Writer Ezra Maloney interviewed trans people around the country forced to self medicate with hormones due to a lack of accessible healthcare. All names, ages, locations and occupations of the people he spoke with have been changed to protect the privacy of those involved.

In November 2019, the National Gender Service at Loughlinstown Hospital in Dublin revealed the shocking loss of over 100 patient files. Patients whose records were lost had been waiting up to 3.5 years for their first appointment with the service. Usually, these patients waited with no contact or updates from the hospital itself, leaving them with no way of knowing that their files were misplaced.

A 2015 survey, ‘It’s Time to Hear Our Voices’ by TENI (Transgender Equality Network Ireland) revealed that 46% of trans people named lengthy waiting lists as a barrier to accessing proper healthcare. 

For many transgender people, myself included, access to hormones is a crucial step in the process of transitioning, as they allow us to be seen as our true gender. Hormones can also ease social anxiety, particularly when meeting new people, and increase a sense of safety in public spaces.

To be physically at ease in your own body is a feeling that every person deserves to have. In Ireland, transgender people are denied that by our healthcare system. According to TENI’s 2013 study, ‘Speaking from the Margins’, 81% of trans people had considered suicide before transition, a figure which dropped to 4% after beginning transition. 

This dramatic decrease reveals how vital access to hormones is for the welfare of trans people, and how crushing it is when treatment is denied or put on hold. Our dysfunctional healthcare system exacerbates mental health difficulties in a community that is already vulnerable due to societal stigma. 

With these factors combined, it’s easy to see why so many trans people, out of frustration with our broken system take charge of their own healthcare and self medicate with hormones purchased online or from sources within the community. 

As I wrote this article I spoke with four other transgender people, all of whom expressed anger, fear and a profound lack of trust in a system that has failed to provide crucial care for them in their time of need. 

One man, 23 year-old Conor from Kildare, wanted to avoid Loughlinstown Hospital from the beginning, saying, “I had seen so many of my peers abused by the system. They’re afraid to question the experiences they’ve had because Loughlinstown can literally decide to take your hormones away. I didn’t want that for me, I knew I’d die stuck on a waiting list.” 

Deciding to self medicate as a trans man can be confusing, as the information available online is largely targeted towards transgender women, who DIY their hormones more often than men. For Conor, the decision was dependent on support from others in the trans community, particularly those who offered tips on how to inject testosterone safely and monitor hormone levels in his blood.

Joe, a 24 year-old student from Dublin, echoed Conor’s experience saying, “If I didn’t have a community that takes collective action in helping each other, I wouldn’t have been able to self medicate. Who knows where I’d be?” 

Feeling frustrated and ignored by the hospital, Joe decided to self medicate and later managed to switch to costly private healthcare. Though he has happily been on testosterone for several years now, he remains on the Loughlinstown waiting list. He has been waiting now for a staggering total of almost four years.

Both Conor and Joe’s stories reflect the absolute neglect faced by trans people in a public healthcare system where wait time averages between 17 months and 3.5 years at present. 

Self medicating has proven more common in the trans feminine community, as many of the forums, Reddit threads and Facebook groups are dedicated to and run by trans women. This is largely due to the fact that access to estrogen pills is more widely available and they are a less invasive and complicated process than injecting testosterone. 

Jack, a 22 year-old bartender from Laois who self medicates with testosterone bought from a local source, says that “a lot of the information I got was mainly from cis men in bodybuilding forums, I’ve never met another trans guy DIY-ing.” Jack has been happy with his choice to self medicate, saying that “it feels like I’m more in control this way.” Living outside of Dublin, Jack doesn’t have the same access to a local trans community, leaving him to do much of his research online and sourcing hormones from the bodybuilding community.

Aside from long wait times, Toby from Wexford highlighted the unfair psychological evaluations implemented by the Gender Service. Explaining his decision to self medicate, he said, “I attempted to go through the HSE and am still in the system, but I was told last year that they’d be unable to put me on hormones because they did not feel my psychological profile is consistent enough for them to give me their stamp of approval. They did not tell me when that would be reviewed, and they did not tell me anything I could or should do in the meantime.” 

Toby’s experience with the clinic highlights the psychiatric model that is still in use in Ireland today despite the WHO (World Health Organisation) declassifying transgender identities as a mental disorder in 2019. The continued practice of intrusive and often humiliating questioning from the psychiatric team at Loughlinstown is not only outdated, but harmful towards trans people.

The fact that Toby was discharged from the system without any further advice or contact only emphasises the dangerous level of ignorance doctors express towards trans patients. 

TENI’s 2015 survey reflected the often-negative relationship between doctors and trans people, with almost all participants reporting that medical professionals lacked even a basic understanding of transgender identities. 

While Toby has managed to buy testosterone gel in the past, he worries now about access to hormones during the current pandemic. Without a prescription from the doctors at Loughlinstown, he has been forced to consider expensive private healthcare, saying, “I’m running out of the testosterone I had and I’m not sure what I’m going to do. I’m considering registering with Gender GP (a private service) but worry I won’t have the money to keep that up.” 

Unfortunately, transition-related financial worries like Toby’s are all too common in the trans community. Many who choose to self medicate or go privately for treatment will be aware of this as Facebook and Twitter are packed with fundraisers for surgery and hormones from those who cannot afford to pay the high costs associated with treatment. Again, it is the LGBT+ community who step in and support one another with donations and fundraising events.

Our emergency fund for trans people has been running for almost four months now with over 3000 euro redistributed in Ireland alone! We're still going so if you're in need contact us here or at [email protected] – happy Pride! 🐢🏳️‍🌈 pic.twitter.com/AE7aFTn29J

— Small Trans Library Dublin (@translibdub) June 27, 2020

As there is currently (shockingly) no surgeons performing gender-affirming operations in Ireland, transgender people are forced to go abroad for private treatment. This was my own experience when I flew to England for top surgery rather than wait for it to become available in Ireland again. Though this was one of the best decisions I have ever made and I have no regrets, I really wish that there had been an option for treatment at home as it would have lessened the financial burden on myself and my family.

In Ireland, organisations like TENI, community groups both online and in person, and activist and grassroots activist groups like This Is Me – Trans Healthcare Campaign and the Small Trans Library have taken on the lion’s share of the work in supporting trans people struggling in the system. These groups show the resilience and dedication of Irish trans people and the strength with which our community continues to thrive. However, it can’t be left only on the community to take care of themselves; we are in desperate need of a compassionate healthcare system that understands and provides, at the very least, acceptable treatment.