A new future for trans healthcare in Ireland
By Ky Walker (they/he)
Andrea Crowley (she/her)
Use the 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 person can make free and informed decisions about their own body and treatment. The informed consent model is not aimed at assessing a person and therefore does not involve an evaluation of their gender or whether they are truly “trans.” Rather, the goal is to facilitate thoughtful decision-making in a way that centres the person’s experience, expertise, needs, and autonomy. An informed consent model has been implemented in various countries worldwide, including Spain [18], Aotearoa New Zealand [19] [20], Australia [21], and Malta [22]. Embed in community and primary care settings The provision of trans healthcare is not a specialty service and therefore should be accessible through primary care providers (PCPs) in our communities. Community- based care enables trans people to access these services locally, delivered by their primary care general practitioners (GPs) and nurses, as well as within sexual health clinics, which is more resilient, efficient, and effective for the health system. WPATH endorses the provision of hormone therapy by primary care doctors, noting that “with training, gender affirming hormone therapy can be managed by most
By implementing an informed consent model in community and primary care settings, Ireland can lead the way in ensuring bodily autonomy in trans healthcare, which will significantly improve the lives of trans people throughout the country. About Trans Healthcare Action Trans Healthcare Action is a grassroots community organisation advocating for an Ireland where all trans and gender diverse people can access the gender-affirming care they need to thrive. We believe that self- determination and bodily autonomy are intrinsic rights that trans people, like all people, are born to actualise. Learn more and join us at www.transhealthcare.ie! Bibliography can be found on the Citations Page.
PCPs,” and that the practice of referring patients to specialist services may result in unacceptable delays, thus “it is imperative that PCPs are able and willing to provide [hormone therapy] for [trans] patients” [17]. Build in co-production with the trans community Trans people should have the agency to advise on and oversee decisions that impact their health, bodies, and lives and should help shape policies and systems at every level. Co-production involves the active engagement and participation of the trans community in the planning, design, delivery, and evaluation of their own gender-affirming healthcare services. This collaborative approach
Introduction Gender-affirming care is medically necessary for the wellbeing of many trans people and is often life-saving. All people, including trans people, have the right to bodily autonomy and safe, affordable, quality healthcare [1] [2] [3] [4]. However, access to gender-affirming care that meets these standards is severely limited–if not impossible–in Ireland. By ending the current de facto centralised “gatekeeping” model for transgender healthcare and building a new system based on informed consent in community and primary care settings, we can create an Ireland where all trans people have access to the care they need to thrive. The System Today To access gender-affirming care, trans people in Ireland are currently directed to a centralised public gender clinic based in Dublin, which is at the root of many barriers. They confront a waiting list of at least three to three and a half years [5]—though the community estimates more than ten years [6]—for an initial appointment. While waiting, trans people are frequently denied access to medically-necessary blood tests and bridging prescriptions of hormone therapy from their primary care providers. At the end of the waiting list, trans people must travel to Dublin for multiple hours-long psychosocial assessments, which is particularly inaccessible for rural trans people. The assessments include invasive questioning often focused on sexual history and adults have been asked to bring family members to validate their experiences. Trans people’s access to care hinges upon these assessments, which treat transness as a psychiatric condition. The convergence of these significant issues, coupled with other barriers such
as discrimination, the absence of youth care, and limited access to gender-affirming surgeries, has resulted in Ireland’s identification as the worst country for trans healthcare within the EU according to Transgender Europe
[7]. Further, LGBT Ireland’s report on progress to date in the government’s National LGBTI+ Inclusion Strategy graded access to trans healthcare an ‘F,’
values the lived experiences, perspectives, and expertise of trans people, ultimately leading to the design of more inclusive, effective, and person-centred care. Conclusion
identifying a dearth of progress, and even regression, in all targets identified within the original strategy [8]. The prevailing system has not only failed to meet the needs of trans people, which can leave them with lasting mental health struggles [9] [10], but has also systematically marginalised them from participating in decisions that directly affect their lives and health. This systemic failure represents a violation of trans people’s fundamental rights to self- determination, bodily autonomy, and access to quality healthcare, which must change. Building a new system for tomorrow Timely access to gender-affirming healthcare is essential for improving the health, wellbeing, and lives of trans people of all ages [11] [12]. To make this a reality, these four pivotal strategies can effect transformative change and construct a new system for trans healthcare [13]:
Depathologise access to care
As Ireland celebrates Pride, it is imperative to recognise the urgency of addressing the systemic barriers faced by trans
Psychiatric evaluations have not been demonstrated to prevent regret or improve trans people’s experiences [14] and often incorporate dehumanising questioning that can cause further harm. Dr. Rosa Almirall Oliver, gynaecologist and founder of Trànsit Catalonia, asserts that “there is no medical, psychological, or psychiatric test that can confirm or deny gender identity” [15]. The World Health Organization (WHO) and the World Professional Association for Transgender Health (WPATH) concur that psychiatric screening, assessment, and diagnosis are not necessary for those seeking gender-affirming care [16] [17]. By removing this barrier, trans people regain their agency and can decide for themselves whether they want to seek mental health support.
people in accessing healthcare.
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