Transgender Healthcare in Ireland is Inadequate

Noah Halpin

Noah is the founder and manager of This Is Me Transgender healthcare campaign, which advocates for safe, accessible, person-centered healthcare for all transgender and non-binary people in Ireland. In 2019, Noah was appointed by then Minister for Health Simon Harris as the ministerial appointee to the Transgender Healthcare Steering Committee. Noah is also an active member of ACT UP Dublin and is passionate about ending the HIV crisis in Ireland.


In 2015, Ireland introduced some of the best and most accessible gender recognition legislation in the world, the Gender Recognition Act.

This law allows trans people nationwide to legally self-identify their gender and have their true gender identified on all legal documents.

This act was the culmination of years of work by the trans community, activists, organisations, and perhaps, most notably, Dr Lydia Foy.

In 1993 Dr Foy began her 22 year battle with the Irish state to have her birth certificate reflect her true gender identity. She was a woman, who simply wanted her birth certificate to state that.

After numerous failed court challenges and appeals brought by Dr Foy, a flicker of hope emerged in 2007 when the High Court ruled that relevant proportions of the law of the Republic of Ireland were incompatible with the European Convention on Human Rights.

In 2014 Dr Foy began legal proceedings to enforce the 2007 ruling to allow trans people to be able to change their birth certificate.

This legal action, the continued support of the trans community along with a new Fine Gael and Labour coalition government, saw the Gender Recognition Act 2015 brought into law.

This legislation is something to be celebrated and has improved the lives of many transgender people in Ireland, but it isn’t without its problems.

Surely having some of the best gender recognition legislation in the world would mean that we also have some of the best healthcare services for transgender people in Ireland, right? Wrong.

Unfortunately, Ireland is far behind.

Speaking from experience, the National Gender Service (NGS) has a three-year waiting list from the first referral. It uses an archaic, non-evidence-based psychiatric assessment model. There are no trans-specific healthcare services for children or adolescents.

Countries like New Zealand, Australia, and Germany follow international best practice standards of care which allow people who are transgender to access treatments and surgery without undergoing mental health evaluation or referral from a mental health specialist.

We are sending our trans people abroad for major invasive procedures because we have no surgery options here. There’s little to no aftercare for us when we return home.

Does this sound familiar?

In November 2019, the NGS was forced to announce that it had “misplaced” 109 referrals to the service.

This number would subsequently rise. But trans people were not surprised by this. We had been trying to flag it with the HSE for years.

Losing referrals, and then re-referring people, meant the general waiting list for services lengthened yet again.

A general increase in referrals, and the aforementioned archaic psychiatric assessment model – which bottlenecks every referral through only two psychiatrists that the NGS will accept a referral for hormone replacement therapy from – has only contributed to this delay.

In just one year, the waiting list to access trans-specific healthcare at the NGS has risen from 15 months to 3 years. Many trans people cannot wait this long.

Seventy-six percent of 29 respondents to a study by the Trans Equality Network Ireland (TENI) said that they self-harmed prior to transition. This dropped to a whopping zero percent post-transition.

Meanwhile, 81 percent had thought about or attempted suicide prior to transition. This dropped to just 4 percent after transition.

These statistics may shock you, but not me. And not the trans community.

Those who tell us that trans-specific healthcare is not a matter of life and death are sorely mistaken.

Our healthcare system for trans people is inadequate, not fit for purpose, and we are losing people.

In recent years, the trans community has found its voice, and between the community, TENI and the This Is Me-Transgender Healthcare Campaign, we held the government and the HSE to account by protesting and relentlessly contacting politicians.

It was then we saw some interest finally being taken in improving transgender healthcare in Ireland, but we were soon to be let down once again.

I first met with the then Minister for Health Simon Harris in April 2019. He agreed that healthcare for trans people in Ireland was inadequate.

He set up the National Transgender Health Care Steering Committee and asked me to be the ministerial representative on the committee. I accepted.

The committee brought together clinicians, representatives from TENI, the Department of Health, and the HSE.

We slogged away for nine months on a report for the minister, which included seven recommendations to improve services.

The committee chair, Dr Siobhán Ní Bhriain, national clinical advisor to the HSE and group lead for mental health, submitted the final report to the Department of Health on 28 February 2020.

Despite a pre-agreed timeline for the publication of the report, the deadline has now passed.

I realised that the department had no idea where this report was. The HSE said it had been misplaced.

As a committee member, despite still remaining under a confidentiality clause until the report’s publication, I decided that this was too important to remain silent about my findings and raised them publicly.

Part of the reason why we now have zero healthcare services for trans young people in Ireland is as a result of the misplacement and delay in implementing the report recommendations.

Again we were let down, and again it was up to the trans community to point this out.

Taoiseach Micheál Martin stood in the Dáil last week and said that it wasn’t satisfactory that the report has not yet been published. He said that he would follow-up, try to find out why the report hasn’t been published, and seek to get it published.

But my question is, what is he going to do about it? Will we have radio silence again until we lose another life? This is what I have come to expect.

But this time, we will not allow them to go silent. We must remain vocal. And this must not be left up to the trans community to fight alone. We’re a small army and we need your help.

We need our allies and our media to amplify our voices. Talk to us and not about us. Listen to us and hear us when we tell you what we need, and what is being done to us.

Opinion pieces about us, written by people who don’t know us or our struggles only serve to harm us.

Listen to those with lived experience. This way, we can make a large collective difference to the lives of transgender people in Ireland.

Nothing about us without us.

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Noah Halpin: Noah is the founder and manager of This Is Me Transgender healthcare campaign, which advocates for safe, accessible, person-centered healthcare for all transgender and non-binary people in Ireland. In 2019, Noah was appointed by then Minister for Health Simon Harris as the ministerial appointee to the Transgender Healthcare Steering Committee. Noah is also an active member of ACT UP Dublin and is passionate about ending the HIV crisis in Ireland.

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