The Professional Association for Trans Health Ireland (PATHI) has called for an “urgent systemic reform” to the country’s “inadequate and unsafe care” for trans people, following troubling reports published by The Journal.

In a series of recent articles, The Journal Investigates shed light on the structural failures within Ireland’s trans healthcare system.

The current clinical programme followed by the HSE requires preliminary psychiatric examinations. This is a model of care that several countries in Europe, including Iceland, Malta and Spain, have moved away from since 2019, as the World Health Organization (WHO) no longer treats being trans as a mental or behavioural disorder, seeing it instead as relating to a person’s sexual health.

Trans people wishing to access gender-affirming care in Ireland face decade-long waiting lists, as well as uncomfortable experiences within the National Gender Service (NGS), where they have been questioned about their sex lives and other personal information. One of the articles published by The Journal highlighted these inappropriate and harmful experiences.

In response to such findings, a HSE spokesperson said that trans health services in Ireland “are not meeting people’s full range of needs”, adding that “waiting times are unacceptably long for the NGS”, which “has caused significant distress” for people.

Responding to the article, PATHI said: “We extend our solidarity and compassion to those who have bravely come forward to share their stories. No one seeking gender-affirming care should be met with disrespect, gatekeeping, outdated practices or abuse. For some years now, Ireland has ranked at the bottom of EU states’ provision of gender-affirming health care – this has to end.”

A second article focused on how, because of the barriers they face when trying to access gender-affirming care in Ireland, several trans individuals are forced to self-medicate or pursue healthcare outside of the official channels. PATHI commented on the article, saying they were “deeply alarmed, but not surprised”.

“It is both unsafe and unjust that trans people are being pushed into these situations,” it said in a statement. “While some trans people choose to self-medicate to retain autonomy over their own care, for many DIY is a last resort born out of desperation for healthcare in the face of long wait times, clinical gatekeeping, and a lack of trust in institutional care.

“This reality speaks volumes about the systemic shortcomings of the NGS and the urgent need for reform.”

The Journal’s third article highlighted how trans people who relocate to Ireland and were already receiving gender-affirming care in their home countries are forced to join waiting lists reportedly exceeding 13 years to maintain their care.

“This situation is indefensible,” PATHI said. “Forcing individuals to interrupt essential medical care due to immigration or relocation is both medically unethical and deeply harmful.”

The trans health professionals continued, “Ireland cannot position itself as a safe, inclusive society while simultaneously denying access to basic, life-saving healthcare. The notion that someone undergoing stable, supervised care abroad must start from scratch and wait over a decade to re-access care is not only medically unnecessary, it is cruel.”

Calling for immediate action to address these systemic failures, PATHI made a series of recommendations:

• Implement a decentralised, informed consent model in primary care settings in line with international best practice;

• End harmful gatekeeping practices and the current centralised, single gender clinic model that creates roadblocks;

• Increase funding and training for all healthcare professionals to ensure competent, affirming care at all levels;

• Meaningfully include and engage trans people in the design and governance of healthcare services;

• Provide services such as blood tests without barriers to those engaged in DIY care to reduce any potential harm;

• Establish clear, streamlined pathways for trans people relocating to Ireland to continue their care without delay;

• Develop a national policy that guarantees continuity of care for all trans people in Ireland, including immigrants, asylum seekers, and refugees.

Ryan Goulding, a registered mental health nurse and PATHI Field Representative for Primary Health, stated: “The Irish trans healthcare system is failing in its duty to do no harm.

They continued, “Trans people are being left with no safe, trustworthy, or accessible options for care. This is a clinical, ethical, and structural failure that cannot continue. The way forward is clear.”

“Trans and gender diverse people deserve safety and support at every point of contact with the healthcare system,” said Nicola Cantwell, pharmacist and PATHI Field Representative for Allied Health. “We need to break down the barriers that prevent trans people from accessing timely, respectful care, and ensure they have the power to make informed decisions about their own health.”

PATHI is a multidisciplinary organisation established to represent, support and connect those working to strengthen the health, rights and wellbeing of trans and gender-diverse people across the island. The group is made up of trans and cisgender professionals working across the fields of primary and allied health, law and policy, advocacy and community organising, and research and education.