Ashley Tambke discusses access to Transgender Healthcare in Ireland and UCD, and argues that the UCD Student Health Service is failing to provide adequate care for Transgender students
For the 2023-2024 Academic year, a group of transgender MA Philosophy students gathered to write a letter to advocate for Transgender Healthcare on the UCD campus. They highlighted the struggles international trans students face through the draconian restrictions placed on them by the National Gender Service (NGS).
The Irish healthcare system makes it very difficult for international transgender students to access Hormone Replacement Therapy (HRT) treatment, get support for their transitions, and get the proper medical care they require.
For most other medications, a letter or document from a foreign Doctor/medical practice is enough to get a prescription; however, transgender healthcare is the exception in Ireland. GPs at large, under the direction of the National Gender Service, do not prescribe HRT or provide treatment for trans needs. Instead, transgender individuals must go through the NGS.
An article from The Beacon revealed that, as of August 2024, the current waitlist for Trans Healthcare in Ireland through the government-run NGS has extended beyond a decade. That is a growth of more than one year from 2023, as nearly 500 new patients have been added to the waitlist.
Ireland is frequently ranked as having the worst trans healthcare within the EU and amongst the worst in Europe by organisations such as Trans Rights and Wellbeing in Europe and Central Asia (TGEU); “The monopoly and centralisation of care in countries like Ireland, Finland and Denmark make it difficult for trans people to see a healthcare professional on time. Monopolies, combined with the refusal of cost coverage for care by independent practitioners in these countries, often puts TSHC (Trans-specific healthcare) out of reach for many trans people.”
The National Gender Service harms Transgender people in Ireland. They are either denied care due to an ever-growing and extremely long waitlist, or they are forced to resort to ‘DIY’ medication, supplying their own oestrogen or testosterone from grey or black market sellers, or seek third-party GPs, which can be prohibitively expensive. Third-party, out-of-state doctors often charge thousands of euros worth of fees.
One of the most important medical checkups for people on HRT is blood tests. People on HRT must take blood tests to monitor their hormone levels as hormone levels naturally change. It can be dangerous to not receive routine blood tests while on HRT, as having imbalanced hormones for too long can have long-term consequences. Routine blood tests allow those on HRT to change their dosages and ensure they are healthy. The Irish healthcare system and NGS regularly deny those on HRT these blood tests if they are not in their system.
A denial of healthcare can cause long-term damage to people’s health. The Irish healthcare system largely just follows the harmful and dangerous transphobic orders of the NGS.
If a student is able to get a meeting with the NGS, they are required to provide their entire medical history, which is a difficult task for those with multiple doctors or international students. The NGS has also been heavily criticised for its invasive and humiliating questioning practices with hired psychiatrists. Asking questions about patients' sexual practices and masturbation habits to “prove they are ready to transition”. Even after going through this traumatising experience, they will still often deny trans individuals treatment, even those who have been transitioning for years.
Denial of treatment is harmful for trans people and is transphobic. Changes in medication can have drastic side effects which effect the mental and physical health of transgender individuals. Trans Women, who are either forced to lower or get off of their estrogen doses after years of use, experience a state similar to menopause. An effect which can have drastic negative mental and physical side effects on transfeminine individuals.
In the letter written by the MA Philosophy students, they state “For those of us who have already been transitioning for years, a disruption to our medication can have serious, harmful side effects.” Many financially struggling international and local students instead decide to not get their blood tests done, and instead, risk it. It also can, and according to our MA students, has made it difficult to complete our academic work due to stress and anxiety around our healthcare, and the physical lack of energy that can be caused by fluctuations in one’s hormones."
In their letter, the students demanded that UCD Student Health Services should be required to offer these routine blood tests for UCD’s trans student population, it read “UCD has done little to help us with the process of transferring into a new medical system. Many of us report being passed from Help Desk to Help Desk when requesting information on transgender medical issues, both before and after our arrivals in Ireland. Thus, both the NGS and UCD have forced us into an awkward position of randomly asking around for help with the process, and comparing notes with other transgender students on this trial and error method.”
Cisgender students on campus can ask for the same treatment on campus and are not denied by UCD Student Health Services (SHS). UCD SHS denies care to transgender students for being transgender. UCD SHS has no excuse to not provide care for Transgender students.
When asked for comment, the head of the UCD Student Health Service (SHS) Dr. Éadaoin Lysaght told the University Observer, “The UCD student health service offers primary medical care (GP care) for a broad range of physical and mental health conditions to registered students of the University. We aim to practise inclusive healthcare however like all General Practice/Primary healthcare settings we must practise within our remit and scope of practice as primary care physicians in compliance with Medical Indemnity, Medical Council and National gender service Guidelines. The provision of transgender care as with all forms of secondary and tertiary care is ultimately the responsibility of the HSE. We encourage the actions taken by our colleagues in the Students' Union to highlight the healthcare disparities that exist nationally between cisgender and transgender people.”
The statement continued,
“The UCD GPs are often the first point of contact for these students and we offer a safe space for transgender people to disclose their gender identity. We pride ourselves in offering an open and non-judgemental approach and our staff undertake regular training to ensure they stay updated on transgender health issues including but not limited to attending courses such as BelongTo, national education conferences (ISHA) and professional education webinars (ICGP)”
In relation to blood testing, Dr. Lysaght commented, “we have a medico legal responsibility for any tests that we request; including interpretation of these. As such we are precluded from ordering or facilitating tests without access to hospital specialist interpretation. In keeping with medical indemnity and medical council advice it is not appropriate to prescribe on recommendation made by online providers or services which do not operate under Irish medical council regulation.”
Many transgender students on campus continue to have issues changing their name within the UCD system, often requiring them to go to the student desk in person and potentially outing themselves after receiving no help from the online form.
The University Observer also conducted an interview with Ciara Donohue, the Welfare officer for UCD Students’ Union. She was asked about a survey that was filled out by fourteen trans students, asking them about their experience at UCD.
The survey found that only 42% of surveyed students felt that UCDSU was doing a ‘good/adequate’ job to protect transgender students. In response to this figure, Donoghue replied, “That’s disappointing, I would have hoped that more trans students would kind of feel comfortable in using the SU as a support service.” She continued, “There are definitely campaigns that we would hope to do in the coming semester during our Pride Week, specifically around trans teens and the experience of trans students on campus. So I'm hoping that some of those things might help to change that. But it's obviously disappointing to hear that 57% of students don't feel that we are doing enough for them.”
When asked about what resources the SU provides, Welfare Officer Donoghue pointed to a system brought in by last year’s Welfare Officer Jill Nelis, whereby “any trans students can get trans-affirming products for free through the Students' Union.” She continued, “We offer binders, tucking underwear, or trans tape for free through the SU. All a student has to do to avail of that service is to book a meeting with me and I can go through the order form and they can avail of a free product too.”