In this month’s article, Clinical Psychologist and Psychotherapist Lisa Brinkman would like to shed some light and information on transgender healthcare and treatment pathways in Ireland and give an overview as to what is involved and necessary, and how and where people with Gender Dysphoria can access these services.
Just for clarity and as a reminder, here is a short definition of Gender Dysphoria and the term ‘trangender’: Transgender refers to people who don’t identify with their biologically defined sex but identify with the opposite gender or have any other form of gender identity outside of the binary system of male and female (for example ‘non-binary’ identity or ‘gender fluid’ gender identity).
Gender Dysphoria is the medical and diagnosis term for the same, that is given after psychological assessment by a Psychologist or Psychiatrist. Most transgender people who identify with the opposite gender of their biological sex wish to undergo medical treatment to align their bodies to how they truly feel. This includes hormone treatment and gender confirming surgeries. Most transgender people are also in need of psychotherapy to help and support them on this difficult journey in their lives.
Once a person starts their transitioning journey, they usually try (and need to) access the following services:
Psychotherapy: Psychotherapy can help and support the person questioning their gender and experiencing gender dysphoria to understand these feelings better. It also aims at supporting the person throughout the many different stages of the transitioning journey. Many transgender people also suffer from depression, social anxiety, low confidence or other mental health problems as a result of their gender dysphoria and psychotherapy aims at helping with these also.
Clinical Psychology/Psychiatry: Any transgender person who wishes to access medical treatment (hormones or surgeries) needs to undergo a clinical assessment to determine if all criteria for the diagnosis of Gender Dysphoria are present and the person is ready and advanced enough in their transitioning journey to access this next step of medical transitioning. Often this process goes parallel and alongside psychotherapy, but sometimes they are sought out independently from each other.
Assessment of Gender Dysphoria usually requires three to six sessions.
Endocrinology: Once a transgender person has an official diagnosis of Gender Dysphoria and has been assessed as eligible for hormone treatment, they are referred to an endocrinologist for hormone treatment.
Hormone treatment involves the administration of ‘hormone blockers’ and ‘cross-sex hormones’, which significantly either ‘masculinise’ or ‘feminise’ the person’s body in different ways.
Surgeries: After being on hormone treatment for at least six-12 months, transgender people can access sex reassigning surgeries (with approval from their Psychologist/Psychiatrist). Most of these surgeries are not performed in Ireland and patients need to access them through the HSE treatment abroad scheme in the UK or privately anywhere else in the world.
Unfortunately we are not doing very well as a country regarding these healthcare services for transgender people. First of all, we still don’t have clear defined medical pathways and treatment protocols for transgender healthcare that are specific to Ireland. As a result, professionals of different disciplines who work in this area have to refer to (different) international guidelines and treatment protocols.
Over the last few years great effort has been put into creating a public ‘National Gender Service’ for adult transgender people in Loughlinstown, Co. Dublin in which different services (Psychiatry, Endocrinology, speech and language therapy) are offered. However, this service is completely under resourced and waiting times are currently up to four years to get a first appointment.
Things are even more dire for children and adolescents. For the last few years, Crumlin Hospital had partnered with the UK Tavistock clinic to be able to offer psychological assessment, support and medical services to under-18-years-old transgender people in Ireland. A team of professionals flew in from the UK every six weeks to hold a specific gender clinic in Crumlin Hospital. However, funding for this service has run out, and currently no public services exist for this age group. The HSE is in the process of creating an Irish based service, which will hopefully commence soon, but long waiting times will be expected for this service also.
The only alternative to this is the private sector, meaning transgender young people and adults have to pay themselves for all necessary health care, including psychotherapy, psychological assessment, hormone treatment and often surgeries. Unfortunately not all transgender people have the relevant means to do so. For those who can afford private healthcare, a small network of highly skilled and experienced professionals of different disciplines exist and work together (this author being one of them).
Many Transgender and LGBT+ advocacy groups are rallying for better public services and often approach the HSE and the government to highlight the urgent need for more funding and resources. The long waiting times in the public sector are detrimental to many transgender people’s mental health and add to their stresses and suffering.
If you are a transgender person or a family member of a transgender person wishing to start the journey of gender change, your GP is usually a good starting point. The GP can refer to the public services. Making contact with a psychologist or psychotherapist who is experienced in transgender matters is also a good first step to get help and support that is often very much needed. Professionals who are working in private practice can usually be contacted directly without a referral needed.
The Transgender Equality Network (TENI) is also a good point of reference. They can often recommend professionals working in this area but also provide support groups for transgender people and their families in various different places in Ireland.
Although these healthcare service are only needed by a small minority of people, it is of utmost importance that they exist and are accessible to the people who need them.
Therefore it is important that non-transgender people (Cis-people) like myself raise awareness about the shortcomings of our health system and if there is anything within our power to do something, to act accordingly.