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Long wait for key treatment ‘risking mental health’ of trans students

EXPERTS, advocates and members of the transgender community have warned that long waits and delays in critical medical treatment for transitioning transgender students is risking their physical and mental health.

With an estimated 48,000 transgender people living in Ireland, just three gender service clinics and no gender affirmation surgeon, thousands of Irish trans people are being left without the treatment they need.

This is despite research by Trans Equality Network Ireland which shows 81 per cent of trans people have thought about or attempted suicide prior to medical transition.

This figure reduces to four per cent after transition.

“This isn’t an overreaction – people are dying because of this. We’re seeing trans people’s suicidal ideation is huge before medical intervention, ” said Noah Halpin, committee founder of the ‘This is Me’ a campaign, working on behalf of the transgender community.

Luke, a University of Limerick student, first came out as transgender to a small group of friends when he was 14 years old. Since then, he’s had first hand experience of the obstacles transgender people face when trying to access healthcare.

“I first went to my GP to look into physically transitioning when I was 15 years old. I started testosterone four months ago when I was 21.”

Six years ago, Luke presented to his local GP and explained he was having mental health difficulties, and that he was trans.

“The first thing they asked me was, had I spoken to my mom about it. I’m from a small town – everybody has the same GP, my mom probably had an appointment there the week before.”

When he explained he wasn’t ready for that step, his GP began to ask him if he was planning to move out for college before saying “I feel like it would be good for you to move out”, sending the then 15-year-old into a panic about the reaction his mother might have.

“That kind of pushed me back more into myself. I think it was one of the big reasons why it took me another year to tell my parents.”

When Luke did come out to his parents at 16, he returned to the doctor seeking the healthcare he needed to transition.

“I got referred to somebody who thought I was just having issues with my parents understanding it – which wasn’t it at all – I was having issues with myself and my identity,” he explained.

“It took until I was 19 to get referred to a psychiatrist who would diagnose me with gender dysphoria which is what I was looking for.”

The HSE defines gender dysphoria as distress experienced by those whose gender identity feels at odds with aspects of their birth body.

In order for a person in Ireland to medically transition to their gender identity, they must be diagnosed with gender dysphoria by a psychiatrist.

Luke recalled how the delay had a big impact on his mental health.

“Nobody knew what they were doing. My GP didn’t know where to refer me to. I didn’t know where to be referred.”

After being diagnosed, Luke was referred to the Gender Service Clinic in Dublin which at the time had a 17-month waiting list. Waiting times for this clinic have since increased to more than three years.

After waiting for a year, he moved his referral to a clinic in Drogheda and after seven months he had his first appointment with an endocrinologist – a medical practitioner who specialises in hormone treatment.

After three months of oestrogen blockers, Luke was then prescribed testosterone, which he is currently taking, and which he said has already resulted in people identifying him as male.

Because only three clinics in Ireland facilitate hormone treatment for transgender people, Luke must travel seven hours to and from Drogheda every six months for his check-ups.

“I need to take a full day off work and college. Usually, I either get my partner or my mom to drive me – they have to take a full day off work.”

Despite the six-year wait it took for Luke to get the treatment he needed he still considers himself “one of the lucky ones”.

“I feel like I fluked by being able to transition in Ireland. It feels like I shouldn’t be able to do this because it’s so hard to even get the treatment. It feels like I lucked out to get where I am.”

Following efforts by campaign groups such as ‘This Is Me’, Health Minister Simon Harris has established a steering committee for transgender healthcare.

Noah Halpin, who sits on the committee, welcomed the establishment of the group however he said: “Nothing’s changing very fast, no services are being approved. In fact, waiting lists are growing.”

Noah continued, “the most important thing that can be done is a change in the model of care. To take it out of the psychiatric model and introduce international best practice which is an informed consent model.

“Once that’s done we can open trans healthcare to other healthcare providers meaning that it’s not all centralised because what’s happening now is it’s all centralised to one clinic. This means you’re creating
this massive bottleneck which is what’s creating these three and a
half year long waiting lists,” he added.

In a statement to Limerick Voice, Ireland East Hospital Group, which oversees the National Gender Service Clinic, said “hormone replacement can be prescribed by any endocrinologist. Most hormone replacement can
also be prescribed by GPs. However, in line with WPATH and Endocrine Society guidelines, prescribers should have access to a full multidisciplinary team, including mental health and social care professionals. This is usually the limiting factor in initiating hormonal transition more broadly across the country.”

Addressing concerns about training doctors to help trans people, the group’s spokesperson said Gender Identity Skills Training (GIST) is offered
nationally by the HSE.

“This three-day training course is designed to educate healthcare professionals on the specific healthcare needs of trans people.

“The course does not in itself qualify people to offer specific treatments [for example] hormonal replacement,” the spokesperson added.

Limerick Voice 2019 newspaper is available today in all copies of the Limerick Leader.

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