Within the last few years, it has become relatively common knowledge that Ireland is ranked as one of the worst countries in the EU for access to gender-affirming care, according to Transgender Europe and Central Asia (TGEU). What is less known is the specific struggles of trans and non-binary migrants and refugees moving to Ireland, who may have been previously accessing HRT in another country, only to be expected to wait years to be seen by the National Gender Service (NGS) and assessed once again.

On the NGS’s website, there is an FAQ section which includes the question: “I live outside of Ireland and am being prescribed by a doctor. I plan to move to Ireland and I want to get my hormone prescriptions via the National Gender Service: What do I do?”

The NGS’s response is: “As we can only accept referrals for people resident in Ireland and from doctors registered with the Irish Medical Council (the regulatory body for doctors in Ireland), we cannot accept a referral for your care yet.”

They instead recommend bringing as much HRT as you can when moving to Ireland, asking your current provider to offer bridging prescriptions until you are seen by the NGS and sourcing any documents on your medical transition.

One person who has faced this reality is an anonymous refugee trans woman who had been taking oestrogen for 12 years and received gender-reassignment surgery before moving to Ireland. In February 2026, she attended a Social Inclusion Clinic in Dublin to seek an oestrogen prescription. The purpose of Social Inclusion Clinics is to provide immediate medical care to those who do not have access to a GP, such as people who are homeless, immigrants or refugees.

Before her appointment, she informed the clinic, “I’m a post-op trans woman who has been dependent on oestrogen for the past 12 years… I need my oestrogen otherwise I will lose my immune system and die.”

However, she was told by a doctor that she did not have the authority to prescribe her oestrogen due to the clinic’s policies, despite her previous record of care and the detriment this would cause to her physical and mental health. Specifically, the reasons given for the denial were the lack of endocrinologist oversight available at the clinic and the nature of Social Inclusion Services not being equipped to handle long-term care and blood monitoring.

Speaking to GCN, the trans woman shared, “[The doctor] basically put the onus on me to obtain a confidential GP list from TENI, or Trans Healthcare Action. She’s like, ‘Well, if I can get that list, I can contact one of them to prescribe you oestrogen’.”

The doctor also made a referral to the NGS and recommended accessing private gender services like Gender GP, though the trans woman stated that she could not afford their fees.

Following the consultation, she sent an email to the HSE’s Community Response for Vulnerable People (CVRP) team, reiterating “IF I DO NOT GET MY ESTROGEN, I WILL LOSE MY IMMUNE SYSTEM AND DIE. THIS PROBLEM WAS NOT RESOLVED. FIX THIS.”

When discussing the impact this denial of oestrogen had on her wellbeing, she explained, “I had to ration. I went off it for a while and it was hell. There were hot flashes galore. It virtually destroyed my mental health.”

Furthermore, she made a formal complaint to the clinic, claiming that she had been treated unlawfully. The clinic responded with a document which stated, “In accordance with Section 16(2) of the Equal Status Act, 2000 (“ES Act”), treating a person differently does not constitute discrimination where the person is so treated solely in the exercise of a clinical judgment in connection with the diagnosis of illness or his or her medical treatment.”

It continued, “The Respondents exercised clinical judgment in not prescribing oestrogen to the Complainant. As such, no discrimination has occurred.”

The document also described that the doctor had contacted the NGS for advice on the situation, though “the National Gender Service confirmed that they could not provide advice regarding individual patients.” This detail in particular shows the severe lack of guidance clinicians receive from the NGS regarding how to support trans patients.

Speaking to GCN, the Executive Director of Transgender Equality Network Ireland (TENI), Daire Dempsey, commented, “It’s so important that anyone moving to Ireland is able to continue any treatment or healthcare that they need, whether that is gender-affirming care or any other type of healthcare. A transfer of care can usually be facilitated to your GP in Ireland, with the support of the prescribing doctor.”

They added, “If you want to continue your gender-affirming care through the NGS, you will need to join the waiting list and move through their assessment, but there’s no absolute requirement to continue care through that service.”

Additionally, Transgress the NGS activist Fiadh Tubridy expressed, “We are frequently contacted by people in this situation looking for support with finding a healthcare provider who will continue their HRT prescriptions. We do our best to provide recommendations for GPs who are willing to continue prescriptions from abroad.”

They continued, “Some GPs are in fact willing to continue prescriptions from abroad, whereas others are not, which shows the complete lack of consistency and experience in gender-affirming care amongst GPs, which urgently needs to be addressed.”

When asked if the new Model of Care that is currently in development will consider this barrier for trans people moving to Ireland, Dempsey said, “This is something the new model of care, and any new services developed, need to be responsive to. With the increasing number of trans people moving here, particularly from the UK and US, we should not be subjecting people to lengthy and unnecessary re-assessment just to continue treatment that they have already been accessing.”

Tubridy also concluded, “One of our demands relating to the new model of trans healthcare that the HSE is working to develop is that interim guidelines must be provided to GPs as a matter of urgency regarding how they can support trans patients, while the new model is being developed.”

Therefore, what happened to this trans woman represents a wider systemic issue which makes continuity of gender-affirming care for those moving to Ireland extremely difficult. This is also not an isolated incident, as The Journal investigated numerous other cases of trans people who were essentially forced to restart their care in Ireland despite receiving it in another country.

If you or someone you know is currently experiencing a similar situation, you can contact TENI ([email protected]), Transgress the NGS ([email protected]) or Trans Healthcare Action ([email protected]) for information and guidance. For those self-medicating, Trans Harm Reduction ([email protected]) is also a valuable resource.