy/hated myself too much to speak to others or speak up in class. I didn’t really make any friends and I didn’t feel like I could ask any questions I had during lectures. I was constantly worrying about how people perceived me and it made me very depressed.” Another spoke of having to leave exams early because of the emotional strain this process had put them under.
Speaking to The University Observer on this topic, UCDSU President Molly Greenough had this to say on the impact of the standard of care for trans students “Without going into detail, I can certainly say that this issue has been raised throughout my time in the Union and the roadblocks trans people face in terms of accessing healthcare has incredibly adverse impacts on students’ mental health, confidence, and overall wellbeing. This then has knock-on impacts on academic performance.”
UCDSU Welfare Officer Míde Nic Fhionnlaoich, when asked if the SU had received much contact from trans students on this topic, said “I can’t go into numbers, but definitely. Particularly the issue of the barriers time and again that they face in accessing that care, also just throws the rest of their lives into this terrible limbo. You’re stuck in a waiting list for years, you need that help now, it has impacts on their mental health, negative impacts on their ability to just walk around and be themselves, on their academics. It’s a really wide ranging, and an incredibly unjust and unfair situation.”
A solution that has come up consistently in response to this map, and to the overall crisis in trans healthcare across Ireland, is the solution for GP led, informed consent based care. Nic Fhionnlaoich echoes the prevailing sentiment in her interview on this topic: “If you can receive HRT from a GP for menopause, there’s no reason that you shouldn’t be able to do so for gender affirming care.”
Our anonymous survey aimed at trans students based in UCD on this topic remains open and accepting responses. Any students wishing to speak on this topic further can contact firstname.lastname@example.org.
Students presently struggling can contact support services across campus, including the SU, Student Advisors, and UCD LGBTQ+, who have contact information for both internal and external supports.